Interviewed by Tsuji Tokiko, senior staff writer, and Edamatsu Yuki, staff writer
COVID-19 has presented Japan with a variety of difficult challenges. Ahead of the upcoming general election, the Asahi Shimbun sat with Omi Shigeru (72), chair of the government’s COVID-19 expert panel, and asked him what qualities he thinks a leader needs to navigate unusual times, how he views the most desirable relationship between politics and science, how Japan’s medical system can be improved, and what exit strategy will be taken with COVID-19.
The Asahi Shimbun: What is your assessment of former Prime Minister Suga Yoshihide?
Omi Shigeru: The former prime minister and his administration did their utmost to deal with the crisis. I hold them in highest regard for their serious and sincere efforts. Nonetheless, I felt the administration failed to give sufficient explanations to Japanese people as to why it decided against the recommendations of the expert panel. Although it is natural for the opinions of the panel and the government to differ, the following points should have been clarified: whether the panel and the government shared the same goal or had different goals; and if they shared the same goal, why the government chose a different method than that recommended by the panel to achieve the same goal.
Asahi: Are there any specific times you felt that?
Omi: I clearly remember the time the panel recommended the government halt the GoTo Travel campaign. Another time was in June, when the panel recommended the Tokyo Olympic Games be held without spectators. The panel also asked the administration to explain to the nation the government’s perspective on Olympic-related risks and its plan for reducing those risks. The administration’s explanation was insufficient, however.
Asahi: The issue of the relationship between science and politics has been discussed over the years. Do you feel the issue is not moving toward resolution?
Omi: Yes. The issue didn’t start with COVID-19, however. The same conflict was present in 2009 with influenza that year and there was another case before that. In countries around the world, scientists and government repeat the cycle of clash and cooperation. All try to figure out the optimal distance they should keep from one another. I believe we need a set of rules to govern the relationship in Japan, which defines what constitutes an expert opinion and clarifies the government process of deciding whether to incorporate the expert opinion.
Asahi: You often remark on the importance of leadership. What do you expect from a leader facing the COVID-19 crisis?
Omi: During a crisis, a leader faces highly complex and difficult challenges. Many people feel worried and dissatisfied at such times. The leader must present an overall vision, a strategy, even though it may come with a difficult solution. Above all else, the leader must give the people a logical explanation and a solid foundation for the vision. Second, the leader must have the will to carry out that vision. Third, the leader needs to inspire the people to follow him or her by perhaps using words that deeply resonate with them.
Asahi: Logic, will, and words that resonate.
Omi: There is another quality. That would be what you might describe as resolve with a sense of acceptance. By definition, responding to a crisis involves the risk of failure. The leader must accept that once the best possible measures have been taken, he or she must wait for verdict of history. All leaders should be able to set aside their ego. I don’t know what the next administration should be or who should be the next leader, but whoever they are they should be able to see beyond themselves.
Temporary medical centers should have opened earlier
Asahi: The fifth wave of COVID-19 was prolonged, straining Japan’s medical system.
Omi: Although the number of available beds nationwide was about 10,000 more this summer compared with the end of last year, the impact of the Delta variant offset the increase. Many patients were forced to recuperate at home, especially in Tokyo, resulting in a large number of deaths at home. In Japan, the majority of hospitals are privately run, and they are not directly answerable to the central government. This meant extra time was spent obtaining the hospitals’ consent to the government policy. Although I have stressed the importance of preparing medical institutions at the local level to cooperate and role-share in times of crisis, some were not prepared. Additionally, temporary medical facilities should have been opened earlier .
Asahi: Before the fifth wave came, you had been saying that doctors at local clinics and visiting nurses should be recruited for COVID-19 countermeasures.
Omi: [The COVID-19 response was] smoother in communities where medical personnel and institutions were habitually interacting and cooperating with each other. It is vital that each local community build this kind of communication among medical institutions. During the COVID-19 pandemic, hospitals that usually see general patients were forced to send them to other medical institutions or to restrict the number of non-COVID patients they accepted. There is no easy solution. That’s something we must solve.
Asahi: What should we do to prepare ourselves [for the next wave]?
Omi: We cannot just double the number of beds for COVID patients. We need a fundamental solution and plans. To prepare the local medical system, relevant issues should be discussed ahead of time, including local clinics’ roles, how to establish temporary medical centers, and how best to designate hospitals for COVID treatment. We must improve our testing system as well to detect positive cases at an early stage so that medication can be used more effectively. A new vision for COVID response should be established while the virus is under control.
The division of roles between the central and local governments is unclear
Asahi: One of the problems during the pandemic was the difficulty in knowing who was directing the response efforts.
Omi: Local medical systems are governed by prefectural governments and so are outside of the direct control of the central government. Decentralization of power notwithstanding, under a contingency such as COVID-19, there is a need for the central government to make decisions that could affect the whole nation. There were grey areas between the jurisdictions of local and central governments, and it was unclear who was responsible for what and who had the final say. Often, this resulted in a stalemate in the government response.
Asahi: Transition from an ordinary setup to an emergency posture was not smooth.
Omi: Trying to handle an emergency with ordinary, everyday arrangements resulted in a delayed response. In a contingency, the central government must lead so that a unified, integrated response can be put in place quickly. Japan should have an emergency system and legislation, as well as rules to be applied under contingencies. The chain of command and division of roles should be stated clearly. Although we recognized the issues concerning local health centers, testing, and the medical system early in the pandemic, [our response was delayed because] it was unclear who held the authority to lead.
Additionally, information sharing between the local and central governments was hindered. That’s another point of regret.
Asahi: What kind of information are you talking about?
Omi: Locations of cluster incidents, for example. A team at the Ministry of Health, Labor and Welfare in charge of tracking clusters went out to the actual locations or tracked them in media reports. This was because the local governments didn’t provide the central government with enough information in a timely manner. In dealing with infectious disease, information on the spread of the virus is of utmost importance. But the transfer of information from the local to the central government was delayed, because the local governments were reluctant to share patient data on the grounds of privacy protection. It cost us precious time. The fifth wave was brought under control because the Japanese people took actions to prevent the virus from spreading further. But the state of emergency lasted so long partly because of this delay in the flow of information.
An all-out effort is needed to deal with a crisis
Asahi: Aside from increasing the number of available beds for COVID patients, securing enough medical staff is also vitally important. What can we do to make sure we have enough staff?
Omi: Japan’s system where doctors have a medical specialty leads to inflexibility. In addition, we have not put enough resources into training specialists in infectious diseases, which encompass a wide range of general diseases. We must have doctors and nurses who can make more comprehensive diagnoses. Aside from this, medical personnel should be given relevant training so as to increase the number of staff capable of fighting COVID-19 during the next surge. Doctors not specialized in infectious diseases can also do much more. Cultivating the environment where people feel they are fighting the COVID-19 pandemic together is important. COVID-19 is just like a natural disaster. When hospitals are not accessible, medical staff could be dispatched to outside facilities, and patients should be treated at temporary centers. This kind of response should be orchestrated at the local level.
Asahi: What will the exit strategy require?
Omi: In the fifth wave of COVID-19, COVID patients were prioritized, and regular patients took a backseat. Still, many COVID patients were forced to stay at home, and some of them died. This very fact revealed the fragility of the Japanese medical system and changed people’s perception. A crisis demands an all-out response. It goes without saying that we must strengthen our medical system. At the same time, the central government must bring down the number of cases and reduce incidents of serious COVID cases by boosting the testing capacity and increasing the percentage of vaccinated people in the population. The government must implement all possible measures, not just one or two. And everyone must participate in the COVID-19 response efforts, so that no significant restrictions are placed by the government on the people’s movements.
Profile: Omi Shigeru was born in 1949 and graduated from Jichi Medical University. He specializes in global health. Omi has been the president of Japan Community Healthcare Organization (JCHO) since 2014. Omi led the efforts to fight SARS as the regional director of the Western Pacific Regional Office for the World Health Organization (WHO).