A lesson learned from a large-scale natural disaster
While the Covid-19 pandemic has become a long-term threat to the global community, Japan has been facing another “crisis with no end in sight” in recent years: large-scale natural disasters. Of particular note are the 1995 Great Hanshin-Awaji Earthquake and the 2011 Great East Japan Earthquake. Despite many years having passed, there still remains a long way to go in both cases in restoring survivors’ lives and revitalizing affected areas.
One of the important lessons learned from these natural disasters is that large-scale disaster management goes beyond emergency response. From the experience of the 1995 Great Hanshin-Awaji Earthquake, it has become clear that disaster management requires another two policy phases after emergency response: recovery and development, and disaster mitigation. Furthermore, the 2011 Great East Japan Earthquake led to the policy “Build Back Better,” which has gained wide recognition in the global community.“The DMC can be used for assessing comprehensive government disaster management from a long-term perspective.”
Today, the disaster management process that integrates the three policy phases of “emergency response,” “recovery and development,” and “mitigation” is called the Disaster Management Cycle (DMC). It has become well known in the disaster management field that to proactively respond to changing policy needs based on the situation on the ground, it is necessary to plan in advance a comprehensive disaster management policy that organizes policy goals and the means to achieve them by each phase of the DMC. In this way, the DMC can be used for assessing comprehensive government disaster management from a long-term perspective.
Here, I attempt to utilize the DMC framework to assess the Japanese government’s infectious disease management of the Covid-19 pandemic to date. The results show that, as of mid-March 2021, Japan’s current situation corresponds to the emergency response phase, and the government has yet to achieve its policy goal. In addition, the Japanese government has made the premature decision to shift the policy emphasis from infectious disease control to economic revitalization too early without a strategic perspective. Also, economic stimulus policies, such as the “Go To Travel” program, do not fit as a policy measure in the recovery and development phase since it would not revitalize the economy in a sustainable manner. Furthermore, the overall picture of the DMC in the context of Japan’s Covid-19 pandemic response remains unclear.
The Covid-19 situation around the world
The end of the fight against Covid-19 remains out of sight worldwide, despite the recent start of long-awaited vaccination programs. The number of fatalities is still on the rise globally and growing fast, while the number of new infections has started to decline (Figure 1). In addition, the impact on society, especially on the economy, is a serious long-term risk in many countries. After the second quarter of 2020, when the economies of Japan, the United States, and Europe plunged at a record pace due to lockdowns and “state of emergency” declarations, real GDP growth slowed again in the fourth quarter due to increased spread of Covid-19 (Figure 2).
Today, policymakers in many countries have realized that they are left with two uncomfortable policy options: contain the virus through coercive policy measures like lockdowns at the expense of significant economic losses or maintain economic activity while allowing a certain level of Covid-19 contagion.
In some countries, such as China and New Zealand, the central government has taken decisive action to respond to the pandemic through quick and large-scale lockdowns and border closures. Other countries, such as Israel, have already vaccinated the majority of the population. However, many countries have adopted ad hoc and inconsistent policy responses due to the fear of economic stagnation. Japan is no exception.
The Japanese government’s haphazard Covid-19 policy
The Japanese government’s public struggles with containing Covid-19 began with the arrival of the cruise ship Diamond Princess, which brought a number of infected passengers to Yokohama on February 3, 2020. Despite the Ministry of Health, Labor, and Welfare’s statement applauding themselves for successfully containing the virus, the arrival of the luxury passenger liner was only the beginning of the spread of Covid-19 throughout the country (Figure. 3). According to a report published by the National Institute of Infectious Diseases, the beginning of the full-scale spread of Covid-19 in Japan is thought to be caused by returnees from overseas who entered the country before travel restrictions began in mid-March 2020.1National Institute of Infectious Disease, “Genomic and Molecular Epidemiological Study of a Novel Coronavirus, SARS-CoV-2,” April 27, 2020.
We can identify a pattern in the Japanese government’s Covid-19 response so far in a policy response that oscillates between infection control and economic stimulation. This seems to indicate that these policies are made without the support of a strategic policy framework.
The initial policy responses of the Japanese government were bold at the beginning of the pandemic. By the end of March 2020, the administration called for the cancellation or postponement of major events, including the 2020 Tokyo Olympic & Paralympic games, to prevent the further spread of the virus. On April 7, 2020, for the first time in Japanese history, the government declared a state of emergency in seven prefectures, including the Tokyo metropolitan area. The government expanded the order to include the entire country on April 16, 2020.“These policies were intended to mitigate the economic impact of the Covid-19 pandemic and declaration of state of emergency rather than to stimulate economy.”
In addition, the Abe administration decided to implement large-scale economic assistance for businesses and the public. No compensation was provided for the suspension of businesses and shortened working hours, but in early April 2020, the government started providing interest-free, unsecured, long-term loans to companies through banks to secure their working capital and deploying various cash transfer measures for households and businesses to cover economic losses and life expenses.2For more detailed information, see Cabinet Secretariat, “COVID-19 Information and Resources: Information on Support Measures Related to COVID-19.” These policies were intended to mitigate the economic impact of the Covid-19 pandemic and declaration of state of emergency rather than to stimulate economy. It could also have served as an infection control policy by allowing households and businesses to slow down economic activity without too many financial repercussions, thus slowing the spread of Covid-19. The total size of the economic policy package is estimated to be about 230 trillion yen (about 2.2 trillion US dollars).
After the state of emergency was lifted on May 25, 2020, the emphasis has gradually shifted from infectious disease control to economic stimulus. With a growing public sentiment that both the spread of Covid-19 and the government’s infections disease control measures posed serious risks to the economy, the government decided against extending the emergency declaration. Instead, it came up with a series of economic stimulus measures. One of the highlights was the “Go To Campaign,”3The “Go To” campaign is a subsidy program to promote household consumption and stimulate domestic demand. It includes four initiatives: Go To Travel, Go To Eat, Go To Event, and Go To Shopping Street. including the “Go To Travel” campaign, which started on July 11, 2020. On September 19, the Japanese government eased restrictions on the number of participants at events. On November 1, 2020, it lifted travel restrictions on 11 countries and areas of the Asia Pacific region. Moreover, in December 2020, “the Green Growth Strategy” and “Digital Transformation” programs were announced as key economic revitalization policies for the post–Covid-19 era.
The government continued to prioritize stimulating the economy over infectious disease control while the spread of Covid-19 gradually increased. In late July 2020, in the wake of a second wave, Prime Minister Shinzo Abe commented in public that it did not seem necessary to immediately declare another state of emergency. In a TV program broadcast at the end of August, the chief cabinet secretary at the time, Yoshihide Suga, objected to criticism of the “Go To Travel” program in the midst of the second wave of Covid-19, emphasizing the positive impact on local economies.“The Suga administration…has maintained the focus on economic stimulus and distanced itself from its own expert panel that had emphasized infectious disease control.”
The Suga administration, which took office in September 2020 after the resignation of former Prime Minister Abe, has maintained the focus on economic stimulus and distanced itself from its own expert panel that had emphasized infectious disease control. In fact, the expert panel was not given an opportunity to comment on the pros and cons of lifting the first state of emergency. On November 25, 2020, in order to stop a third Covid-19 wave, the panel proposed that the government suspend “Go To Travel” in metropolitan areas like Tokyo. However, the government did not act on this recommendation until a sharp increase in new infections in December 2020.
The arrival of the full-scale third wave that month forced the government to prioritize infectious disease control and disrupted the government’s plan to push economic stimulus. On December 14, Prime Minister Suga announced the temporary cancellation of “Go To Travel” throughout the country. On December 26, the government decided to deny entry to foreigners from all countries and regions in response to the global spread of a new variant of the Covid-19 virus. Suga followed up by declaring a second state of emergency on January 7, 2021.4On March 21, 2021, the state of emergency that had been in effect in Tokyo and its three neighboring prefectures was lifted. This third wave has led the Japanese government to adopt stricter policies, allowing the suspension of business without declaring a state of emergency and giving local governors the authority to enforce hospitalization and contact tracing rather than relying on self-restraint.5On February 13, 2021, the Diet passed amendments to the Coronavirus Special Measures Law and the Infectious Diseases Law. The former allows the government to order businesses to shorten their working hours or to shut down in areas where a state of emergency has been declared. Or, without issuing the state of emergency, the legislation enables local authorities to inspect businesses to ensure the suspension of business if there is concern about the spread of infection. The latter enables the governor to order Covid-19 patients to be hospitalized or to cooperate with public officials in tracking their infection. In case of violation, the administration can impose fines.
Today, the government’s concern has shifted to the supply of vaccines and vaccination, but Japan has been the slowest of the G7 countries to start the vaccination process,6It has been pointed out that the reason for this is that the efficacy of vaccines is carefully checked, and that the small size of the domestic pharmaceutical industry makes it inferior in the competition for vaccine development. See NHK, “Vaccination: What Is the Situation in the World? What Is the Reason for Japan’s Delay?” February 8, 2021. which only began in mid-February 2021. As of mid-March 2021, the vaccination process was already delayed with little likelihood of securing the necessary number of vaccines.“Over nine months later, the Japanese government’s infectious disease management remains inconsistent.”
As we have seen so far, the Japanese government’s infectious disease management of Covid-19 has not only lacked a long-term perspective and oscillated between infectious disease control and economic stimulus, but has also continued to lag behind changing circumstances. The Asia-Pacific Initiative (API) noted in its report7Asia Pacific Initiative, The Independent Investigation Commission on the Japanese Government’s Response to COVID-19: Report on Best Practices and Lessons Learned (January 2021). that one of the government’s key informants described the series of policymaking processes as “a rough ride” that “turned out okay in the end.” Over nine months later, the Japanese government’s infectious disease management remains inconsistent. As a result, not only is there no prospect of containing the Covid-19 epidemic in Japan to date, but the Japanese economy is on the verge of another downturn.
The disaster management cycle in the case of the Covid-19 pandemic
Why has Japan’s infectious disease management taken such twists and turns? One of the possible explanations is that the government did not initially plan for policies that could adapt to changing rates of infection based on projected scenarios. In other words, the government did not anticipate applying the Disaster Management Cycle to the Covid-19 pandemic beforehand. Therefore, the government’s response to changing rates of infection has been reactive rather than proactive.
Generally speaking, the DMC for a large-scale natural disaster consists of three phases: emergency response, recovery and development, and mitigation. This is because such disasters not only put many lives at risk, but can also severely damage public and private physical capital, and disrupt social activities. Disaster management during or following a large-scale disaster does not end with emergency response, such as saving lives and providing emergency goods and services. It goes beyond, covering policy areas that address the recovery of survivors and the sustainable revitalization of affected areas. To avoid repeating crises, the DMC further extends to building resilience through social and institutional reform to mitigate the potential impacts of future disasters.
Since the Covid-19 pandemic threatens not only human lives but also social life, and economic activities, the DMC framework can be applied to address the pandemic. Infectious disease management, like disaster management for large-scale natural disasters, needs to go beyond addressing infectious disease control to recovery and development as well as mitigation.“The goal of the emergency response phase would be to ensure the safety of the public, confirm the containment of the Covid-19 epidemic, and sufficiently reduce the likelihood of the respreading.”
In the case of the Covid-19 pandemic, the phased policy goals of the DMC could be as follows. The goal of the emergency response phase would be to ensure the safety of the public, confirm the containment of the Covid-19 epidemic, and sufficiently reduce the likelihood of the respreading.8Vital to the emergency response phase are the implementation of timely and widespread vaccination, the provision of on demand medical services, and the expansion of material and financial support for medical facilities and their human resources. In order to contain the pandemic, the policy toolkit must include measures such as expanded intensive PCR testing and isolation of positive cases, active epidemiological surveillance for in-depth tracking of the infection route, state of emergency declarations, provision of funds to curtail outings and social activities, and promotion of habit formation such as social distancing, hand washing, staying home, and wearing a mask. In the recovery and development phase, one of the policy goals would be to restore the health of the severely infected and those suffering from aftereffects, and to normalize daily life.9Here it is worth considering policy measures such as promoting investment in R&D of new vaccines and therapies, providing soft loans to companies, and cash transfers to households. Another important policy goal in this phase would be to revitalize society by improving socioeconomic conditions in a sustainable manner.10To achieve this goal, a variety of broad policy measures are needed. Lowering inequality through the reform of social security, the educational system, and the labor market is necessary to offer structural support for those who suffer the most during a pandemic, such as the elderly, very young, and part-time, contract, and essential workers. Achieving sustainable economic growth that helps revitalize business sectors is another pillar policy agenda for job creation and raising income levels. Improving industry productivity and quality of life through policies such as public investment in infrastructure and natural environmental conservation should incentivize companies and entrepreneurs to move in and accelerate investment and innovation that lead to sustainable growth. The goal of the mitigation phase is to build a resilient society that can adapt quickly to address future infectious diseases.11Resiliency requires civil society initiatives to change lifestyles to be more adaptable to future infectious diseases and changing circumstances. In particular, Japan’s work culture, characterized by long working hours and gender role division of labor that deprive citizens of flexibility in their lives, as well as collective action that discourages remote work, needs to change. Serious consideration should also be given to strengthening healthcare infrastructure, such as institutional reform to improve the health insurance system, increase investment in medical facilities and healthcare workers, provide public health education to citizens, establish basic laws, and a central agency similar to the US CDC to deal with future pandemics.
In order to advance from one disaster management phase to another, it is necessary to achieve the current phase’s policy goals to lay the adequate groundwork for the subsequent phase. Without doing so, it becomes difficult for the government to advance the DMC and achieve the policy goals of the following phases.12For example, in order to start restoring daily life and improving socioeconomic conditions, the government needs to ensure a certain level of safety in society through policies such as widespread vaccination and PCR testing, as well as active epidemiological surveillance to contain the pandemic. Also, before implementing policies toward a disaster-resilient society, there must first be progress toward recovery, development of the economy, and revitalization of social activities.
Consideration should also be given to the policymaking process, ensuring the engagement of stakeholders and their preferences in order to gain broad support so that policies can remain in effect while adapting them to real-world demands and circumstances. Presenting a big picture of the government’s infectious disease management plan based on the DMC to the public can help in cultivating citizens’ opinions and hence clarifying their policy preferences
Assessing Japan’s Covid-19 response based on the Disaster Management Cycle framework
First, from the perspective of the DMC framework, Japan’s current situation corresponds to the emergency response phase since the government has yet to fulfill this phase’s policy goals. In fact, as of April 2021, the Japanese government had not yet achieved containment of the Covid-19 pandemic, and the Osaka prefectural government has been reportedly considering requesting the central government to declare a third state of emergency. Until containment of Covid-19 is confirmed, the Japanese government needs to focus on implementing infectious disease control or the spread of Covid-19 will prevent social and economic recovery.
Second, the Japanese government attempted to shift from infectious disease control to economic revitalization too early in fall 2020. The “Go To” campaign was launched before containment of Covid-19 was guaranteed and travel restrictions were lifted during the second and third waves of infection. Though these policy measures were undertaken as economic stimulus, they were unlikely to succeed and may in fact increase contagion. The government should have first focused on containing Covid-19, rather than stimulating the economy in the middle of a pandemic. Only then would it be possible to allow social life to “return to normal” and move forward with policies to revitalize economic activities.“The Japanese government needs to reconsider the implementation of such short-term economic stimulus measures and focus on planning a sustainable economic recovery by promoting structural economic change and innovation.”
Third, even if the “Go To” campaign would have had an effect to boost tourism demand during its implementation period in the short term, it does not fit as a policy measure for recovery and development phase. It could have a negative impact on the economy in the long term. We will face a “demand cliff” once the policy ends. If demand falls sharply, the supply side will be forced to scale back the production level in response, which could have a significant impact on employment and future investment. In addition, the program unlikely contributes to increase productivity in existing industries by promoting innovation as well as to induce industrial shift through creating new investment in the tourism industry. Rather, this policy could serve inefficient firms to remain in business, producing so-called “zombie firms,” and subsequently hindering productivity and growth in the economy. The limited length of the program would also not be able to adequately incentivize existing businesses to make new investment and newcomers to enter the market. The Japanese government needs to reconsider the implementation of such short-term economic stimulus measures and focus on planning a sustainable economic recovery by promoting structural economic change and innovation.
Fourth, the overall picture of the DMC of Japan’s infectious disease management is still unclear. The government has not been able to set a fundamental strategy for curbing the spread of Covid-19. In the end, the Japanese government’s infectious diseases control measures have been limited to declaring states of emergency, promoting self-restraint behavior such as “stay home,” and expecting the public to voluntarily change their behavior, the effects of which are difficult for the government to control.13According to the API report, Japan’s Ministry of Health, Labor and Welfare, along with a panel of experts, had early on emphasized the importance of infection control through active epidemiological surveillance. At the same time, despite repeated requests from the public and Prime Minister Abe at the time, the ministry had objected to expanding PCR testing to cover asymptomatic people. The concern was that the number of false positive patients would increase if they expand the PCR testing blindly, leading to a collapse of the medical system and restrictions on the activities of those who actually tested negative. It was also a concern that if the number of potential false-negative patients increased with the expansion of the PCR tests, it would be difficult to control the pandemic. However, around the second and third wave, infection control through active epidemiological surveillance had lost its effectiveness due to the increasing proportion of unknown routes of infection and resource constraints on investigations. Concrete policy plans for the recovery and development phase and the mitigation phase have not even been outlined yet, and only recently have policy discussions begun.14Prime Minister Suga mentioned in his first press conference that the “Green Growth Strategy” and “Digital Transformation” will be pillars of growth strategy post–Covid-19; however, the concrete policy plans have not been proposed yet. Also, there is still no mention about policies in regard with institutional reform toward building an infectious disease resilient society, such as improving the social security and medical systems or establishing basic laws and a central agency like the CDC.
Fifth, the policy formation process has been vague and lacked transparency. There have been conflicts within the government over infectious disease control policies, which have given the public the impression that the government’s actions so far have been ad hoc, and have been implemented without long-term prospect. The government has not proactively explained its infectious disease management process, the policy formation process, the policy goals or their intentions.15It should be noted that the Japanese government has lacked diligence in preserving official documents related to the Covid-19 response. The government has not produced sufficient detailed minutes of important regular meetings related to Covid-19 policy decisions and discussions, which seems to obscure the process of policy formation. Kei Sato, “In Spite of the ‘Historic Emergency’… There are Four Cases of Mandatory Minutes for the Corona Response,” Mainichi Shinbun, February 26, 2021. This has presumably resulted in increasing public uncertainty about the prospects for policy implementation, consequently making it difficult for businesses and households to resume social activities.
Suggestions for long-term infectious disease management of the Covid-19 pandemic
The Japanese government should present the overall picture of its infectious disease management plan for the Covid-19 pandemic based on the DMC framework. Presenting the policy measures to achieve the goals of each phase of the DMC, as well as the conditions for transitioning from one phase to another, will not only reduce public uncertainty about policy implementation and its prospects, but also help build consensus and support for the government’s infectious disease management plan through public dialogue.
The government needs to accelerate the national discussion on how the government promotes revitalizing society as well as how society should build resilience for the post–Covid-19 era while the policy response to contain the pandemic is underway. The discussion should go beyond the mere compensation of losses as well as establishing so-called “new lifestyles.” So far, the government has presented several ideas for the future of Japanese society and the ways to achieve them, including “Green Growth Strategies” and “Digital Transformation.” Yet, it is not sufficiently clear whether these strategies are favorable for revitalizing society as well as building resiliency against future infectious diseases. The government should further deepen discussions with the public about what a future society might look like and the policy measures to pursue it.“It will become increasingly important to invite broader citizen representation into the policymaking process to shape regional development plans.”
The government should encourage the formulation of regional development strategies based on local initiatives. When it is unclear how Japanese society will adapt to the post–Covid-19 era, diversity is key. As regions compete with each other in terms of their economic vitality, natural environment, public infrastructures, social security, education systems, social ties among citizens, culture, and lifestyle, we can find ways to adapt Japanese society to the coming reality. In order to encourage such competition among the regions, it is important to formulate and implement development plans that reflect local individuality and preferences. One way to promote this is by the central government giving local governments more autonomy and discretion in policymaking and finance through decentralization. Moreover, it will become increasingly important to invite broader citizen representation into the policymaking process to shape regional development plans.
Lastly, the establishment of a pandemic research institute would be a useful investment for the future. A research institute would promote sustained policy discussions through research projects that address policy issues related to the pandemic, and it should encourage the participation of domestic and international practitioners and researchers. This is an effective measure not only to pass on the lessons of the Covid-19 pandemic to future generations, but also to train future experts as well as develop research fields. The Disaster Reduction and Human Renovation Institution (DRI), established in Kobe after the 1995 Great Hanshin-Awaji Earthquake, serves as a good model.
The fight against the Covid-19 pandemic in Japan, and elsewhere, still has “no end in sight,” and there is still a long way to go in the fight against infectious diseases. The policy recommendations laid out here would help to lay the groundwork to cope with the pandemic and its aftereffects in the long term.