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. 2025 Aug 19;23(4):270–275. doi: 10.1089/hs.2023.0139

Strengthening Bilateral Cooperation Through the Japanese Ministry of Health, Labour, and Welfare Liaison to the US Administration for Strategic Preparedness and Response

Yukimasa Matsuzawa 1,✉, Adam Tewell 1, Jun Sugihara 1, Takeo Okada 1, Tomoka Funasaka 1, Yu Nanamatsu 1, Yoshiteru Yano 1, Kanako Kitahara 1, Kazunori Umeki 1, Takanori Funaki 1, Rieko Takahashi 1, Sayaka Hikida 1, Akiko Kitayama 1, Ryusuke Matsuoka 1, Kilsun K Hogue 1, K Gayle Bernabe 1, Silvia Garcia-Livelli 1, Bonnie Arthur 1, Chris Crabtree 1, Erik Vincent 1, Tomoya Saito 1, Norio Ohmagari 1, Michael Nealy 1, Takaji Wakita 1, Joseph Lamana 1
PMCID: PMC12499883  PMID: 40765215

Abstract

Beginning in 2016, the Japanese Ministry of Health, Labour and Welfare (MHLW) began stationing liaisons within the US Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response to strengthen cooperation on bilateral health security engagement and collaboration. Notable accomplishments include the establishment of the US–Japan Health Security Committee and collaborations between the US–Japan Disaster Medical Assistance Team on mass event responses, such as the repatriation of American citizens from the Diamond Princess in February 2020 and the COVID-19 response. Japan has also embedded liaisons at the US Centers for Disease Control and Prevention to advance collaboration on public health. In 2021, with COVID-19 highlighting the importance of collaboration on pandemic preparedness, MHLW established a liaison program with the US National Institute of Allergy and Infectious Diseases. These liaisons with HHS agencies have paid dividends to health security collaboration, particularly by enabling greater connections between technical experts in MHLW and HHS.

Keywords: Public health preparedness/response, Biodefense, International collaboration

Introduction

Since 2016, Japanese Ministry of Health, Labour, and Welfare (MHLW) liaison officers have been embedded within the US Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response (ASPR) to strengthen US–Japan bilateral health security cooperation on operational and policy issues. This program started as a 1-year pilot and was formalized in a memorandum of cooperation between MHLW and HHS in May 2017.1 ASPR had previously hosted liaisons from other countries, but the US–Japan liaison program is the longest-running and most extensive liaison program ASPR has hosted.

ASPR’s responsibilities for health crisis management, including responses to infectious diseases, natural disasters, and chemical, biological radiological, and nuclear (CBRN) threats, are summarized by its vision for “a nation more prepared to prevent, respond to, recover from, and reduce the adverse health effects of public health emergencies and disasters.”2 ASPR was established by the 2006 Pandemics and All-Hazards Preparedness Act (PAHPA),3 with a primarily domestic-focused mission. However, PAHPA’s authors knew that health security threats do not adhere to international borders, and collaboration with trusted partners was necessary to advance health security. One of the ASPR’s 6 responsibilities enumerated in PAHPA is to “provide leadership in international programs, initiatives, and policies that deal with public health, and medical emergency preparedness and response.”3 Since its creation, PAHPA has been reauthorized twice to expand ASPR’s mission to address the current health security challenges. During the COVID-19 pandemic, ASPR’s expertise and ability to lead the national health emergency response was demonstrated and its mission evolved postpandemic to meet the new threat landscape.

MHLW is responsible for developing health policies, managing public health crises, ensuring the safety of pharmaceuticals and medical devices, and coordinating emergency preparedness and response efforts. Additionally, MHLW conducts disease surveillance, supports research, and enhances health security through international collaboration. Through the COVID-19 pandemic, Japan strengthened the structures of health authorities and public health systems, including the establishment of a cabinet-level crisis management agency for infectious disease hazards, the restructuring of the department of infectious diseases at MHLW, and the scheduled merger of the National Institute of Infectious Diseases and the National Center for Global Health and Medicine into a single entity as the Japan Institute for Health Security.4

The liaison officer position has faciliated efficient engagement between US and Japanese technical experts on medical countermeasures (MCMs) development and deployment policies, emergency response, and global health security, which improved collaboration, coordination, and understanding of preparedness and response efforts. The liaison officers are selected from among the medical officers of the MHLW based on their expertise, experience, ability to foster international collaboration, leadership and decisionmaking skills, and government and institutional endorsement. By selecting liaison officers based on these criteria, MHLW ensures that the individuals representing Japan in health security matters are highly qualified and capable of advancing mutual goals with HHS. Since the program began in 2016, ASPR has hosted 9 liaison officers from MHLW and supported a liaison officer sent to the National Emerging Special Pathogens Training Center (NETEC). These medical officers all returned to MHLW to assume leadership roles in Japan’s preparedness and response structure and continued to serve as important bridges between the Japanese and the US governments. MHLW liaisons expanded preparedness, response, and MCM development activities during their respective terms. Each liaison’s focus areas and activities varied by the preparedness focus and response events occurring during their tenure in ASPR. They were able to expand collaboration and leave their mark on the US–Japan health security partnership, returning to their further assignments in MHLW with expert knowledge of how HHS worked and as a contact for continued US–Japan health security collaboration. For example, the liaisons contributed to the development of another engagement between the National Center for Global Health and Medicine and NETEC for sharing of best practices, experiences, and expertise on emerging infectious diseases.5 Also, most of the previous liaison officers have been working at the government entities related to health security and continue to contribute to the enhancement of bilateral collaborations in each area.

While liaison officers were based in ASPR, they also engaged with other HHS entities, including the Office of Global Affairs, the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC) (Figure). They also organized meetings with leadership from the Center for the Biomedical Advanced Research and Development Authority, Public Health Emergency Medical Countermeasures Enterprise, and other offices at ASPR to discuss strategic priorities, policy decisions, and collaborative opportunities between Japan and the United States in health security and emergency preparedness. Part of the deployment was not only to support ongoing activities but to build an understanding of the structure and function of each country’s government. The presence of liaisons helped identify, coordinate, and blend similar streams of government efforts common between MHLW and HHS partners, for example, during the 2017 Zika virus response, preparation activities for the 2020 Tokyo Olympics, the February 2020 Diamond Princess repatriation, and the COVID-19 response. The CDC and NIH both established formal relationships with liaisons and directly engaged them in their own activities specific to their bilateral engagement with Japan. These relationships, along with the CDC’s new East Asia and Pacific office, continue to build the US–Japan partnership in this region.

The liaison program will continue to expand the strong foundation of US–Japan health security collaboration and the ability of both countries to collaborate efficiently and effectively during global health emergencies. The description of the liaison program provided in this case study will be a useful resource to other entities that intend to deepen their international collaboration in health security. Both governments value this partnership as it not only bolsters national health security but also contributes to global health resilience.

Liaison Accomplishments

US–Japan Health Security Committee

Originally, the US–Japan Medical Biodefense Research Symposium, under the Framework Initiative for a Safe and Secure Society, was a bilateral project launched in 2007 to enhance information-sharing and collaboration in research and development of MCMs against CBRN threats. It has since been expanded, with efforts by several MHLW liaisons, to include discussions of MCM policies. This symposium has become a community for national researchers, medical professionals, and government officials of both countries to build trusting relationships essential to successful collaboration during emergency responses, as was demonstrated during the 2020 Diamond Princess repatriation operations. The fortuitous timing of the December 2019 symposium involved many key players in the early US and Japan COVID-19 responses—including the NIH, CDC, and ASPR—8 weeks before the emerging COVID-19 pandemic resulted in the Diamond Princess cruise ship anchoring in Yokohama. The symposium helped facilitate communication and foster collaborations, such as the clinical trial and regulatory authorization of remdesivir in Japan. It was canceled during the COVID-19 pandemic but resumed with a mini-virtual symposium in February 2022 and an in-person symposium in August 2022, which included discussions of therapeutics development, the CDC’s Laboratory Response Network (LRN), and COVID-19 lessons learned as well as mapping a way forward to face new health security threats. The new US–Japan Health Security Committee was launched in 2023, broadening the perspective to all-hazards health security issues, including disaster management. It was formalized through the signing of a letter of intent between MHLW and HHS in 2023, which extended and enhanced the scope of the 2017 memorandum of cooperation.6 One of the liaisons’ notable achievements was coordinating the signing of the bilateral agreement, which formalizes and strengthens collaborations in health security.

Figure.

Figure.

Collaborative governmental organizations and institutes in the United States and Japan. Abbreviations: ASPR, Administration for Strategic Preparedness and Response; BARDA, Center for the Biomedical Advanced Research and Development Authority; CDC, Centers for Disease Control and Prevention; EMMO, Office of Emergency Management and Medical Operations; HHS, Department of Health and Human Services; MHLW, [Japanese] Ministry of Health, Labour, and Welfare; NCGM, National Center for Global Health and Medicine; NIAID; National Institute of Allergy and Infectious Diseases; NIID, National Institute of Infectious Diseases; OGA, Office of Global Affairs.

Travel Advisories

The first liaison arrived in June 2016 as Zika cases were being identified throughout the United States.7 The Japanese government decided to update travel advisories to the United States and needed to ensure that the information was accurate and up to date, especially regarding health-related concerns. To achieve this, liaison officers facilitated the rapid coordination of a call between HHS and MHLW. During this call, representatives from both HHS and MHLW discussed various health questions that could impact travelers, including current health risks, preventive measures, and any ongoing health advisories. The goal was to ensure that both countries had a unified and clear message regarding health and safety for travelers. By addressing these health questions directly and collaboratively, the call allowed Japanese government to provide well-informed and coordinated travel advisories. This not only helped in maintaining public health but also ensured that travelers received consistent and reliable information from both governments. The value of liaisons was proven multiple times over the coming years through both technical and ministerial level engagements, such as exchanges of information regarding travel restrictions in each country.

US–Japan DMAT Collaboration

US and Japan Disaster Medical Assistance Teams (DMATs) engaged in discussions on preparedness for mass events and medical response in the spring and fall of 2019 as Japan prepared to host the Rugby World Cup and the 2020 Tokyo Olympics. This engagement, as well as the support of previous MHLW liaisons to ASPR who had returned to Japan, facilitated the deployment of a US DMAT to Japan to support the repatriation of American citizens onboard the Diamond Princess cruise ship. When the COVID-19 outbreak occurred on the cruise ship in February 2020, the former MHLW liaison officers’ expertise and connections were instrumental. Their prior engagement with ASPR allowed for seamless communication and coordination between Japanese and US health authorities. This collaboration was essential in deploying a US DMAT to Japan to assist with the repatriation. The Japan DMATs also shared lessons learned from that operation the following month when US DMATs supported the Grand Princess disembarkation in Oakland, California. In 2021, ASPR and MHLW conducted a 5-part virtual tabletop exercise, in partnership with the United States. The US Embassy in Tokyo and the Ministry of Foreign Affairs of Japan, as well as other relevant agencies, exercised deploying US DMATs in Japan to support the response to a natural disaster, and worked to address challenges and lessons learned from the Diamond Princess repatriation operation. US and Japanese DMATs continue to share lessons learned from the COVID-19 response and the future landscape of emergency medical response.

Laboratory Response Network

Through the liaison program, MHLW and the CDC have strengthened relationships in emerging infectious disease preparedness work. The National Institute of Infectious Diseases, a technical institution within MHLW, and the CDC signed the memorandum of cooperation on LRN in 2022. The Laboratory Response Network for biological threats (LRN-B), led by the CDC’s Division of Laboratory Systems, protects against public health threats through early and definitive detection of biological threat agents, enabling responders to identify public health threats to speed response efforts.8 Increasing the number of LRN-B laboratories in strategically determined countries can enhance global health security. The LRN’s purpose is to coordinate a network of laboratories that can respond to biological and chemical threats and other public health emergencies. The LRN has grown since its inception. It now includes state and local public health, veterinary, military, and international laboratories. For the past several years, the CDC has been collaborating with MHLW and National Institute of Infectious Diseases. The CDC has hosted several visitors from Japan and has implemented a guest researcher program for strengthening technical cooperation between the CDC and the Japanese government with the goal of enhancing biological threat and emerging infectious disease event preparedness. Through the guest researchers/liaison program, the CDC and MHLW have forged a strong, trusting relationship. Specifically, the guest researchers/liaisons have understood the strengths of the LRN-B and have encouraged their government to join the network.

Joint Criminal–Epidemiological Investigations Workshop

The International Workshop on Joint Law Enforcement/Public Health Response to Bioterrorism was successfully held in Tokyo, Japan, in 2019. It was hosted by the MHLW Health Science Research Group on Smallpox Vaccine and Bioterrorism, in partnership with the CDC, the US Federal Bureau of Investigation, the Robert Koch Institute, and the Berlin Police of Germany.9,10 Liaisons are eligible to participate in training and workshops that are primarily designed for US government officials. For example, past MHLW liaisons attended the Joint Epidemiological and Criminal Investigation Workshop course while deployed to the CDC and understood the benefits of cooperation between the law enforcement and public health response on bioterrorism investigation/response. The liaisons partly coordinated the event to bring the workshop to Japan through cross-disciplinary training, knowledge exchange, and facilitating coordination. The workshop was the first of its kind planned in Japan, focusing on the cooperation between law enforcement and public health in bioterrorism investigation. The workshop was well attended, including officials from both local and national public health and law enforcement agencies. The response from the participants was positive, and it was clear that they understood the roles and values of cooperation between public health and law enforcement. This workshop was a great opportunity to gain new perspectives on countermeasures against bioterrorism from the viewpoint of cooperation between public health and law enforcement. It is another example of the benefits of the liaison program, not only for sharing information but also for exploring further areas of technical cooperation.

Other Liaison Programs

MHLW established another liaison program within the CDC in 2017. In August 2021, in the context of COVID-19, the MHLW liaison established a new role as a liaison to NIH’s National Institute of Allergy and Infectious Diseases (NIAID) through the ASPR liaison program. The purpose of this role includes 3 main areas: (1) coordinate and promote bilateral and possibly multilateral cooperation and collaboration on basic and clinical research on emerging and pandemic-potential diseases between NIAID and MHLW; (2) understand NIAID’s role and response to emerging infectious diseases, such as COVID-19, including coordination with ASPR to contribute to the US–Japan collaboration against emerging infectious diseases; and (3) enhance knowledge and learn more about coordinating, planning, and implementing biodefense research to enhance US–Japan collaboration against biological global threats, including coordinating with potential US–Japan biodefense-related activities. Through the NETEC–MHLW engagement, MHLW deployed another liaison to NETEC for the exchange of training and workshops for infectious disease clinical experts and the strategies for a clinical research network.

Conclusion

The liaison program has underscored the importance of joint meetings and conferences, cross-disciplinary training, and effective communication channels for coordinated health emergency responses. Moving forward, strategic focus areas should include enhancing surveillance, strengthening MCMs, building health system surge capacity, and improving care for high-consequence infectious diseases, while also addressing CBRN threats through ongoing collaboration.

No nation can act alone in the face of health threats, which include emerging infectious diseases, pandemics, CBRN threats, and the impacts of climate change, in the 21st century. The US–Japan liaison program facilitates stronger engagement, interoperability, and sharing of expertise that benefits citizens in both countries and can serve as a model for future partnerships to encourage bilateral and multilateral engagement on health issues. Moreover, the COVID-19 pandemic has shown that strengthening global health security collaboration between countries is essential to a safe and secure world.

Acknowledgments

The findings and conclusions in this case study are those of the authors and do not necessarily represent their respective affiliations.

References


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