The Flight Evacuation Mission for COVID-19 from Wuhan, China to Tokyo, Japan from January 28 to February 17, 2020.

Multiple countries have reported evacuation missions to repatriate their citizens in the early phase of the emergence of COVID-19 from China. However, a paucity of data exists on how to optimally execute an evacuation while balancing the risk of transmission during the flight and avoiding spread to the evacuees' home countries. We describe the collective findings of the flight evacuation mission from Wuhan, China to Tokyo, Japan from January 28 to February 17, 2020. The evacuation team established the evacuation processing flow, including a focused health questionnaire, temperature monitoring, ticketing and check-in, and boarding procedure planning. The evacuees were seated according to pre-planned zones. Additionally, to facilitate the triage of evacuees for medical needs, we conducted in-flight quarantine to determine the disposition of the evacuees. All evacuees, regardless of their health condition, were required to perform rigorous hand hygiene frequently and to wear surgical masks throughout the flight. We implemented strict infection prevention and control throughout the mission, including in-flight quarantine. The pre-planned protocol and vigilant observation during the flight were crucial elements of this mission. Our experience is of value in developing a more refined plan for the next outbreak.

Infectious Disease Emergency Specialist (IDES) Training Program in Japan: an innovative governmental challenge to respond to global public health emergencies.

In 2015, Japan created a unique governmental program to train experts in health emergencies called Infectious Disease Emergency Specialist (IDES). This is a concept paper to set out the goal and structure of the program, and to describe the achievement and the way forward to further contribute to global health security. The IDES program background, mission, structure, achievement, and future directions were reviewed and discussed by the IDES trainees, graduates, and program coordinators/supervisors. Since 2015, thirteen Japanese medical doctors have graduated from the program while five are currently in training. The IDES core competencies were identified in the context of a wide range of skillsets required for health emergencies. A large national and global network has been created through the training. Coordinated work with surge capacity of experts is of paramount importance to prepare for and respond to public health emergencies. The IDES program can be a good model to many other governments, and contribute to global health security.

First Major Practical Step toward Appropriate Antimicrobial Use by the Government of Japan.

Antimicrobial resistance (AMR) is one of the top public health issues in Japan. Since Japan published the national action plan on AMR in 2016, its implementation has been a major focus of the Ministry of Health, Labour and Welfare. The ministry recently published the first edition of its Manual of Antimicrobial Stewardship (including an English version), a narrative review with a particular focus on the outpatient setting of primary care and 2 common infectious disease conditions. This is one of the very few occasions in which the ministry has proactively set out clinical guidance for healthcare delivery at the facility level. Implementation of the manual is further supported by a change in Japan's social health insurance coverage.

Emergency/disaster medical support in the restoration project for the Fukushima nuclear power plant accident.

The Fukushima Daiichi Nuclear Power Plant (1F) suffered a series of radiation accidents after the Great East Japan Earthquake on 11 March 2011. In a situation where halting or delaying restoration work was thought to translate directly into a very serious risk for the entire country, it was of the utmost importance to strengthen the emergency and disaster medical system in addition to radiation emergency medical care for staff at the frontlines working in an environment that posed a risk of radiation exposure and a large-scale secondary disaster. The Japanese Association for Acute Medicine (JAAM) launched the 'Emergency Task Force on the Fukushima Nuclear Power Plant Accident' and sent physicians to the local response headquarters. Thirty-four physicians were dispatched as disaster medical advisors, response guidelines in the event of multitudinous injury victims were created and revised and, along with execution of drills, coordination and advice was given on transport of patients. Forty-nine physicians acted as directing physicians, taking on the tasks of triage, initial treatment and decontamination. A total of 261 patients were attended to by the dispatched physicians. None of the eight patients with external contamination developed acute radiation syndrome. In an environment where the collaboration between organisations in the framework of a vertically bound government and multiple agencies and institutions was certainly not seamless, the participation of the JAAM as the medical academic organisation in the local system presented the opportunity to laterally integrate the physicians affiliated with the respective organisations from the perspective of specialisation.