AJISS-Commentary
The Association of Japanese Institutes of Strategic Studies
IIPS

RIPSInstitute for International

The Japan Institute ofResearch Institute for

Policy Studies

International Affairs

Peace and Security

Editorial Advisory Board:

No. 208

Akio Watanabe (Chair)
Masashi Nishihara
Yoshiji Nogami
Taizo Yakushiji

24 December 2014

Editorial Committee:
Taizo Yakushiji
Hisayoshi Ina
Tsutomu Kikuchi
Shujiro Urata andToshiro Iijima
Editor & Online Publisher:

HOW TO ADDRESS INCREASING RISKSTO HEALTH SECURITY : LESSONSLEARNED FROM SARS AND PANDEMIC
INFLUENZA
Sigeru Omi

Yoshji Nogami
President, JIIA・ The impacts of globalization, global warming
and other such factors have made crisis
management more important than ever in
infection control, and further international
collaboration and cooperation is needed
・ Regions and countries with fragile healthcare
systems require more assistance than everfrom the international community, andbolstering these countries' first-response
capabilities is essential for the international
community as a whole
・ Better infection control measures and morerobust healthcare systems should be regarded
as an inseparable pair
The views expressed in this piece are the author’s own and should
not be attributed to The Association of Japanese Institutes ofStrategic Studies.

AJISS-Commentary
The Association of Japanese Institutes of Strategic Studies

This year saw the first cases of dengue fever reported in Japan in 70years. Shortly after these cases came to light, three countries in West Africa
suffered a major outbreak of Ebola fever and, at the time this article is being
written (December 2014), the world remains seriously concerned by thisoutbreak. Surveying the history of infectious diseases, it appears that
progressing globalization over recent years has led to the emergence at theglobal level of one new infectious disease a year on average. The significance of
this is clear: humanity must continue combatting the threat of infectious diseases.
This article attempts to summarize the issues that individual countries and theinternational community as a whole should be addressing, drawing primarily on
the author's personal experiences in combatting communicable diseases in suchcapacities as World Health Organization (WHO) Regional Director for theWestern Pacific and as chair of the Japanese government's H1N1 Influenza
Task Force.
The lessons learned from SARS, which emerged in 2003 as a publichealth crisis in the early years of the 21st century, include: (1) information sharing
and first responses at the initial stages of an outbreak are extremely important,(2) major outbreaks of infectious diseases have a huge socioeconomic impact in
the context of globalization, and (3) preparedness at all times is imperative.
Before SARS, many countries regarded infectious disease control primarily as
the responsibility of health ministers and medical personnel, but the SARS
outbreak prompted prime ministers, presidents, foreign ministers and otherleaders outside the health sector to commit firmly to global infectious disease
control. In fact, when a major outbreak of avian influenza (H5N1) occurred inAsia and elsewhere shortly after the aforementioned SARS had been brought
under control, leaders throughout the international community expressed serious
interest in preventing the spread of the disease. In 2005, two years after theSARS outbreak, the International Health Regulations (IHR), in all but name aninternational treaty, were revised to extend their scope beyond smallpox, plagueand cholera to include all risks to public health. Individual countries were alsoasked to develop the capability to rapidly detect, analyze and report risks that
could have harmful health effects worldwide.

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AJISS-Commentary
The Association of Japanese Institutes of Strategic Studies

There were three lessons learned from the 2009 swine flu (H1N1)
pandemic: (1) discussions were held at the World Health Organization (WHO)and elsewhere in recognition of the need for a consensus among individual
countries and within the international community on defining and declaring
emergencies, resulting in a decision to make comprehensive and generalevaluations not only of transmissibility but also the seriousness of clinicalillnesses and their impact on the health care sector; (2) decision-making
processes and chains of command during emergencies must be made clear at
all times as part of crisis management, and (3) first responses are extremely
important during emergencies but, as the information initially available isuncertain, responses must be tailored to worst-case scenarios and suitably
revised as more accurate information comes in.
This year saw the first cases of dengue fever reported in Japan in 70years, due in part to (1) a steeper uptrend in cases of dengue fever, particularly
in Asia and South America and (2) an expansion of the inhabitable zone formosquitoes in Japan because of global warming. With a similar outbreakpossible next year, infection control preparations should be made ahead of time.
What triggered the outbreak of Ebola fever that has shaken the international
community this year? A comparison with the 2003 SARS outbreak makes thesituation easier to understand. These two outbreaks shared in common anextremely

highmortality

rate.

However,SARS

hadextremely

hightransmissibility, confirmed by the presence of "super spreaders," infectedindividuals capable of transmitting the disease to multiple persons throughdroplet infections. Ebola fever, on the other hand, can only be transmitted bydirect contact with an infected person's blood or other bodily fluids. In fact, themost clear-cut difference between the two is the backdrop against which thedisease spread. SARS was a "21st century-style infectious disease" propagatedaround the world by aircraft from the international travel hub of Hong Kong. Therecent outbreak of Ebola fever that started in West Africa, where health caresystems and water supply are extremely fragile, can be attributed to poverty andeconomic disparities. This Ebola outbreak can also be said to demonstrate quite

http://www.jiia.or.jp/en/commentary3

AJISS-Commentary
The Association of Japanese Institutes of Strategic Studies

vividly that the spirit of the aforementioned IHR upon which the international
community officially agreed has yet to be manifested in practice.
Putting the above lessons to full use, the international community andindividual countries should address the following key issues:① The effects of globalization and global warming have made crisis
management vis-a-vis infectious diseases and natural disasters more
important than ever, and further international collaboration and cooperation
are required.
② Regions and countries with fragile health care systems need more support
than ever from the international community.
③ Bolstering the first-response capabilities of these countries is also vital to theinternational community as a whole.
④ Controlling infectious diseases and enhancing health care systems should beseen as an inseparable pair.

Shigeru Omi is President of Japan Community Health care Organization (JCHO)
and a member of WHO Executive Board. His past experiences include Regional
Director for the Western Pacific(1999-2009) and President of the 66th World
Health Assembly(2013).

http://www.jiia.or.jp/en/commentary4