My Vision No.51
2020.12Preparedness for Response to Unknown Infectious Diseases
Among Regional and Local Government Leaders
In 2020, the spread of COVID-19 forced regional and local governments to respond to an unknown
infectious disease. In this issue of My Vision, we review the responses of regional and local authorities
to COVID-19, asking three prefectural governors and two city mayors to discuss their state of
preparedness for responding to the first wave of the pandemic.

About this Issue
Changes Born From the Search for Solutions and the Flexible Formulation of Responses
by Regional and Local Government Leaders– Developing the Relationship Between Central and Regional Administrations
Shigeki Uno
NIRA Executive Vice President, / Professor, Institute of Social Science, The University of Tokyo
Keywords…Roles of national and regional/local governments in responses to COVID-19, problems and responsesof regional and local governments, ideal relationship between national and regional/local governments andregional and local governments themselves, provision of support by the national government, maximization ofability of each of the nation’s regions to search for solutions and flexibly formulate responses, sharing of acquired
knowledge, developing relationship between central and regional/local governments and regional and local
governments themselves

Expert Opinions
Preparedness for Response to Unknown Infectious Diseases Among Regional and Local
Government Leaders
What problems have different regional and local governments faced in responding to COVID-19, andhow have they overcome them? What preparations should we make for the future?

Pursuing a better type of regional and local
government through responsive dialogue

Making logical decisions that are faithful tothe basics of the infectious disease law

Taizo Mikazuki

Yoshinobu Nisaka

Governor, Shiga Prefecture
Keywords…Fear/anxiety regarding COVID-19
infection, altruistic spirit, responsive dialogue withprefectural citizens, division of functions andcooperation between local governments, mechanism
for proposals from regional governments to national
government

Governor, Wakayama Prefecture
Keywords…First hospital-borne infection in Japan,
early detection and isolation, PCR testing of allcontacts, thorough investigation of behavior history of
infected persons, integrated networking of healthcenters, division of roles between national andregional governments

How should we share information with
Our staff understood that our course ofneighboring local governments and residents? action was not set, and we took charge of thesituation
Kazumi Inamura

Shiho Ishiyama

Mayor, Amagasaki City, Hyogo Prefecture
Keywords…Economic zone and living area for Osaka,provision of information to residents and privacy of
infected patients, prompt sharing of information
between city leaders, horizontal cooperation between
health centers, utilization of HER-SYS

Mayor, Ono City, Fukui Prefecture
Keywords…Small local governments far from cities,
lack of information and inability to see the actual
situation, fumbling responses, resolving to decide on
responses, utilization of the initiatives and budgets of
the national and prefectural governments

Immediate implementation of rational
strategies and cooperation with the national
government
Shinji Hirai
Governor, Tottori Prefecture
Keywords…Many elderly citizens, limited medical
resources, lessons learned from previous new strains
of influenza, urgent responses, cooperation of medical
associations, approaches guided by situation on the
ground, relationship of trust between regional/local
and national governments

Interview period：October, 2020
Interviewer : Shota Watanabe（NIRA Research Coordinator,
Researcher）

This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement

My Vision No.51
2020.12
About this Issue

Changes Born From the Search for Solutions and the Flexible
Formulation of Responses by Regional and Local Government Leaders– Developing the Relationship Between Central and Regional Administrations
The wide variety of attempts being made to halt the spreadof COVID-19 may also represent the trigger for significant changes
in the relationship between Japan’s central and regional
governments, and between regional and local governments
themselves.
Needless to say, in order to determine the actual nature ofan unknown virus and prevent its spread, it is necessary to mobilize
all the knowledge of relevant experts and put measures in place ona national scale. In addition, the establishment of laws and the
Shigeki Unoorganization of financial programs are essential to the
NIRA Executive Vice President,
implementation of the measures, and these are also primarily the/ Professor, Institute of Socialrole of the national government. Provision of the necessary support
Science, The University of Tokyo
to individuals infected with the disease, in addition to people andcompanies that have suffered financial hardship, must also be national government-led initiatives.
At the same time, it is not always necessary to adopt uniform measures in a country as large
as Japan. It is the role of regional and local governments to implement targeted measures that take
into consideration the specific situation in their specific region. Depending on the situation, they may
have no choice but to make different decisions to the national government. And given that regional andlocal governments are closer to the residents of their areas, it is also their role to respond to the diverse
opinions of those residents and put the necessary measures in place.
These issues were apparent even before the spread of COVID-19, but they have surely cometo be felt as increasingly urgent since the appearance of concrete COVID-related problems and the needto respond to them. It would be of great significance at this time to collate information regarding theunique countermeasures implemented by each of Japan’s regional and local governments, andmutually share the knowledge that they have acquired in doing so. For this issue of My Vision, wetherefore interviewed the leaders of five local and regional administrations, and discussed the
difficulties faced by these administrations during the COVID-19 pandemic and the ideal relationshipthat should exist between the national and regional/local governments and between regional and local
governments themselves in responding to such a situation.

Responding to the opinions of residents / Sometimes forced to make decisions thatran counter to national government policy
It is symbolic of our theme that the Governor of Shiga Prefecture, Taizo Mikazuki, has been
concerned above all else with what he terms “responsive dialogue.” In every part of Japan, there arecases in which fear of this new and unknown virus has increased calls for the identification andisolation of patients. If this situation were to escalate, not only would it invite human rights violations,but it could potentially lead to the collapse of the foundations of society. The individual analysis of theopinions expressed in the deluge of “Letters to the Governor” received in Shiga Prefecture, and theirreflection in policy decisions, is perhaps a contribution to the response to our situation which could only
be offered by using the characteristics of regional and local governments. It is important that we takenote of Governor Mikazuki’s assertion that Shiga Prefecture has emphasized the freedom and equalityof its citizens and the values of diversity and sustainability, and in these respects has also not forgotten
its foreign residents.
The case of Wakayama Prefecture is also important. When the first hospital-borne infection in
Japan occurred in the prefecture, prefectural authorities developed their own model, rather thanThis is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement

My Vision No.51
2020.12
following the national government’s recommendation of restricting the subjects of PCR tests.
Prefectural Governor Yoshinobu Nisaka tells us that the decision to conduct tests on everyone
suspected of possibly being infected, complete isolation through hospitalization, and the thoroughanalysis of the behavior history of infected patients allowed the spread of the infection to be prevented
at an early stage. At that time, the “integrated network” of health centers within the prefecture proved
to be highly effective, and this provides valuable information for future pandemic responses. Governor
Nisaka’s words “[…] having made a logical judgment, I think that one should take responsible action[…]” have a powerful impact.

Japan’s regions: seeking solutions, formulating responses, and acquiringknowledge
What about Japan’s cities, towns and villages? Kazumi Inamura, Mayor of Amagasaki City,
which is located at the eastern end of Hyogo Prefecture and has strong ties with Osaka as an economic
zone and a living area, points out that information exchange with the leaders of neighboring local
governments in the Hanshin region has been important. While measures that will have limited impact
if implemented only by some local governments have been rolled out over a wide area, it is also
noteworthy that various local governments have decided to put in place measures that are specific totheir own situations. Mayor Inamura’s indication that if people’s residences and workplaces are locatedacross prefectures, the difficulty of sharing information between health centers in different jurisdictions
necessitates the creation of a nationwide integrated database, provides us with much food for thought.
The case of Ono City, located about one hour from Fukui Station on a local line, which is thelargest city in Fukui Prefecture by area, but a small city with a population of only 32,000, is also
important. Shiho Ishiyama, Mayor of the city, tells us of the unique difficulties generated by the factthat they did not have information regarding the disease that would guide the formulation of measures.
For the residents and the administration of Ono City, the national government’s request for thenationwide closure of elementary, junior high and high schools triggered a change in awarenessregarding COVID-19. As indicated by Ms. Ishiyamas statement that the city “[made] maximum use[…] of national and prefectural government measures and budgets,” it is important for small
municipalities like Ono City to seek out measures that are unique to their own region while also
effectively utilizing the support of the national and prefectural governments.
Shinji Hirai, the Governor of Tottori Prefecture, tells us that “Given that we have 47
prefectures, we will have 47 strategies.” If we add municipalities to the list, the number will become
even higher. Tottori Prefecture has the lowest population of any of the nation’s prefectures, and also
has a high proportion of elderly residents. If the virus had spread against a background of inadequate
medical resources, the situation could have become catastrophic. This sense of crisis saw the prefecture
work to introduce measures that would halt the spread of the virus in advance of the national
government. Because the number of beds for COVID-19 patients was low, the administration enlisted
the aid of the prefecture’s medical associations, and donated them the supply of masks that it hadcollected. Governor Hirai points out that national laws initially constrained approaches based on thesituation on the ground, but that a relationship of trust eventually developed between the regional andnational administrations, a fact which we find to be of considerable interest.
How can we maximize the ability of each of the nation’s regions to search for solutions andflexibly formulate responses, having secured the support of the national government? And will wecreate a nationwide database to share the knowledge that is obtained from these processes? It is myhope that the formulation of measures to respond to COVID-19 will allow us to develop the relationshipbetween national and regional administrations and between regional and local administrations
themselves.
Professor Uno is an Executive Vice-President of NIRA, and a Professor in The University of Tokyo’s Institute of Social
Science. He holds a Ph.D. in Law and Politics, and specializes in the study of the history of political thought and politicalphilosophy.
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement

My Vision No.51
2020.12Expert Opinions

Pursuing a Better Type of Regional and Local
Government Through Responsive Dialogue

Taizo Mikazuki
Governor, Shiga Prefecture

Fear and anxiety over the potentially life-threatening
COVID-19 outbreak are ongoing, although the intensity of these waves
of anxiety varies.
In April, when the number of infected people increased
sharply as a result of factors such as the first cluster outbreak in Shiga
Prefecture, anxious residents of the prefecture flooded the authorities
with inquiries and requests. Some were so afraid of being infected
themselves or that the people around them would be infected that
there were even calls for the identification and isolation of patients. I
was very frightened by this, because I felt that people would lose theircompassion for others, causing strain in the social fabric, and that if
this situation was not addressed, the foundations of our society would
collapse. And I discussed these feelings honestly with the citizens of

the prefecture.
Amid this crisis, what would a better type of regional and local government look like? The
thing that I kept in mind above all was "responsive dialogue." The first thing I considered was grasping
and analyzing the feelings, doubts, and requests of the citizens of the prefecture in order to enable us
to respond to them. We read through each of the opinions we received in our program of “Letters to theGovernor,” and exchanged opinions with the members of the prefectural assembly on a regular basis.
We made use of the opinions of the citizens of the prefecture that we understood through this process
in countermeasures. In addition, many parents were worried about how to balance the safety ofchildren with opportunities for education. We therefore conducted a questionnaire survey of thechildren concerned, analyzed all of the approximately 32,000 responses received, and formulated new
indicators for children’s activities and behavior, which we call "Smile/Action."
Against the background of the COVID-19 crisis, division of functions and cooperation between
local governments is essential. The prefecture has been able to build a system of collaboration andcooperation between local governments to implement essential services for residents, while theprefecture is in charge of public health services that cannot be handled by smaller municipalities. The
proposal of a variety of suggestions to the national government from the regions at the forefront ofcountermeasures against the virus through the National Governors' Association and the subsequentexchange of opinions led to the reform of national systems and the formulation of a supplementarybudget. The making of proposals by the regions, which understand the actual conditions of their own
area, and cooperation between regional administrations and the national government to formulate
countermeasures, may be one effective method of transforming Japan’s social systems in the future.
Rather than seeing the COVID-19 crisis as a transient phenomenon, I would like to treat it as
a lesson for the future and a turning point for social change. Through this experience, we are proposing
to the citizens of our prefecture “the spirit we seek to cherish,” “the perspective we seek to cherish,” and“the attitude we seek to cherish.” The spirit that we seek to cherish is an altruistic spirit that isaccompanied by self-reflection. The perspective that we seek to cherish refers to freedom and equality
for all, diversity and sustainability. And the attitude that we seek to cherish is the guarantee of rights,
responsive dialogue, and change through collaboration. Based on these, we are taking up the challengeof pursuing better local government and true democracy, aiming to realize a “healthy Shiga” in the true
sense of the word.
Mr. Mikazuki is the Governor of Shiga Prefecture. Following his graduation from Hitotsubashi University, he joined theWest Japan Railway Company. Mr. Mikazuki took his current position in 2014, following terms as a member of theHouse of Representatives (through four sessions), Parliamentary Vice-Minister for Land, Infrastructure, Transport andTourism, and Vice-Minister for Land, Infrastructure, Transport and Tourism. He is currently in his second term. Mr.
Mikazuki is an alumnus of the Matsushita Institute of Government and Management. As Governor, he emphasizes
dialogue, empathy and cooperation with the citizens of Shiga Prefecture, and “Hi! Here’s Governor Mikazuki,” aninitiative in which he visits sites of activity in the prefecture and conducts dialogues directly with citizens, has now been
held 75 times. He is also taking up the challenge of introducing design thinking to policy formulation, and the prefecture
has used persona analysis, a core element of design thinking, in considering future measures for the COVID-19 era andthe post-COVID-19 era.
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement

My Vision No.51
2020.12Expert Opinions

Making Logical Decisions That Are Faithful to the
Basics of the Infectious Disease Law
Japan's Infectious Disease Control Act and health centersystem are very effective measures in responding to COVID-19.
Even when the first hospital-borne infection in Japan was confirmed
at Saiseikai Arida Hospital in Wakayama Prefecture in midFebruary this year, it was early detection and early isolation, thebases of the Infectious Disease Control Act, that were consideredmost important in responding. In addition, the behavioral histories
of infected patients were thoroughly investigated, and triage wasconducted to prioritize tests from persons closely related to thosepatients, while the hospital also suspended acceptance of outpatients.
Yoshinobu Nisaka
This response was due to the importance of thinking rationally andimplementing the fundamentals. However, Saiseikai Arida Hospital
Governor, Wakayama Prefecture
also went to extra lengths. At that time, we did not know what kindof illness it was, and the citizens of the prefecture were afraid. We therefore rejected the government’s stanceof restricting the subjects of PCR tests, and conducted tests on 474 individuals who were suspected of having
contact. In three weeks, the hospital was successfully cleared of COVID-19, and resumed all normal
operations on March 4.
Thorough investigation of the behavior history of infected people is still important. It has beenpossible to adequately implement these checks because of the existence of the Japanese health center system.
What is particularly essential in conducting investigations of behavior histories has been the “integrated
networking” of health centers in the prefecture. As we have gradually learned, if health centers operate
independently of each other, we cannot make our responses work. Health center in Wakayama City, a core
city in the prefecture, was previously under the jurisdiction of the mayor, but with the mayor’s
understanding, the prefecture now manages the health centers in an integrated fashion, enabling smooth
implementation of early detection and isolation.
This series of responses was praised as the “Wakayama model,” but involved the exercise of theauthority granted to the prefecture under the Infectious Disease Control Act. The prefecture is in a position
to also take the initiative in implementing the measures stipulated by the amendment to the Act on Special
Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response. Within thescope of the authority granted by the law, we have tested and improved a variety of measures, and we haveattempted to incorporate good practices from other prefectures. Sometimes our position differs from the
instructions of the national government, but if it is possible to explain the situation to the citizens of theprefecture after making a logical judgment, I think that one should then take responsible action within thescope of one’s authority as the governor. For example, Wakayama Prefecture did not follow the instruction
from the national government for citizens not to visit a hospital for four days even if they showed symptoms
that made them suspect a COVID-19 infection. The government has now withdrawn this instruction. The
government has also, ultimately, displayed readiness to correct its responses in the right direction. The
national and regional governments should not be in conflict, but should adopt roles that enable them torespond effectively in each area that we are dealing with. It is important for each to take responsibility
independently.
Japanese people tend to think that Europe and the United States always provide the model, but
Europe and the United States do not have the Infectious Disease Control Act and the functions of Japan’s
health centers (early detection, early isolation, and thorough investigation of behavior history based on the
Infectious Disease Control Act). Japan should make the most of these assets.
Mr. Nisaka is the Governor of Wakayama Prefecture. Following graduation from The University of Tokyo, he enteredthe (then) Ministry of International Trade and Industry. He took his current position in 2006, following terms in positions
including Deputy Director-General of the Ministry of Economy, Trade and Industry’s Manufacturing Industries Bureau,
Ambassador of Japan to Brunei, and Executive Managing Director of the Japan Foreign Trade Council, Inc. He iscurrently serving his fourth term. Mr. Nisaka takes communication with the citizens of the prefecture seriously, andsince taking office, he has provided a great deal of information and policy explanation via the “Governor’s Message” onthe prefectures’ website and through email magazines. Mr. Nisaka promoted the spread of “workations” in advance of
local governments throughout the country. As work styles are reevaluated as a result of COVID-19, Mr. Nisaka seeks toattract companies to Wakayama Prefecture through the use of “workations.” He established the Workation AllianceJapan (WAJ) in 2019, and serves as its Chairman.
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement

My Vision No.51
2020.12Expert Opinions

How Should We Share Information With Neighboring
Local Governments and Residents?
Amagasaki City is one of Hyogo Prefecture’s core cities, with apopulation of 450,000. The city is provided with health center under thejurisdiction of the city administration, and a research facility where PCR
tests can be performed. Adjacent to Osaka City at the eastern end of
Hyogo Prefecture, it is a city with a strong sense of unity with Osaka as
an economic zone and living area. Because the city is in the closest
contact with residents and is the entity at the forefront of administration,
the way in which we should share information with residents
represented an issue. The first problem we faced was the question of thedegree to which privacy should be protected when dealing with
Kazumi Inamura
information regarding infected patients. Residents had a need to obtain
Mayor, Amagasaki City,
as much detailed information as possible, but if too much information
Hyogo Prefecture
was provided, the patient in question could be identified. In Amagasaki,
we knew from the experience of other cities the harmful effects of providing too much information, andso we sought to disclose information in a comparatively controlled fashion while consulting with thehealth center. For example, we make announcements regarding the family members of infectedpatients by describing them as “living in the same household,” without identifying the precise family
relationship.
While performing our duties, we frequently communicated with leaders of municipal
administrations in the Hanshin area via SNS, sharing information and reviewing it with a sense of
considerable urgency. It was useful to us to see the different aspects of the situation taking shape
between different local governments as multiple leading figures in different administrations
communicated together at the same time. After getting an idea of each other's thinking and the
direction of our initiatives, we organized measures that would not be effective if implemented by only
some local governments (such as requesting pachinko parlors to close) to be implemented across a wider
area, while individual local governments made their own decisions on the implementation of uniquemeasures tailored to their specific needs.
On the other hand, it was difficult for health centers to implement “horizontal” information
sharing. Health centers are decentralized and strongly locally-focused organizations. For example, inthe case of a person who was a resident of Amagasaki but worked in Osaka, while the individual’sfamily would be under the jurisdiction of a health center in Amagasaki, the individual’s workplace
would be under the jurisdiction of a health center within Osaka. If we do not combine the two sets of
information, it can be difficult to see the big picture, but this has been difficult at times due to the hugeamount of work involved. In the future, following the construction of an integrated database on anational scale, which will involve the utilization of HER-SYS (a support system for the acquisition andmanagement of information concerning patients infected with COVID-19, etc.), which represents theinformation platform for COVID-19 responses, the preparation of manuals for the operation of thisdatabase that balance the acquisition of information with the protection of privacy will enable us toprepare for the next epidemic and new infections.
Not restricted to the current COVID-19 situation, horizontal cooperation between leading
officials, local governments and health centers that transcends prefectural borders will become
increasingly important in the future. It is extremely difficult to establish, in advance, wide-areaadministrative mechanisms that are able to respond to all situations. It will therefore be important todetermine how to acquire the ability to flexibly respond to unexpected situations.
Ms. Inamura is the Mayor of Amagasaki City. Following graduation from Kobe University, she joined a local securities
firm. She took her present position in 2010, following a period as a member of the Hyogo Prefectural Assembly, and is
now in her third term in office. Amagasaki City has been steadily working to establish a sustainable administrative andfinancial foundation through the administrative and financial reform plan “Amagasaki Connecting to the Future Project,”which was formulated in 2013 amid an ongoing period of financial difficulty for the city. In response to the COVID-19
crisis, the city established a data analysis team at an early stage, and the status of infection revealed by the team’s
analyses is published on the administration’s website in easy-to-understand formats using graphs, etc. As further
measures to respond to COVID-19, the city has also flexibly strengthened PCR testing and the functions of health centersand citizen support centers in response to changes in the situation.
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement

My Vision No.51
2020.12Expert Opinions

Our Staff Understood That Our Course of Action Was
Not Set, and We Took Charge of the Situation
The largest city in Fukui Prefecture by area, Ono City is asmall municipality with a population of 32,000. It is located about anhour away from Fukui Station on a local line. The spread of COVID19 necessitated completely different responses to conventional
disaster and infectious disease countermeasures. Following ournormal disaster responses, we have clear guidelines as to how to
rescue, reconstruct and restore, but COVID-19 is a new virus, and we
did not have information regarding the disease that would guide theformulation of measures. The only way for the city to respond was toimplement measures one-by-one while confirming precisely which
Shiho Ishiyama
information was accurate based on the announcements of thenational and prefectural governments and television and newspaper
Mayor, Ono City, Fukui
Prefecturereports.
Because Ono City is remote from Tokyo, both thegovernment and citizens initially felt that the spread of the infection was like a story from a distantworld. However, the request from the national government at the end of February to close all
elementary, junior high, and high schools nationwide triggered a change in our awareness. Realizingthat the national government, which possessed the greatest amount of information about our viralenemy, had decided that uniform action must be taken nationwide, I also resolved to decide on our own
measures. I told city employees that what we faced was an emergency situation, and that if they
approached it using their normal ideas of work, we would be unable to respond. It was necessary tothink of it as a disaster response, and to take action.
The first infection in Fukui Prefecture occurred in the middle of March, and several people
were infected in Ono City in April. During this period, tensions increased day by day. As the idea that
we might have to close certain facilities, or that Ono City staff might become infected or be involved inclose-contact activities became increasingly realistic, we held meetings of our Novel Coronavirus
Response Headquarters almost every day. Based on the reports coming from relevant departments andpersonnel and information from prefectural press conferences, every weekend I organized things to myown satisfaction and considered countermeasures for the next week, and shared these at theCountermeasures Headquarters meeting on Monday. In formulating measures, it was difficult for Ono
City alone to provide all the necessary financial resources, and maximum use was therefore made ofnational and prefectural government measures and budgets. Ono City’s first supplementary budget
was established in early May, and a budget incorporating measures unique to the city was establishedin mid-May. After this, we were able to prepare to make use of extraordinary grants from the national
government.
Without knowing the true nature of the infectious disease that we were facing, we werecompelled to make fumbling responses, questioning what was the correct information and what
measures we should take on its basis, but we continued to seek the best measures, knowing that we
had to make the correct responses in order to protect the citizens of Ono City. It was unavoidable that
our responses would involve trial and error. I asked the administration’s staff to understand that ourcourse of action was not set, and they worked their hardest. I believe that we will be able to put all of
the worries and experiences that we have accumulated throughout this period to good use in the future.
Ms. Ishiyama is the Mayor of Ono City. Following graduation from The University of Tokyo, she joined the (then)Environment Agency. She took her present position in 2018, following periods performing official roles in Ono City, andis currently serving her first term. Ms. Ishiyama seeks to increase the “earning power” of the citizens of Ono, by, in
addition to compiling the Ono City Child-raising Support Package and working to create an environment that willencourage young people to want to live, get married, and raise children in Ono, establishing the "Echizen Ono Arashima
no Sato" roadside station, scheduled to open in April 2021. Spurred by the COVID-19 crisis, she is also promoting thedigitalization of education and administration. The city is accelerating the introduction of tablet terminals for each of its
students, a plan which is scheduled to come to fruition at the end of this fiscal year. It is also promoting plans including
the realization of cashless administration and the development and operation of a digital environment.

This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement

My Vision No.51
2020.12Expert Opinions

Immediate Implementation of Rational Strategies andCooperation With the National Government
Tottori Prefecture has the lowest population of any ofJapan’s prefectures, and is home to a high proportion of elderly people.
Due to insufficient medical resources, we feared that once theinfection spread, it would become a catastrophic situation, and wetherefore discussed how we should engage with COVID-19 from anearly stage. Japan’s first positive case was discovered on January
16th. On that day, we set up a consultation desk for residents, and weheld a liaison meeting five days later. Our basic strategies were “early
detection by testing,” “prevention of hospital-borne infections”, and“thorough prevention of the spread of infection.” As a result of oururgent implementation of measures to respond to a desperate
Shinji Hirai
situation, as of March, Tottori Prefecture was the leader in Japan in
Governor, Tottori Prefectureterms of the number of beds secured per population.
Despite being a prefecture with limited medical resources,
we were able to put a variety of measures in place in advance of the national government because we
responded with a sense of urgency based on lessons learned from the speed with which new influenza
infections we had experienced in the past had spread. The infectivity of these new strains of influenza
had been extremely strong, and the pace with which the number of patients had increased had risen
rapidly.
Initially, the prefecture's hospitals had only 12 beds available for countermeasures against
COVID-19. Judging that it would not be possible to fight the disease with only these resources, I
hurriedly decided to obtain the cooperation of the regional medical associations. Due to the small sizeof Tottori Prefecture’s community, face-to-face networks had been developed between prefecturaladministrators and medical personnel. However, the doctors and medical staff who were putting theirlives on the line on the scene were very anxious due to a serious shortage of masks at medical
institutions. We therefore provided as much support as possible, including providing all of the 220,000
masks stockpiled by the local government to the medical associations. The medical associations
responded to this with gratitude, and in a short period of time, we were able to increase the number ofbeds to 300. It is a result of this relationship of trust that more than 80% of clinics in Tottori Prefecture
cooperate with the Medical Care and Testing Facilities, of which there is a shortage nationwide.
Given that we have 47 prefectures, we will have 47 strategies. The conditions for measures to
respond to COVID-19, such as the status of spread of the infection, the medical resources that havebeen secured, and the degree of understanding and cooperation of the residents, vary widely fromregion to region, and each region has its respective solutions. Simply following guidelines from thenational government will not get the job done; we should emphasize approaches that are guided by thesituation on the ground. Initially, despite the fact that the responsible prefectural personnel thoughtthat certain measures should be implemented, things did not always proceed as planned due to therestrictions of government laws, but the government’s response gradually became more flexible, andoverall, communication between national and regional governments functioned effectively; in mostregions, responses were adopted that were suited to the specific circumstances of that region. If therelationship of trust that has been created between regional and national governments in this crisis
can be further developed, it has the potential to significantly change the nature of administration inthis country.
Mr. Hirai is the Governor of Tottori Prefecture. Following graduation from The University of Tokyo, he joined the (then)Ministry of Home Affairs. He took his current position in 2007, following terms in positions including Director of the
Tottori Prefectural administration’s General Affairs Department and Vice Governor of the prefecture. He is currently
serving his fourth term. Mr. Hirai is a member of the government's Advisory Council on Countermeasures against Novel
Influenza and Other Diseases and Subcommittee on Novel Coronavirus Disease Control. He is the Representative and
Deputy Director of the Novel Coronavirus Response Headquarters of the National Governors' Association, responsible
for compiling proposals and negotiating with the government. As the prefectural Governor, he has acted in advance ofother regions in implementing responses to COVID-19, for example by enacting the first cluster countermeasuresordinance of any of Japan’s prefectures and creating prefecture-specific guidelines in relation to the prefecture’s tourism
industry amid the COVID-19 crisis at an early stage. These measures have controlled the spread of infection in theprefecture.
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation presented here.
Translated by Michael Faul.
Copyright Ⓒ 2020 by Nippon Institute for Research Advancement