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Summary

In addition to Japan’s general crisis management system, the Japanese government has implemented a health crisis management system.  The Ministry of Health, Labour and Welfare, the primary agency in charge of responding to infectious disease outbreaks and other health crises, has issued guidelines for health crisis management.  Japan’s Infectious Diseases Prevention Act of 1998 provides the legislative framework for the country’s response to a potential health crisis caused by infectious disease.  The Act classifies infectious diseases covered by the Act into several categories, depending on infectiousness and the severity of symptoms.  Under the Act, the Ministry of Health, local governments, and the institutions under them monitor and report on the outbreak of infectious diseases and coordinate their roles to prevent more infections.  Medical doctors report incidences of infectious disease to governors through local health centers.  Those health centers have broad jurisdiction over health-related issues and play an important role in health crisis management.

Japan has designated hospitals with special facilities to deal with patients who are infected with serious and highly infectious diseases.  A governor may order the hospitalization of patients in certain cases.  A quarantine system is activated when the outbreak of an infectious disease overseas becomes a threat to the Japanese people.  When the system is activated quarantine officers may ask questions of incoming passengers and take their temperatures.  When the head of a quarantine station finds or suspects that a person is infected with one of several specified diseases, he or she may isolate the person in an appropriate place.

The Special Measures Act on New Influenza was also enacted in 2012, creating an emergency system specifically for influenza. 

I.  Government Structure 

In Japan executive power is vested in the Cabinet, which consists of the Prime Minister and other ministers.  The Prime Minister is designated from among the members of the Diet (Parliament) by a resolution of the Diet.  He then appoints the other ministers.  Localities are divided into prefectures and municipalities.  

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II.  Structure of Public Health Crisis Management System 

A.  National Health Crisis Management 

The Cabinet has a Deputy Chief Cabinet Secretary for Crisis Management who manages emergency measures when a situation causing significant damage to Japanese people’s lives or assets occurs or is likely to occur.[1]  As stated below, the Deputy Chief Cabinet Secretary for Crisis Management chairs the conference of relevant ministries and agencies on Ebola, which is preparing to take coordinated measures among government agencies in case Japanese nationals are infected with Ebola abroad or persons infected with Ebola are found within Japan.

The Ministry of Health, Labour, and Welfare (MHLW) is the primary agency in charge of responding to infectious disease outbreaks and other health crises in Japan.[2]  In 1997, the MHLW published the Basic Guidelines in Health Crisis Management[3] and four management implementation guidelines for health crises caused by medicine, infectious diseases, drinking water contamination, and food poisoning.[4]  The MHLW has established an electronic health crisis management information system and has also issued guidelines for municipal governments, instructing them to make preparations and develop plans for emergency situations.5[]  

The Health Risk Management Office of MHLW is continually gathering domestic and overseas information from related departments and from national research and development institutes.  Departments within MHLW exchange information at the Health Risk Management Coordination Meeting held two times per month.[6]  A Coordination Meeting can also be convened in an emergency and members may act to establish emergency management headquarters, dispatch staff and experts to the affected areas, and provide citizens with information on health risks.[7]

B.  Local Public Health Crisis System

Prefectures are in charge of conducting various on-the-spot measures during a health crisis.  In Japan, local government health centers play an important role in local health care management.[8]  Prefectures and designated cities have established at least one health center in each of their jurisdictions,[9] resulting in the creation of approximately five hundred health centers throughout the country as of April 2014.[10]  The health centers have broad jurisdiction over health-related issues, including administration of food sanitation, administration of medical and pharmaceutical matters, and prevention of infectious diseases.[11]  

During a health crisis, the health centers become the center of local health crisis management.[12]  The Basic Guidelines Regarding Promotion of Measures to Improve Local Health Issues, issued by the MHLW, recommend that local governments create manuals containing concrete measures for managing a health crisis.[13]  The director of the local health department and the heads of health centers manage health crises at the local level.  Health centers are to respond to emergency information twenty-four hours a day, seven days a week.  Health centers are expected to coordinate services provided by medical service providers.[14] 

C.  Pandemic Influenza Special Measures

Japan established a system to deal with new influenza when avian flu (H5N1) threatened its citizens.  In 2004, the government established the Conference of Relevant Ministries and Agencies to Counter New Influenza and Avian Influenza.[15]  The Action Plan to Counter Influenza was approved by the Conference in November 2005,[16] and revised in February 2009.[17]  When a new influenza outbreak occurs, the Prime Minister and all Ministers form the Headquarters Against New Influenza, which in turn forms the New Influenza Countermeasures Expert Advisory Committee.[18]

To improve the system, the Special Measures Act on New Influenza was enacted in May 2012.[19]  Under the new Act, the government’s action plan[20] and guidelines[21] were updated.[22]  When an influenza outbreak involving a new strain of influenza occurs, the Prime Minister establishes the New Influenza Countermeasures Headquarters upon a Cabinet decision, unless symptoms of the new influenza are no graver than usual seasonal influenza.[23]  The Prime Minister is in charge of the Headquarters[24] and, as such, can declare an emergency when the infection route of the new influenza is not determined by the local governments’ investigations or when such investigations reveal that the activities of the person infected or suspected of being infected pose a great risk of widely spreading the disease.[25] 

When an emergency is declared, emergency measures can be implemented for up to two years, with the possibility of a one-year extension.  The area of the emergency must also be specified.[26]  Authorized emergency measures include

  • requesting residents to refrain from going outside and requesting entertainment businesses to limit or close their business or events,[27]
  • vaccinating residents,[28]
  • opening emergency medical facilities,[29] and
  • requesting the sale of specified goods to the government.[30]

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III.  Powers of Public Health Authorities 

A.  Surveillance

Japan conducts nationwide surveillance of infectious diseases on an ongoing basis.  The Infectious Diseases Prevention Law classifies infectious diseases into the following eight categories based on their infectiousness, the seriousness of the symptoms, and types of diseases: 

  • Category I:  Ebola hemorrhagic fever, plague, smallpox, and others. 
  • Category II: Tuberculosis, SARS (severe acute respiratory syndrome), H5N1 avian influenza, and others. 
  • Category III: Cholera, bacillus dysentery, E. coli O157 infection, typhoid, and paratyphoid. 
  • Category IV: Hepatitis E, hepatitis A, yellow fever, anthrax, infantile botulism, avian influenza (excluding H5N1) and others.  An infectious disease can be added to this category by Cabinet order.
  • Category V: Influenza (excluding avian flu and new influenza), viral hepatitis (excluding hepatitis E and A), AIDS, MRSA (methicillin-resistant Staphylococcus aureus), and others.  An infectious disease can be newly added to this category by MHLW ordinance. 
  • New Influenza.
  • Designated Infectious Disease. 
  • New Infectious Disease.[31] 

When physicians make a diagnosis or suspect the incidence of symptoms of one of the diseases in Categories I through IV, or a New Infectious Disease, they must immediately report the incidences to the governors through health centers.  In the case of incidences of Category V diseases, physicians have seven days to make such reports.[32]  Veterinarians must do the same when they make a diagnosis in monkeys or other designated animals of Ebola hemorrhagic fever, Marburg hemorrhagic fever, and other infectious diseases in Categories I through IV that are designated by a Cabinet order because they are regarded as being infectious to humans as well.[33]  The governors must forward such reports to the Minister of MHLW.[34]  

Governors designate hospitals and clinics to monitor incidences of (1) specified Category V infectious diseases; and (2) incidences of fever and respiratory problems, and fevers and rashes that are similar to symptoms of diseases in Categories II to IV and some Category V infectious diseases.  Managers of designated hospitals must report cases treated by their physicians to the governors, and the governors must in turn forward the reports to the Minister of MHLW.[35] 

Governors may question doctors and conduct investigations of incidences and suspected cases of infectious diseases in Categories I to V and New Diseases if necessary to determine the cause of the incidences.  In an emergency, the Minister of MHLW can do the same.[36] 

The National Institute of Infectious Diseases (NIID), under the supervision of the Health Science Division of the MHLW,[37] collects reports of the detection of infectious agents from prefectural public health institutes and those of incidents of infectious diseases from selected clinics.[38]  The NIID also maintains and distributes reference materials on matters such as microbial pathogens, antigens, and antisera.[39]  In the case of an epidemic or outbreak of an infectious disease, NIID carries out epidemiological investigations and exchanges information with infectious disease surveillance organizations in other countries.  To make these activities more efficient, the Infectious Disease Surveillance Center (IDSC) was organized within NIID.[40]  IDSC publishes the Infectious Disease Weekly Report and other publications and makes them available online.[41] 

B.  Infectious Disease Control 

A prefectural governor may advise a person who is reasonably suspected of being infected with a Category I, II, or III disease, or New Influenza, to undergo a medical examination.[42]  If the person does not voluntarily undergo an examination, the governor may dispatch an officer to examine the person.[43]  Except in emergencies, however, the governor must give notice to the person before issuing a medical examination recommendation or dispatching an officer.[44] 

When a governor receives a report that a person is infected with a Category I through III disease or New Influenza from a medical doctor, the governor sends a notice to the person prohibiting him or her from engaging in specified jobs, such as chef and waiter positions at a restaurant, for a period of time that depends on the disease.[45]

A system of recommended or forced medical diagnosis and hospitalization may be activated when a person is suspected of being infected with certain infectious diseases.  A governor may advise a person infected with a Category I or II disease or New Influenza to be hospitalized in a designated hospital.  If the person does not follow the advice, the prefectural governor may force the person to stay in a designated hospital.[46]  The term of the hospitalization must be seventy-two hours or less initially.[47]  If the governor finds during the initial hospitalization that it is necessary to continue to hospitalize the person to prevent the spread of a Category I or II disease or New Influenza, the governor may recommend hospitalization for up to an additional ten days, with the possibility of two ten-day extensions, if necessary.[48]  If the person does not follow the advice, the governor may force the hospitalization,[49] but must give the patient and/or his or her guardian an opportunity to state their opinions.[50]  

The Infectious Diseases Prevention Act contains provisions aimed at protecting the rights of patients.  All measures taken against individuals who are infected or suspected of being infected with certain infectious diseases must be at the minimally required level.[51]  A person must be released from the hospital when it is determined that he or she does not have a pathogen.  The hospitalized person can request release from hospitalization, whereupon the governor must test the person to determine whether he or she has a pathogen.[52]  The governor may seek the opinion of experts before making a decision.  Such an opinion is provided by an infectious disease examination council that each health center maintains.  When a governor issues a notice that restricts the infected person from engaging in certain jobs, advises hospitalization, and extends the period of hospitalization, as stated above, the council gives its opinion to the governor.[53]  A hospitalized person can appeal the governor’s decision to the Minister of the MHLW.  The Minister then makes a decision in consultation with the MHLW experts’ council.[54]  

In addition to the examination and hospitalization of persons infected with certain infectious diseases, prefectural governors may take various measures when necessary to prevent incidences or the spread of particular infectious diseases.  In order to prevent incidences or the spread of Category I through IV infectious diseases and New Influenza, a governor may order the infected person, the guardian of the person, or the person or organization that manages the place affected to disinfect that place.  If such disinfection is not effective, the governor may order a municipality that has control of the site where the patient was or other contaminated places to sterilize such places.[55]  A governor may also order a person or organization that manages the site where rodents or insects contaminated by the pathogen exist to exterminate such rodents and insects.  If such extermination is not effective, the governor may order municipalities to exterminate them.[56]  Further, a governor may order holders of possibly contaminated food, clothing, bedding, and other items to restrict the movement of, sterilize, or dispose of the items.  A governor may also dispatch prefectural officials or order a municipal government to sterilize or dispose of such items.[57] 

To prevent incidences or the spread of Category I through III infectious diseases and New Influenza, a governor may restrict the movement of an infected corpse, or require a permit for the burial of an infected corpse.  Generally, an infected corpse must be cremated, but with sterilization treatment and a permit, the body can be buried.[58]  To prevent incidences or the spread of Category I through III infectious diseases, a governor may restrict the use of water or a water supply that is suspected of being contaminated.  In such cases, municipalities must provide clean water for residents.[59]  

To prevent incidences or the spread of Category I infectious diseases, stronger measures may be taken.  A governor may restrict access to buildings that are contaminated or suspected of being contaminated with a Category I infectious disease,[60] and may also restrict traffic for up to seventy-two hours around the place where the patient is located or the place suspected of being contaminated.[61]  

C.  New Infectious Diseases or New Threats by Known Infectious Diseases

The Infectious Diseases Prevention Act has provisions to combat new infectious diseases or new threats by known infectious diseases.  Where threats of new influenza, or known influenza that poses renewed threats to public health, are recognized, a governor may seek a report of the health conditions, including body temperature, of the person suspected of being infected for a period that is determined after considering the incubation period of the influenza.  A governor may also request that such person not go outside of his or her residence, and take other actions that are necessary to confine the disease.  In such cases, the governor may provide meals and other necessities for the infected person.[62]  Where the influenza is virulent and it is especially necessary to prevent its incidence or spread, the national government can restrict access to a building and control traffic, as stated in the previous section—measures that are normally applied to Category I infectious diseases.[63] 

In the case of a new disease other than influenza, the governor may recommend that a person who is suspected of being infected receive a medical examination.  If the person does not voluntarily undergo a medical examination, the governor may have a prefectural official examine the person.[64]  Other measures used for other categories of infectious diseases under the Infectious Diseases Prevention Act can be used, including mandatory hospitalization and sterilization of the affected building.[65]  The governor must consult with the Minister of the MHLW prior to taking these actions, however,[66] and the Minister must give the governor technical advice.[67]  When the MHLW has devised effective measures to prevent the spread of a new infectious disease, the government issues an order to make available all measures for Category I infectious diseases under the Act for up to a year in order to prevent the spread of the new disease.[68] 

Designated Infectious Disease is a category for a known infectious disease (other than Category I through III infectious diseases and New Influenza) that newly becomes a threat to the Japanese people.  The government makes this designation by issuing an order that makes all measures under the Act available for the newly designated disease for up to a year.[69] 

For example, severe acute respiratory syndrome (SARS) was designated as a New Infectious Disease on April 3, 2003, and then named a Designated Infectious Disease on June 20, 2003.[70]  Later, at the time of the 2006 amendment to the Infectious Diseases Prevention Act, SARS was added to Category II infectious diseases.[71]  H5N1 avian influenza was designated as a Designated Infectious Disease on June 2, 2006.[72]  Later, at the time of the 2008 amendment to the Infectious Diseases Prevention Act, H5N1 avian influenza was added to Category II infectious diseases.[73] 

D.  Designated Hospitals

Japan has a designated medical institution system for particular infectious diseases under the Infectious Diseases Prevention Act. 

  • A Designated Specified Infectious Disease Medical Institution is designated by the Minister of the MHLW upon the institution’s consent, and treats patients stricken with New Infectious Diseases, Category I and II infectious diseases, and New Influenza.[74]  
  • A Designated Category I Infectious Disease Medical Institution is designated by a governor upon the institution’s consent and treats patients with Category I and II infectious diseases and New Influenza.[75] 
  • A Designated Category II Infectious Disease Medical Institution is designated by a governor upon the institution’s consent and treats patients with Category II infectious diseases and New Influenza.[76] 

These Designated Medical Institutions must accept patients with the specified diseases for hospitalization, and follow instructions from the Minister of MHLW or the governor.[77] 

The MHLW has issued standards for Designated Category I and II Infectious Disease Medical Institutions.  The standards for the designated hospital for Category I diseases is significantly higher than the one for Category II diseases.  For example, the hospital standards for Category I diseases require that 

  • the patient’s room have air pressure that is lower than the surrounding area so that pathogens will not exit the room; 
  • there must be a room between the patient’s room and hall or other area;
  • there must be an independent ventilation system for the patient’s room; and
  • there must be equipment that sanitizes drained water from the room or the area where the room is located.[78]  

As of April 2014, Japan had three Designated Specified Infectious Disease Medical Institutions, forty-four Designated Category I Infectious Disease Medical Institutions, and 335 Designated Category II Infectious Disease Medical Institutions.[79] 

E.  Quarantine

Two ministries have jurisdiction over quarantines.  Human and food quarantine is under the MHLW’s jurisdiction.  Plant and animal quarantine falls under the jurisdiction of the Ministry of Agriculture, Forestry and Fishery. 

Under the Quarantine Law, vessels or aircraft that originated from or visited a foreign country, or encountered and received persons or material from a foreign country, must obtain a Free Pratique, or a Provisory Free Pratique before they enter into ports in Japan, except when they enter into designated quarantine areas.[80]  The captains of vessels or aircraft must inform the Chief of the Quarantine Station in advance of matters prescribed in the MHLW ordinances, such as whether patients suffering from or who have died from quarantine infectious diseases have been on board.[81]  “Quarantine infectious diseases” refers to Category I infectious diseases, New Influenza under the Infectious Diseases Prevention Act, and other infectious diseases specified by Cabinet order.[82]  People on board vessels and aircraft must not leave the designated area until a Free Pratique or a Provisory Free Pratique is issued unless the Chief of the Quarantine Station has confirmed that persons or materials on board are not contaminated by pathogenic microorganisms causing infectious diseases that are subject to quarantine.[83] 

When vessels and aircraft enter into the designated quarantine areas, the head of a quarantine office may order quarantine officers to ask questions of the passengers of vessels and aircraft from foreign countries.[84]  Quarantine officers may also examine passengers, vessels, and aircraft in order to determine the existence of a pathogen.[85]  When swine influenza spread in Mexico, the US, and Canada in 2009, international airports in Japan strengthened their quarantine measures.  Quarantine officers went into airplanes arriving from these three countries, distributed health condition questionnaires, and examined body temperatures.  Where a passenger was found to have symptoms of swine influenza infection, an instant infection test kit was used for the person.[86]

When a vessel leaves or passes areas where there was a case of a quarantined disease, when a passenger of a vessel was infected with a quarantined disease, or when the existence of mice that were likely infected with plague is confirmed in a vessel, the head of the quarantine office may take the following measures, among others, if necessary: 

  • Isolate the person infected with a Category I disease or New Influenza; 
  • Force the person suspected of being infected with a Category I disease or New Influenza to stay at the designated facility or on the vessel, provided that this is necessary to prevent entrance of the pathogen into Japan, and that the infection is recognized in the relevant foreign country and would seriously threaten people’s health and lives in Japan; 
  • Sanitize items and places that are suspected of being contaminated, or discard items if they are not sanitized effectively; and 
  • Vaccinate people.[87] 

Persons who are infected with Category I infectious diseases or New Influenza are isolated at an appropriate, designated medical institution.[88]  Persons suspected of being infected with a Category I disease or New Influenza are also kept in appropriate designated medical institutions, but can be kept in other medical institutions or onboard the vessel on which they arrived under special circumstances.[89]  Persons suspected of being infected with New Influenza can be kept at a designated medical institution, other medical institutions, hotels, or the vessel on which they arrived.[90]  Persons who were isolated or kept at a designated place will be released when a medical professional confirms that the person does not have a pathogen.[91]  Other than Category I infectious diseases and New Influenza, when the incidences of other known infectious diseases or a new infectious disease is recognized in a foreign country and the government recognizes the necessity of quarantine to prevent the entry and spread of the disease, the government may apply these measures of isolation and forced stay.[92] 

F.  Tracking Persons

The head of a quarantine office must report specified information concerning a quarantined person who is infected with a Category II through IV disease, or a Designated or New Infectious Disease, to the governor who has jurisdiction over the person’s residence.[93]  In addition, when the head of a quarantine office decides not to keep in quarantine a person who might be infected with a Category I disease or New Influenza, the head of the quarantine office must collect information on the person, such as name, address, or place of stay in Japan, and the schedule of his or her travels in Japan, and notify the governor who has jurisdiction over the address or place of stay of this information.[94]  The governor who receives such a report may monitor the condition of the person by asking the person for a report or by dispatching a local health care officer to talk to the person.[95]

G.  Animal Quarantine

To prevent infectious diseases of animal origin, the Infectious Diseases Prevention Act provides for animal quarantines and bans.[96]  For example, the import of monkeys from Africa is basically prohibited.  To import them, special permission from the MHLW and the MAFF are needed,[97] in order to prevent the incursion into Japan of Ebola hemorrhagic fever and Marburg viral disease.[98]  In addition, the Rabies Prevention Law provides that dogs, cats, raccoons, foxes, and skunks imported into the country must be quarantined.[99]  The Livestock Infectious Diseases Prevention Act also has quarantine provisions for imported livestock.[100]   

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IV.  Transparency of the Public Health Crisis Management System 

The MHLW Basic Guidelines makes the administration of health care crises transparent.  The guidelines also direct the MHLW to provide and publicize various pieces of information it holds about a given crisis.[101]  Health care crisis management by local governments is based on the MHLW’s Local Health Crisis Management Guidelines, which identify providing information to the public as one important task of local health centers.[102]  

The Infectious Diseases Prevention Act also has provisions to ensure the transparency of public health crisis management information.  The Act provides that the national and local governments must educate people with correct information on infectious diseases and provide analytical information on infectious disease trends.[103]

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V.  Cooperation with WHO 

Japan is a member of the World Health Organization (WHO)[104] and complies with the International Health Regulations (IHR).[105]  When the MHLW recognizes an incidence of an infectious disease listed in the IHR, it reports the information to the WHO.  The MHLW may report information to the WHO even if the disease is not subject to reporting under the IHR Regulations.[106]  Japan’s National Institute of Infectious Diseases (NIID) has been designated as the Collaborating Center for Influenza along with other WHO-assigned centers and laboratories.[107] 

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VI.  Recent Developments 

As discussed in Part II(C), the Special Measures Act on New Influenza was enacted in 2012.  That Act created an influenza emergency system.

More recently, a bill to amend the Infectious Diseases Prevention Act was submitted to the Diet in October 2014.  Pursuant to the bill, Middle East Respiratory Syndrome (MERS) would be added to Category II infectious diseases.  Avian flu (H7N9), which was temporarily added to Category II by Cabinet order designation, would also be added to Category II on a permanent basis.  In addition, the bill contains provisions that would enable the governor to collect specimens from persons infected with specified infectious diseases.[108]  

In response to the Ebola outbreak in West Africa in 2014, the Japanese government decided to allow the use of a drug approved for influenza treatment in certain situations[109] for Ebola treatment, and to enhance detection and examination of people who arrive at airports in Japan and have been in four African countries where Ebola has spread (Liberia, Sierra Leone, Guinea, and Nigeria).[110]  Yasuhisa Shiozaki, Minister of MHLW, said that Japan stockpiles the drug sufficient to treat 20,000 people.[111]  On October 27, 2014, Prime Minister Shinzo Abe met with Minister Shiozaki and directed him to set up a meeting of relevant Cabinet members on responses to Ebola.[112]  The meeting was approved by the Cabinet on October 28, and the first meeting was held immediately after the Cabinet meeting.[113]  The meeting established the conference of relevant ministries and agencies on Ebola, which is chaired by the Deputy Chief Cabinet Secretary for Crisis Management.[114]  The goal is to prepare for coordinated measures among government agencies in cases where Japanese nationals are infected with Ebola abroad or persons infected with Ebola are found within Japan.[115]

Prepared by Sayuri Umeda
Foreign Law Specialist
February 2015


[1] Naikaku hō [Cabinet Act], Act No. 5 of 2010, amended by Act No. 108 of 2013, art. 15.

[2] Ministry of Health, Labor, and Welfare Establishment Act, Act No. 97 of 1999, art. 4, para. 1, items 4 and 19.

[3]MHLW, Kosei rōdō shō kenkō kikikanri kihon shishin [Basic Guidelines in Health Crisis Management], http://www.mhlw.go.jp/general/seido/kousei/kenkou/sisin/index.html (last visited Oct. 8, 2014). 

[4] The four health crisis management implementation outlines are available on the MHLW website, http://www.mhlw.go.jp/general/seido/kousei/kenkou/index.html (last visited Oct. 8, 2014). 

[5] Chiiki ni okeru kenko kikikanri ni tsuite [Regarding Local Health Crisis Management], MHLW (Mar. 2001), http://www.mhlw.go.jp/general/seido/kousei/kenkou/guideline/index.html.

[6] MHLW, Annual Health, Labour and Welfare Report 2009–2010, pt. 2, ch. 1, § 9, http://www.mhlw.go.jp/ english/wp/wp-hw4/dl/honbun/2_1_9.pdf.

[7] Regarding Health Emergency Management Measures of the MHLW, MHLW, http://www.mhlw.go.jp/ seisaku/2010/03/01.html (in Japanese; last visited Oct. 10, 2014).

[8] Chiiki kenko kiki kanri gaidorain [Local Health Crisis Management Guidelines], MHLW Circular, Kenso No. 17 (Mar. 30, 2001), I, 1, http://www.mhlw.go.jp/general/seido/kousei/kenkou/guideline/index.html.

[9] Chiiki hoken hō [Local Health Act], Act No. 101 of 1947, last amended by Law No. 83 of 2014, art. 5. 

[10] Jichitai betsu hokenjo secchi sū no suii [Changes of Numbers of Health Centers by Local Governments], as of April 1, 2014, Zenkoku hoken sho chō kai [Japanese Association of Public Health Center Directors], http://www.phcd.jp/03/HCsuii/index.html

[11] Local Health Act art. 6. 

[12] Basic Guidelines Regarding Promotion of Measures to Improve Local Health Issues Based on Local Health Act Article 4, Paragraph 1, MHW Notification No. 374 (Dec. 1, 1994), last amended by MHLW Notification No. 464 (July 31, 2012), http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000049526.pdf (in Japanese).

[13] Id

[14] Local Health Crisis Management Guidelines, supra note 8, II 1(4)(5). 

[15] Shingata infuruenza oyobi tori infuruenza ni kansuru kankei shōchō taisaku kaigi no secchi ni tsuite [Regarding Establishment of Conference of Relevant Ministries and Agencies to Counter New Flu and Avian Flu], Agreement Among Relevant Ministries (Mar. 2, 2004), http://www.cas.go.jp/jp/seisaku/ful/konkyo.pdf.  

[16] Press Release, MHLW, Pandemic Influenza Preparedness Action Plan of the Japanese Government (Summary), (Nov. 2005), http://www.mhlw.go.jp/english/topics/influenza/pandemic01.html.

[17] Shingata Infuruenza taisaku kōdō keikaku [Action Plan to Counter Influenza], Conference of Relevant Ministries and Agencies to Counter New Influenza and Avian Influenza (Feb, 2009), http://www.cas.go.jp/jp/seisaku/ ful/kettei/090217keikaku.pdf.

[18] Guidelines for the Prevention and Control of Pandemic Influenza (Phase 4), Introduction, Conference of Relevant Ministries and Agencies to Counter New Influenza and Avian Influenza (Mar. 26, 2009), http://www.mhlw.go.jp/ bunya/kenkou/kekkaku-kansenshou04/pdf/09-e01.pdf.

[19] Shingata infuruenza tō taisaku tokubetsu sochi hō [Special Measures Act on New Influenza], Act No. 31 of 2012.

[20] Shingata infuruenza tōtaisaku seihu kodo keikaku [National Action Plan for Pandemic Influenza and New Infectious Diseases] (June 7, 2013), English translation available on the Cabinet Secretariat website, at http://www.cas.go.jp/jp/seisaku/ful/keikaku/pdf/national%20action%20plan.pdf.

[21] Shingata infuruenza to taisaku gaidorain [Guidelines on Countermeasures Against Pandemic Influenza and New Infectious Diseases], Conference of Relevant Ministries and Agencies to Counter New Influenza and Avian Influenza (June 26, 2013), http://www.cas.go.jp/jp/seisaku/ful/keikaku/pdf/gl_guideline.pdf.

[22] Government plans are available on the Cabinet Secretariat’s website, at http://www.cas.go.jp/jp/seisaku/ ful/keikaku.html (last visited Oct. 24, 2014). 

[23] Special Measures Act on New Influenza art. 15.

[24] Id. art. 16.

[25] Id. art. 32; Enforcement Order of Special Measures Act on New Influenza, Order No. 122 of 2013, art. 6.

[26] Special Measures Act on New Influenza art. 32.

[27] Id. art. 45.

[28] Id. art. 46.

[29] Id. art. 48.

[30] Id. art. 55.

[31] Kansen shō no yobō oyobi kansenshō no kanja ni taisuru iryō ni kansuru hōritsu [Act on Prevention of Infectious Diseases and Medical Care for Patients of Infectious Diseases] (Infectious Diseases Prevention Act), Act No. 114 of 1998, last amended by Act No. 30 of 2008, art. 6, para. 2, items 2–9. 

[32] Id. art. 12, para. 1. 

[33] Id. art. 13, para. 1. 

[34] Id. art. 12, para. 2 & art. 13, para. 3. 

[35] Id. art. 14; Infectious Diseases Prevention Act Enforcement Ordinance, MHLW Ordinance No. 99 of 2008, arts. 6 & 7. 

[36] Infectious Diseases Prevention Actart. 15. 

[37]MHLW Organization Order, Order No. 252 of 2000, art. 26. 

[38] Outline – Organization: History, NIID, http://www.niid.go.jp/niid/en/aboutniid-2.html (last visited Oct. 10, 2014). 

[39] Id

[40] Outline – Organization: Functions, NIID, http://www.niid.go.jp/niid/en/aboutniid-2.html (last visited Oct. 10, 2014).

[41] Infectious Disease Weekly Report, NIID, http://www.niid.go.jp/niid/ja/idwr.html (in Japanese; last visited Oct. 11, 2014).  Some publications are available in English at http://www.niid.go.jp/niid/en/idwr-e.html (last visited Oct. 11, 2014).

[42] Infectious Diseases Prevention Act art. 17, para. 1. 

[43] Id. art. 17, para. 2. 

[44] Id. art. 17, para. 3.

[45] Id. art. 18. 

[46] Id. art. 19, paras. 1–3 & art. 26. 

[47] Id. art. 19, para. 4 & art. 26. 

[48] Id. art. 20, para. 4 & art. 26. 

[49] Id. art. 20, paras. 1–3 & art. 26. 

[50] Id. art 20, para. 6 & art. 26. 

[51] Id. art. 22-2.

[52] Id. art. 22.

[53] Id. art. 24. 

[54] Id. arts. 25 & 26.

[55] Id. art. 27. 

[56] Id. art. 28. 

[57] Id. art. 29. 

[58] Id. art. 30. 

[59] Id. art. 31. 

[60] Id. art. 32. 

[61] Id. art. 33. 

[62] Id. art. 44-3. 

[63] Id. art. 44-4. 

[64] Id. art. 45. 

[65] Id. arts. 46 & 50. 

[66] Id. art. 51, para. 1. 

[67] Id. art. 51, para. 2. 

[68] Id. art. 53. 

[69] Id. art. 6, para. 8 & art. 7. 

[70] Jūshō kyūsei kokyūki shōkō gun [SARS], IDSC (Feb. 2005), http://idsc.nih.go.jp/idwr/kansen/k05/k05_06/ k05_06.html.  

[71] Act to Amend the Infectious Diseases Prevention Act, Act No. 106 of 2006. 

[72] Infuruenza (H5N1) o shitei kansenshō to site sadameru tō no seirei [Order Concerning Designation of Influenza (H5N1) as Designated Infectious Disease], Order No. 208 of 2006. 

[73] Act to Amend the Infectious Diseases Prevention Act and Quarantine Act, Act No. 30 of 2008. 

[74] Infectious Diseases Prevention Act art. 6, para. 13 & art. 38, para. 1. 

[75] Id. art. 6, para. 14 & art. 38, para. 2. 

[76] Id. art. 6, para. 15 & art. 38, para. 2.

[77] Id. art. 38, para. 3. 

[78] Kansenshō no yobō oyobi kansenshō no kanja ni taisuru iryōni kansuru hōritsu dai 38 jō dai 2 kō no kitei ni motoduku kōsei rōdō daijin no sadameru kansenshō shitei iryō kikan no kijun [Standards for Designated Infectious Disease Medical Institutions Set by the Minister of MHLW, Based on the Infectious Disease Prevention Law, Article 38, Paragraph 2], MHLW Notification No. 43 (Mar. 19, 1999). 

[79] Kansenshō shitei iryō kikan no shitei jōkyō [Statistics of Designated Infectious Disease Medical Institutions], MHLW (Apr. 1, 2014), http://www.mhlw.go.jp/bunya/kenkou/kekkaku-kansenshou15/02-02.html.  

[80] Ken-eki hō [Quarantine Act], Act No. 201 of 1951, last amended by Act No. 69 of 2014, art. 4. 

[81] Id. art. 6. 

[82] Id. art. 2. 

[83] Id. art. 5. 

[84] Id. art. 12.

[85] Id. art. 13. 

[86] Measures Against New Influenza at Narita Airport Quarantine Office, 30 Infectious Agents Surveillance Report 257 (Oct. 2009), http://idsc.nih.go.jp/iasr/30/356/dj3561.html (in Japanese).

[87]Quarantine Act art. 14. 

[88] Id. art. 15. 

[89] Id. art. 16, para. 1.

[90] Id. art. 16, para. 2.

[91] Id. art. 15, para. 2 & art. 16, para. 4. 

[92] Id. arts. 34-2, 34-3, 34-4. 

[93] Id. art. 26-3. 

[94] Id. art. 18, paras. 4 & 5.

[95] Infectious Diseases Prevention Act arts. 15-2 & 15-3.

[96] Id. ch. 10. 

[97] Id. art. 54; Ordinance to Set Areas from Which Imports Are Banned Based on Infectious Diseases Prevention Act Article 54, Item 1, MHLW & MAFF Ordinance No. 2 of 1999, art. 1.

[98] What Is Animal Quarantine?, Animal Quarantine Service, MAFF, http://www.maff.go.jp/aqs/english/ (last visited Oct. 19, 2014).

[99] Kyōkenbyō yobō hō [Rabies Prevention Act], Act No. 247 of 1950, last amended by Act No. 160 of 1999, art. 2; Kyōkenbyō yobō hō shikō rei [Rabies Prevention Act Implementation Order], Order No. 236 of 1953, art. 1. 

[100] Kachiku densenbyō yobo hō [Livestock Infectious Diseases Prevention Act], Act No. 166 of 1951.

[101] Basic Guidelines in Health Crisis Management, supra note 3.

[102] Local Health Crisis Management Guidelines, supra note 8.

[103] Infectious Diseases Prevention Act art. 3, para. 1 & art. 16, para. 1. 

[104] Countries, WHO, http://www.who.int/countries/en/ (last visited Oct. 20, 2014).

[105] See About IRH (International Health Regulations), WHO, http://www.who.int/ihr/about/en/ (last visited Oct. 20, 2014).

[106] Kansenshō kenkō kiki kanri jisshi yōryō [Infectious Disease Health Risk Crisis Management Implementation Manual], Health Div., MHLW, Mar. 2007, last amended Oct. 2013, 3(2) ko, http://www.mhlw.go.jp/general/seido/ kouse i/kenkou/kansen/index.html

[107] Outline – Organization: Functions, supra note 40.

[108] Bill to Amend the Infectious Diseases Prevention Act (submitted Oct. 14, 2014), available at http://www.mhlw. go.jp/topics/bukyoku/soumu/houritu/187.html (in Japanese).

[109] Press Release, Toyama Chemical Co., Ltd., The New Drug Application Approval of “AVIGAN® Tablet 200mg” in Japan for the Anti-influenza Virus Drug (Mar. 24, 2014), https://www.toyama-chemical.co.jp/eng/news/ news140324e.html.

[110] Ebola taiō kyōgi e kankei kakuryō kaigi . . . shushō ga shiji [Meeting of Relevant Cabinet Members on Responses to the Ebola Virus Disease . . . Prime Minister Directed], Yomiuri Newspaper (Oct. 27, 2014) (on file with author).

[111] Ebora kokunai taisaku, mishōnin yaku 2man nin bun bichiku . . . Kōrōsō [Ebola Measures, Stockpiled Unapproved Drug for 20,000 People . . . MHLW Minister], Yomiuri Newspaper (Oct. 28, 2014) (on file with author).

[112] Id.

[113] Ebora shukketsu netsu taisaku kankei kakuryō kaigi no kaisai ni tsuite [Regarding Opening of Meeting of Relevant Cabinet Members on Responses to the Ebola Virus Disease], orally approved by Cabinet Meeting, Prime Minister of Japan and His Cabinet, Oct. 28, 2014, http://www.kantei.go.jp/jp/singi/ebola/youkou.pdf.

[114] Ebora shukketsu netsu ni kansuru seifu no taisei ni tsuite [Regarding System to Counter Ebola Hemorrhagic Fever], Deputy Chief Cabinet Secretary’s Office, Oct. 28, 2014, http://www.kantei.go.jp/jp/singi/ebola/ dai1/sankou3.pdf.

[115] Ebora shukketsu netsu taisaku kankei kakuryō kaigi [Meeting of Relevant Cabinet Members on Responses to the Ebola Virus Disease], Prime Minister of Japan and His Cabinet, http://www.kantei.go.jp/jp/singi/ebola/index.html (last visited Oct. 28, 2014).

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Last Updated: 06/09/2015