On Tuesday, March 30, 2021, Health and Global Policy Institute (HGPI) held a special HGPI Seminar entitled, “Grassroots Efforts to Change Society in Response to COVID-19 – The Movement to Transform Healthcare Led by COV-Navi.”

At this HGPI Seminar, we hosted COV-Navi representative Dr. Kensuke Yoshimura who gave the titular lecture during which he discussed the the founding and past activities of COV-Navi, a website that provides information on Coronavirus Disease 2019 (COVID-19). He also explored various themes including collaboration between industry, Government, academia, and the clinical field.

To prevent the potential spread of COVID-19, this seminar was held online.

 

Key points of the lecture

– To broadly disseminate accurate medical information to the public and healthcare professionals regarding SARS-Cov-2, the symptoms of Coronavirus Disease 2019 (COVID-19), and relevant vaccine information, a group of highly specialized experts from Japan and abroad came together to form COV-Navi.

– To disseminate accurate medical information, it is important to ensure that information is correct and that the organization providing it is trustworthy and transparent. It is also necessary to use easy-to-understand methods of providing information that are based on behavioral science.

– When working to transform healthcare, activities undertaken from the positions of industry, Government, academia, and the clinical field are all equally important. Given that the COVID-19 pandemic is still ongoing, people in Government, academia, and the clinical field have their hands full with vaccination programs and are too busy to engage in sufficient educational activities for the public. COV-Navi is providing that education to bridge the gap.

– It is likely that vaccinations and health communication can be promoted among the Japanese public through grassroots efforts like COV-Navi.

 

■ Dr. Yoshimura’s view on healthcare
Before I became the representative of COV-Navi, I was an industrial physician specializing in psychiatry. I spent about eight years working in industrial healthcare. I then took on a role in policy-making and system planning at the Ministry of Health, Labour and Welfare (MHLW). It was during that time I learned that it is necessary to listen to opinions from various people in various positions during policy-making and similar processes, that it takes time to provide certain types of information to society, and that decisions have significant impact once they are made.

Therefore, I believe it is necessary to create an environment that ensures people other than specialists are provided with information in a transparent and open manner and allows them to participate in and advance discussions. These people include healthcare beneficiaries as well as those around them, such as family members, paramedical staff providing healthcare, and people in various positions like public administration.

As a science, medicine relies on scientific reasoning and involves a degree of compromise, and is created through a certain process. However, healthcare is a system and an undertaking in which results must be generated through the investment of finite resources. While this does not excuse the need for evidence based on medical science, there are some situations in matters regarding the healthcare system where there is not a strong need for evidence based on medical science. As a matter of fact, I think that it is equally important that beneficiaries of healthcare services have a sense of the compromise that is incorporated into the system.

■ The road to COV-Navi’s activities
My experience managing care beds for critically ill patients and working at the quarantine station as part of Chiba Prefecture’s COVID-19 task force has made me aware of the need to think of issues from an upstream perspective as well as from a public health perspective when taking measures for COVID-19 control. Over the course of my time engaged in those measures, I realized that neither the public nor medical personnel are being provided with a sufficient amount of accurate information. In response, my partners and I formed a team for disseminating information on COVID-19 vaccines and established a general incorporated association to advance COV-Navi activities. After recruiting an international team of volunteers with highly-specialized knowledge and good communication skills, we began providing information on our website in February 2021.

The specialists at COV-Navi quickly collect high-quality and complete information, compile it, and provide what the general public and medical professionals need to know in an easy-to-understand format. We share videos providing evidence-based SARS-Cov-2 information and first-hand accounts of people’s experiences being vaccinated, and we strive to make sure the medical information we provide is accurate.

In the future, we will have to provide information in a manner customized to the population being targeted for vaccination or the current stage of the vaccination plan. For example, I think we might have to adopt formats like paper media instead of the Internet to provide information to elderly people.

■ Moving healthcare forward from industry and the clinical field
To move healthcare forward, activities undertaken from the perspectives of the public sector, the private sector, academia, and the clinical field will also be important. Each sector has its own strengths and weaknesses. For example, the public sector attracts a broad variety of human resources, but it faces challenges related to insufficient financial resources and the complex structures of its initiatives. Decision-making and progress on initiatives are rapid in the private sector, but the organizations require profits to maintain operations, which can cause them to develop the tendency to pursue short-term results. On the other hand, those in academia emphasize the search for truth. While academia has authority and can be trusted, its initiatives are slow to begin and take time to develop. Finally, those in the clinical field can work directly with patients, but they are limited in what they can do by the difficulty of taking any action outside of the set patterns of medical practice. Each sector faces its own limitations when attempting to keep up with rapidly-changing situations like the ongoing COVID-19 pandemic.

With that context, I think it may be best not to rely entirely on large organizations when considering the possibility of expanding social security and healthcare in a society with a declining birth rate and an aging population. I think it will grow increasingly important for organizations to join together or to collaborate with those in the public, private, academic, and clinical spheres on establishing more agile organizations that can be operated on a project basis and that can be dissolved once their goals have been achieved.

COV-Navi has a small team where quick decisions are made and each member is capable of independent judgment. This allows COV-Navi to respond in a rapid, versatile manner. Government agencies and local governments currently have their hands full with vaccine logistics, so COV-Navi is disseminating information through many forms of media, including social networking sites like Twitter, Facebook, and Instagram, as well as the mass media, and in a way only COV-Navi can accomplish. We are always thinking of how to most effectively invest our limited resources and set priorities, and we are engaged in these efforts with a sense of responsibility for our own actions.

Information regarding vaccines is extremely sensitive, and there will always be challenges regarding people’s attitudes toward vaccines, such as their tendency to respond to the topic emotionally. Despite these challenges, we want to broaden communication possibilities through our efforts at COV-Navi.

 

Below is a summary of the conversation held between HGPI CEO and Board Member Ryoji Noritake and Dr. Yoshimura after the presentation.

■ Special Discussion – The relationship between health communication and the public in civil society in Japan and during the ongoing COVID-19 pandemic

Mr. Noritake: Dr. Yoshimura, as a member of the public, I would like to thank you once again for your leadership in shaping your own experiences in various sectors of industry, Government, academia, and civil society to create the COV-Navi platform. I feel that there is an affinity between COV-Navi’s activities and HGPI’s mission and activities. I think your activities at COV-Navi are not only highly significant as a countermeasure against COVID-19, but also because you are bridging the gap between evidence and people’s behavior by disseminating medical information and interacting with the public. Therefore, to begin, from COV-Navi’s perspective on science communication and in the context of Japan, please share some points that should be kept in mind when providing information. 

Dr. Yoshimura: Our members have been very helpful by providing advice from the perspective of behavioral science on topics like the state of vaccine policies abroad. Both the accuracy of the information being provided and the attitude of the person providing it are very important. When interacting with the public, I think better communication quality and speed can be accomplished by showing you have a trustworthy background or by assigning someone to be the face of the organization when providing information.

Mr. Noritake: Considering vaccine hesitancy and Japan’s delay in vaccinations, I can see how it is important to have a highly-transparent organization and to create an environment in which the public can see the faces of the people in that organization. Regarding partnerships with external organizations or when promoting public-private partnerships in the future, what perspectives are required of the Government and of neutral, private sector organizations like COV-Navi?

Dr. Yoshimura: While the Government possesses vast amounts of information, financial resources, authority, and human resources, it lacks effective methods for rapidly utilizing or mobilizing those resources. For example, I think it would be good if the Government shared its information publicly, specifically information regarding various domestic situations, and if it was open about current challenges, necessary human resources, and the limitations of Government efforts. Rather than a structure in which industry, academia, and the clinical sectors follow orders issued by the Government, I think that they need to be arranged in a horizontal platform.

 
Mr. Noritake: People in Japan tend to equate the “public sector” with the Government, but I think that members of the public like us and every stakeholder in industry, Government, academia, and civil society need to adopt the mindset that the “public sector” is made up of everyone. Next, I’d like to ask how the internal administration of COV-Navi works. How do COV-Navi’s members come together to make plans and take action?

Dr. Yoshimura: COV-Navi is unique as a team. I give advice as the leader when the person seeking it trusts my judgment, but in general, each member is responsible for their own work. It may be that this style is only possible because COV-Navi is made up of mature professionals, but I think organizations can sometimes stifle the creative output and agility of the individual. That’s why I place my trust in our members and try to run COV-Navi in a way that does not impede on the opinions of its members.

Mr. Noritake: Are there any COVID-19 control measures that you think Japan needs to take in the future?

Dr. Yoshimura: I can think of three. First is to promote infection prevention measures. I think masking has greatly contributed to controlling infections in Japan. This played a part in helping keep the public healthy without lockdowns like there were in other countries.

Second is strengthening control measures at international points of entry, specifically the quarantine system. I think this topic needs more attention. Although our quarantine system functions well during normal times, it is somewhat weak during emergencies like pandemics. More resources including human resources should be invested in it in the future. In addition, it could be said that in a sense, the current quarantine system operates under the benevolence principle. I think it will be extremely dangerous to continue operating it in that manner. We have to take measures to ensure the quarantine system can fully operate as originally intended. For example, entry and exit procedures could be made more rigorous.

Third are vaccines. Reviewing its experiences with the HPV vaccine and other vaccines, the Government’s primary concern with COVID-19 vaccines is public sentiment. It is concerned with how to provide information and how receptive the public will be to vaccination. On a national level, Japan needs to do a better job of spreading accurate vaccine information. I think it may be useful to look at the actions of the public relations departments at the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). One of COV-Navi’s roles is to promote vaccination by disseminating a certain volume of information at a certain speed. We would like to continue fulfilling the role required of a Japanese version of the CDC.

Right now, it is extremely difficult to secure a sufficient number of care beds. Those of us on the frontlines of healthcare are working diligently to maintain normal medical services while handling COVID-19.

Mr. Noritake: While there has been some talk regarding the fact that Japan has many general care beds compared to other Organisation for Economic Co-operation and Development (OECD) members, very few of them are devoted to infectious disease care. In the future, I think we must raise standards for infectious disease control overall.  Dr. Yoshimura, you have worked in various positions as a specialist in public health over the course of your career. What is your vision for the future of public health?

Dr. Yoshimura: I would like us to first focus our efforts on ending the COVID-19 pandemic. I think it is also important to review the vulnerabilities in our society and other challenges highlighted by SARS-Cov-2.  We must evaluate and analyze current problems facing efforts to supply COVID-19 vaccines and make the changes needed to prevent them from reoccurring. Mr. Noritake, you mentioned behavioral changes earlier. Such behavioral changes are necessary among those in the positions to solve challenges facing the field of public health – namely, people in the Government, the private sector, academia, and the clinical field. Right now, by advancing activities to communicate information regarding COVID-19 even slightly, we can recruit members who will build Japan’s future social security and healthcare systems and serve as the next major driving force.

We want to perform to our utmost to stop the spread of SARS-Cov-2. People have various concerns about vaccination. These include the frequency of adverse reactions, the incidence of severe cases, and their impact on family and employment. Based on my experience as a psychiatrist, I know that we can group types of anxiety into various patterns. If we can communicate the facts in an easy-to-understand manner that fits the needs of each pattern, I think we can solve many of those issues.

Mr. Noritake: During the COVID-19 pandemic, compared to the more heavy-handed countries, countries considered to be mature, bottom-up democracies more frequently tended to pursue health communication with the public as a control measure. However, it was difficult for them to cause behavioral changes through health communication. Philosopher Michel Foucault coined the term “biopower,” and recently, states have been trying to exercise authority over and control people’s lives through medicine. There have been cases in which people have demonstrated very strong resistance to having restrictions placed on private rights, especially in Western countries. Given these circumstances, I am impressed by COV-Navi’s bottom-up approach to educating the public and promoting dialogue. Such efforts are not only very important for formulating healthcare policy; they will also be significant when shaping civil society in Japan moving forward.

 

■Profile:

Dr. Kensuke Yoshimura (Representative, COV-Navi; Representative Director, Group for Health and Medical Literacy Promotion)
Dr. Kensuke Yoshimura is a physician and possesses a Master of Public Health degree and a Doctor of Medicine degree. He was born in 1978. His specialties are healthcare policy, public health, and mental health. He serves as Director and specially-appointed Professor at the Chiba University Hospital’s Center for Next Generation of Community Health. Dr. Yoshimura is a graduate of Chiba University Graduate School of Medicine, the University of Tokyo Graduate School, and Chiba University Graduate School. He previously served as a Medical Technical Officer in the Ministry of Health, Labour and Welfare. In April 2020, he joined the Secretariat of Chiba Prefecture’s Task Force on Novel Coronavirus Infections.