Abstract
Introduction
T
Japan introduced the Infectious Disease Emergency Specialist (IDES) training program in 2015 after realizing it could not sufficiently respond to the Ebola outbreak. Japan has aligned its efforts with the global call for enhanced preparedness and response capabilities, and since the COVID-19 crisis, it has considered further expansion of this program. 3 This commentary advocates for the value of models that embed visiting faculty within partner systems to enhance international coordination, exchange best practices in preparing for and responding to health emergencies, and strengthen global response systems to manage emerging infectious diseases and health crises.
The IDESraining Program
Japan’s Ministry of Health, Labour and Welfare (MHLW) initiated the IDES training program during the 2014-2016 West Africa Ebola virus disease outbreak in response to the realization that the Japanese government could not provide a sufficient number of physicians to deploy with the Global Outbreak Alert and Response Network to support the outbreak response. 3 IDES is a comprehensive 2-year training program designed to equip Japanese infectious disease emergency specialists with the skills and knowledge needed to effectively respond to health emergencies. The criteria for candidacy for the IDES training program are possession of a Japanese medical license; at least 3 years of clinical or public health experience, including postgraduate clinical training; and sufficient English proficiency to work at overseas administrative agencies. In addition, work or training in the field of infectious diseases is desirable.
The IDES training program has 2 phases. During the first year, trainees work within national public health institutions, including the MHLW, the National Institute of Infectious Diseases (NIID), and the National Center for Global Health and Medicine. During the second year, trainees work in an international setting. IDES trainees have the opportunity to select institutions based on their interests and expertise, aligning their experiences with the institution’s objectives. 3 For example, as part of their second-year training, IDES trainees have been dispatched to the World Health Organization, the US National Institutes of Health, the US Administration for Strategic Preparedness and Response (ASPR), the US Centers for Disease Control and Prevention, the European Centre for Disease Prevention and Control, and the UK Health Security Agency.
Most training programs of this nature, such as the US Centers for Disease Control and Prevention Public Health Emergency Management and Epidemic Intelligence Service fellowship programs, are of shorter duration and conducted within a specific field. Further, the classes, workshops, and seminars are often conducted separately from the actual job duties, outside of work settings.4,5 In contrast, the IDES program’s core competencies are obtained not by specific field training but by on-the-job training in cross-sectional fields during the IDES training term; such training could involve planning projects related to infectious disease countermeasures in the MHLW, providing evidence related to emerging infectious diseases as an NIID team member, and diagnosing and caring for patients with infectious diseases in the National Center for Global Health and Medicine. 6 In addition, the most remarkable component of the IDES program is the second-year international training, which offers trainees the opportunity to gain international experience and exposure to different healthcare systems, protocols, and approaches to infectious disease management. This global perspective is valuable for responding to emerging infectious diseases, promoting international collaboration, and strengthening global health security systems. 7
The IDES program is still in its developmental stages, with the first cohort of IDES trainees starting the program in 2015. Since then, it has already cultivated specialized expertise and established a cadre of professionals capable of contributing to both Japan’s preparedness for health emergencies and international health security. Each annual cohort consists of 3 to 6 candidates, depending on the number of candidates applying to the program. In the 9 years since the inception of the IDES program, approximately 30 individuals have successfully completed the program. IDES-trained individuals are included on the MHLW’s list of candidates for deployment in a global pandemic; some of them were dispatched to Wuhan, China, during the early stage of the COVID-19 pandemic. Although measures of success for this program have not been clearly established, successful completion of the program requires trainees to demonstrate not only clinical experience and epidemiological knowledge related to infectious diseases but also their comprehensive knowledge and abilities, including skills in administrative management and international coordination. The continuous development of professionals who have the knowledge and abilities to protect the public from emerging infectious diseases can serve as a bridge between Japan and other countries.
Learning From NETEC
The emergence of the COVID-19 pandemic has revealed new and intricate challenges to both domestic and international health security. While this extensive health crisis impacted healthcare and public health systems, it also brought to light a wide range of tangential challenges, including international socioeconomic and political impacts. In Japan, the COVID-19 pandemic revealed vulnerabilities and an insufficient readiness in the research and development of therapeutics and vaccines. 8 Consequently, it became evident that to prepare for future pandemics and infectious disease outbreaks, significant investments and strategic reassessment are imperative in Japan’s medical research and development sector. Moreover, the rapid surge in the number of patients resulting from the pandemic underscored the need for appropriate allocation of resources and sharing of information among healthcare institutions. 9 Inadequate collaboration among healthcare institutions was identified as a significant challenge to mitigating the impact of future disease outbreaks; the importance of strengthening cooperation and coordination was identified as essential. 9 This has led to a call for efforts to establish a comprehensive healthcare network in Japan to prepare for potential health crises.
In 2015, the United States took significant strides in addressing these challenges by establishing the National Emerging Special Pathogens Training and Education Center (NETEC), which is funded by ASPR. 10 NETEC successfully established a network and coordination scheme among the 13 US Regional Emerging Special Pathogen Treatment Centers specializing in high-consequence infectious disease management, care, and transport. It also created the Special Pathogens Research Network, which notably contributed to the swift facilitation of clinical trials for COVID-19 therapeutics, making it an invaluable resource for responding to the demands of a pandemic. 11
Building treatment networks for infectious diseases across regions, addressing gaps in healthcare needs among and between institutions, collaborating with key stakeholders, and optimizing local resources—all while maintaining collaborative capacity and coordination—present highly intricate and diverse challenges. 12 However, NETEC has devised strategies and best practices to systematically tackle these complexities, making valuable contributions to elucidating how other countries can design systems and networks for the management of infectious diseases. 2
Consequently, Japan sought to learn from NETEC’s collaborative and coordination capabilities to address gaps and challenges in the country, particularly related to improving and strengthening the clinical research infrastructure for infectious diseases and intermedical facility collaboration in readiness for surges in healthcare demands due to emerging infectious diseases. It is often assumed that differences in culture and budget scale exist between Japan and Western countries; however, the ability to identify infrastructure and human resource training needs in advance of outbreaks and incorporate them into the national preparedness system for emerging infectious diseases is not unique to Japan but is an internationally accepted approach. Moreover, the MHLW deemed that learning from NETEC’s successful strategies and maintaining an international cooperative relationship with them hold tremendous importance in the domestic and global crisis management domains. 11
Collaboration Between NETEC and IDES
Because of the remarkable success of NETEC’s coordination and strategies, the MHLW believes that conducting onsite visits to US healthcare institutions to gain insights into their operational practices and increasing formal partnerships with those institutions are essential to the development of a clinical research network and increased coordination of hospitals in Japan. The ministry also recognizes the potential for collaboration and knowledge exchange in the networking of multiple facilities’ clinical research. Thus, Japan considers NETEC a valuable place for IDES trainees.
With the agreement and acceptance of principal investigators at ASPR and NETEC, the MHLW dispatched a trainee to NETEC as a first liaison for 1 year from 2022 to 2023. This NETEC and IDES collaboration facilitated the sharing of best practices, experiences, and expertise in handling special pathogens and other emerging diseases. It allowed the IDES trainee to participate in a range of training exercises, including a mystery patients drill, a Category A waste management exercise, a transportation exercise for pediatric patients with suspected high-consequence infectious diseases, a patient transportation exercise requiring interfacility collaboration, tabletop exercises on the international transfer of patients with high-consequence infections, and tabletop exercises on coordinating surge capacities at NYC Health + Hospitals/Bellevue, the University of Nebraska Medical Center, and Emory University Hospital. Additionally, discussions on how NETEC addressed challenges during the early response to the COVID-19 pandemic provided an opportunity for the IDES trainee to hear insights from leaders of NETEC’s working groups on readiness consultation and technical support, training and education, the Special Pathogens Research Network, and its international partnerships program. Furthermore, the IDES trainee could also join regular NETEC working group meetings.
The various scenario exercises and reality-based activities offered by NETEC enhance Japan’s readiness for national emergencies and international cooperation. To further deepen their collaboration, the University of Nebraska Medical Center (1 of the NETEC institutions) and the National Center for Global Health and Medicine (Japan’s national research and development agency under the MHLW) signed a memorandum of understanding for promoting collaborative research efforts on preparedness for international infectious disease crises and contributing to enhancing national and international health security. 13 Through learnings from NETEC, research has started in Japan on the swift establishment of a clinical trial network and the enhancement of leadership skills necessary for collaboration among hospitals and various stakeholders involved in public health decisionmaking. This effort is expected to significantly contribute to Japan’s future crisis management. In fact, the framework for clinical trials on highly pathogenic infectious diseases and the network for human resource education learned at NETEC will be an important reference for the conception of a new Japanese disease control and prevention center, recently named the Japan Institute for Health Security, which will be established in the next fiscal year.
Conclusion
This commentary highlights the critical role of international collaboration in strengthening global health security, as exemplified by the partnership between the IDES training program and NETEC. By comparing the efforts and handling of special pathogens in Japanese healthcare institutions with those of NETEC and the US healthcare system, we underscore the importance of developing leaders, exchanging knowledge, and establishing robust healthcare networks around the world. We also advocate for implementing similar models of embedding visiting faculty within partner systems to advance international coordination and best practices for special pathogen readiness and response. Ultimately, we argue that these collaborative efforts contribute to a more secure and prepared world despite emerging infectious diseases and health emergencies.
Footnotes
Acknowledgments
We would like to thank A. Marie Betancourt from NETEC for her thoughtful discussions on this topic.