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Recommendations on Japan's Response to the international community on the Ebola Crisis

November 13, 2014

Liberal Democratic Party of Japan

The recent outbreak of Ebola Virus Disease (EVD) constitutes a threat to international peace and security, and the response to this crisis has become a critical issue with direct links to our people's health and security.
The magnitude of the crisis has required urgent action in the emergency phase. However, given that one of the main causes of the current epidemic can be attributed to a vulnerable primary health care in the most affected countries, the importance of providing medium to long-term assistance for strengthening their health systems, as well as humanitarian aid, have been also recognized.
Japan has been advocating the concept of Universal Health Coverage (UHC) which aims to realize a resilient health system available for all people. As a responsible member of the international community, Japan should extend positively its contribution to realizing human security.
In this context, the Party recommends the following responses to cope with the current Ebola outbreak, as well as possible epidemics of similar infectious diseases in the future.

1. Short-term Response

(1) Japan's Contributions
Since April, the Government of Japan, in its emergency response to the Ebola outbreak, has provided financial assistance through international organizations and relief goods including Personal Protective Equipment (PPE). In addition to these contributions, under the framework of WHO for the Ebola response, Japan has dispatched experts. (Japan has covered their travel expenses and other costs associated with the dispatch, in accordance with the Act Concerning Dispatch of Japan Disaster Relief Team. So far, the Government of Japan announced it would provide about 145 million US dollars in total and about 500 thousand sets of PPE. 6 experts have already participated in the WHO framework.
Furthermore, Japan International Cooperation Agency (JICA), continues to support the neighboring countries' Ebola response through technical cooperation).

(2) Dispatch of Experts
Through the WHO framework, the Ministry of Foreign Affairs and the Ministry of Heath, Labour and Welfare of Japan, should strive continuously to dispatch Japanese experts as long and as possible, while avoiding a negative impact on the preparedness in Japan. In particular, the Ministry of Health, Labour and Welfare should expand the list of candidates, which is submitted to WHO.
When dispatching experts, it is essential to pay maximum attention to help them avoid infection by ensuring they wear PPE in an appropriate manner, as well as by providing adequate and continuous training for their dispatch.

(3) Recovery of Health Services
While the emergency responses are needed for the treatment and prevention of further expansion of the disease, the Government of Japan, together with the international community, should also support the recovery of the damaged basic health services in the affected countries, to prevent the spread of other infectious diseases. This assistance should also be made while taking into consideration its impact on strengthening the health system of the affected countries in the medium to long term.

(4) Measures Based on Scientific Evidence
It is necessary to cease the outbreak in West Africa in order to eliminate the threat of Ebola. Based on this perspective, the GOJ should actively provide the above-mentioned assistance. Furthermore it should also continue to implement the maximum measures to prevent domestic inflow. When doing so, the Party calls on the GOJ not to impose travel and border restrictions, not based on scientific evidence, as those measures could isolate the affected countries and might cause a further expansion of the outbreak. Besides, the GOJ should promote the correct understanding towards the Ebola Virus Disease to prevent overreaction by the public based on rumors or misunderstanding.

(5) Medical Evacuation
Japanese Medical professionals and aid workers who actively work in the field of the affected countries are the pride of our country and should be respected. Therefore, it is an urgent requirement that we establish a system of emergency transport to Japan for them by taking any means including using Japan's Self Defense Force (SDF) cargo aircraft, in case of their possible infection.

(6) Activation of Biosafety Level 4 Facility
In terms of the domestic system, the GOJ has been strengthening the entire system by maintaining the designated medical institutions for specified infectious diseases based on Infectious Disease Control Law, and by training medical service workers who are likely to treat infected patients. However, to take thorough measures against infectious diseases, securing and activating biosafety level (BSL) 4 facilities is a pressing issue and should be carried out immediately, while considering the safety of the surrounding neighbors.

(7) Promotion of Community Understandings
Upon the activation of BSL4 facility, its neighborhood residents might have concerns about the operation. Therefore the Ministry of Health is recommended it enhance its effort to promote understanding with the local residents by explaining the importance of the facility, as well as reporting trends of the infection prevalence timely.

2. Medium-term Response

(1) Cooperation with Other Countries
There is a need for making a better environment for Japan to dispatch support teams, such as the Japan Disaster Relief Team overseas to respond to infectious diseases crises like EVD.
Currently, the United States, France and the U. K. are playing a central role in Liberia, Guinea, and Sierra Leone respectively and, together with international organizations, they have dispatched medical personnel and support teams.
During the process of developing its capacity, Japan should strengthen its cooperation with these countries and international organizations, and make an effort to obtain the necessary know-how for consideration of an appropriate system for Japan in the future, as well as improving the effectiveness of assistance.

(2) Promotion of Japan-US cooperation
Regarding the United States, the US agency for International Development (USAID), is closely cooperating with the US Army. To strengthen Japan's international emergency response system including the Japan International Cooperation Agency (JICA) and the SDF, Japan should establish our own response system in reference to other countries such as the U.S. At same time Japan should coordinate with the U.S. closely for the promotion of Japan-US cooperation.

(3) Providing Relief Goods in a Timely and Appropriate Manner
The current Ebola outbreak has increased the needs for PPE. In case of similar infectious diseases in the future, the Government of Japan should pay careful attention to the process from the beginning to the expansion of the outbreak, and establish an efficient relief goods supply system such as procurement, stockpiling and transport to enable a timely and appropriate contribution.

3. Long-term Response

(1) Promotion of UHC
The Government of Japan, while leveraging its years of financial assistance and technical cooperation implemented by the GOJ and JICA, should continue to promote UHC, and make contributions to strengthen health systems focusing on primary health care, in the area of nutrition improvement, advocacy activities, as well as vaccination in developing countries. In the future, those efforts, when maximized, should prevent the outbreak of infectious diseases like Ebola.

(2) Significant Personnel Contribution
In a similar case of infectious diseases outbreak overseas in future, it is essential to respond even more actively, particularly in personnel contribution or human resources support, as it would ultimately benefit the security of our national citizens, as well as building capacity in the area of biosafety and bio-security through the accumulation of knowledge and experience. The Ministry of Foreign Affairs, Ministry of Health and the Ministry of Defense should strengthen the cooperation and establish a system to ensure the coordination.

(3) Expansion of Readiness and Capability
In accordance with the existing law, it is possible to organize and dispatch a disaster relief team including the Self-Defense Forces in response to the large-scale outbreak of infectious diseases in foreign countries. However, the current capability of Japan's disaster relief team may not allow it to carry out self-standing activities in the remote locations from Japan such as in Africa, in a safe manner avoiding risk of infection. Hence, the GOJ, seeking the possibility of stably dispatching a large number of experts for a long period, should strive to develop the capability and readiness of its human resource in the health field as well as the Self-Defense Forces for an infectious disease crisis and to accumulate the knowledge and experience for meaningful activities in remote locations with risk of infection.

(4) Human Resource Development in Public and Private Sectors
With respect to the above, the GOJ should foster human resources widely in public and private sectors that can be engaged in the infectious disease crisis management. That contributes not only to the international community, but also to the establishment of a system to deal with infectious disease crises in Japan.

(5) Establishment of other BSL4 Facilities
Even if the BSL4 facility at the National Institute of Infectious Diseases Murayama Office were activated, there would still be no other facility in operation in the country. Several BSL4 facilities should be established in the country with respect to crisis management against infectious diseases such as EVD.

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