An open letter to Japan's new Prime Minister.

On Sept 16, 2020, Yoshihide Suga was inaugurated as Japan's new Prime Minister after the resignation of former Prime Minister Shinzo Abe. One of Abe's political legacies was Japan's commitment to global health. Abe has been the leading advocate for human security and universal health coverage. Under his leadership, Japan contributed to revamping global health security systems by strengthening WHO's function and establishing the Pandemic Emergency Financing Facility and the Coalition for Epidemic Preparedness Innovations, all of which are now critical in the ongoing global response to COVID-19.

There are, however, major challenges in Japan's current response to COVID-19. Although the COVID-19 mortality rate is relatively low, the reasons behind this achievement are not as well understood as for other successful responses in nearby east Asian countries. Key lessons from Japan's initial response were anecdotal, and there has been no formal scientific evaluation of governmental responses.

The government is now accelerating domestic travel through it's Go To Travel campaign and encouraging the population to eat in restaurants with its Go To Eat campaign. The lack of accountability, combined with the government's rather laissez-faire approach, resulted in the recent large resurgence of COVID-19. Japan's pressing challenges in its COVID-19 response should be of the highest priority for Prime Minister Suga.

First, in order to maintain socioeconomic activities without draconian measures, and to minimise the long-term economic costs, it will be essential to develop a comprehensive testing strategy and to ramp up both PCR and antigen testing capacity. Ensuring sufficient testing and tracing capacities, and implementing locally managed, non-pharmaceutical interventions, will contain COVID-19 transmission promptly and effectively.Second, supporting vulnerable and high-risk populations will mitigate the overall impact of COVID-19. A risk-based, bottom-up approach based on scientific assessment should be explored. Oversimplified practices implemented in a top-down manner, such as the New Lifestyle campaign, might not be applicable to essential workers, migrant workers, and service sectors.

Finally, but not least important, protect front-line health-care workers. The burden on the overstretched health-care workforce is growing. The current financing scheme needs to be revised as part of an ongoing work style reform. Regular protective screening for essential workers will reduce transmission, mitigate further depletion of the workforce, and maintain their health conditions.5, 6

COVID-19 has posed sector-wide challenges and revealed the fundamental inequalities in the human security agenda. The Japanese health system is no exception. Considering Prime Minister Suga's enthusiasm for saving citizens' livelihoods and revitalising the economy, we, health-care workers and scientists, expect him to manage and control the crisis by expressing empathy to vulnerable and high-risk populations and by protecting front-line workers. A human security approach—a fundamental value in Japan's foreign policy that prioritises protecting human lives—is pivotal. Containing COVID-19 domestically through invigorated science and innovation will strengthen global and regional health security; such an approach will also help Japan revamp the highly politicised COVID-19 response and resume a leadership role in global health policy to end the pandemic.