Influenza Preparedness Research Articles

Conflicting Scientific Narratives at the Convention on Biological Diversity and Other Fora: Analysis and Contradiction in the Discussions on Dematerialization of (Plant) Genetic Resources

This article examines the use of scientific arguments in negotiations on the status of Digital Sequence Information (DSI), focusing on the Convention on Biological Diversity (CBD), the International Treaty on Plant Genetic Resources for Food and Agriculture (ITPGRFA), and the Pandemic Influenza Preparedness Framework (PIP). DSI is a placeholder term used in negotiations on the dematerialization of genetic resources: the ability to sequence “physical” genetic resources and use this “intangible” information, which radically changes research practices. The CBD (among other instruments) establishes rules for Access to the Genetic Resource and the Fair and Equitable Sharing of Benefits from their utilization (ABS). This applies to “physical” genetic resources, but it is not clear for DSI. Indeed, different legal interpretations and political narrative are conflicting over the integration of DSI into these legal frameworks. This article explores how science is used in these negotiations, particularly in its rhetorical and epistocratic dimensions. The methodology combines an interdisciplinary approach (legal technique, philosophy of law and science) and a comparative discourse analysis: on the terminology; the inclusion of DSI in the definition of genetic material; and the inclusion of DSI in ABS systems. While scientific arguments play a crucial role in this technical issue, this article shows that scientific arguments can be used to support political positions (under the guise of objectivity and neutrality), and that this use of scientific arguments is not consistent, even contradictory (between PIP and CBD/ITPGRFA).

Pandemic influenza preparedness plan in Liguria, Italy: a valuable tool for Public Health.

As known, influenza presents a multifaceted challenge to public health, causing disease that ranges from mild cases to severe pandemics with significant morbidity and mortality. Effective pandemic preparedness demands a comprehensive strategy that integrates research, surveillance, response coordination and community engagement, to mitigate the impact of future health emergencies. The pandemic preparedness cycle involves dynamic, cyclical phases of preparation and response aimed at enhancing response capacity. Italy's 2021-2023 National Strategic-Operational Plan for Pandemic Influenza (PanFlu) incorporates lessons learned from past pandemics and serves as a framework for regional plans, such as Liguria's. The Ligurian plan delineates governance structures, surveillance strategies, healthcare services and communication measures necessary for effective pandemic management. It emphasizes the need to strengthen links between emergency structures, to avoid duplication and to adopt flexible approaches to scale actions appropriately and highlights the need for risk/benefit analysis to support evidence-based decision-making as well as clear guidance on data collection and communication activities. By integrating these elements, the region's overall readiness and resilience against influenza pandemics are expected to be reinforced.

Wastewater-based surveillance is an efficient monitoring tool for tracking influenza A in the community

Around the world, influenza A virus has caused severe pandemics, and the risk of future pandemics remains high. Currently, influenza A virus surveillance is based on the clinical diagnosis and reporting of disease cases. In this study, we apply wastewater-based surveillance to monitor the amount of the influenza A virus RNA at the population level. We report the influenza A virus RNA levels in 10 wastewater treatment plant catchment areas covering 40 % of the Finnish population. Altogether, 251 monthly composite influent wastewater samples (collected between February 2021 and February 2023) were analysed from supernatant fraction using influenza A virus specific RT-qPCR method. During the study period, an influenza A virus epidemic occurred in three waves in Finland. This study shows that the influenza A virus RNA can be detected from the supernatant fraction of 24 h composite influent wastewater samples. The influenza A virus RNA gene copy number in wastewater correlated with the number of confirmed disease cases in the Finnish National Infectious Diseases Register. The median Kendall's τ correlation strength was 0.636 (min= 0.486 and max=0.804) and it was statistically significant in all 10 WTTPs. Wastewater-based surveillance of the influenza A virus RNA is an independent from individual testing method and cost-efficiently reflects the circulation of the virus in the entire population. Thus, wastewater monitoring complements the available, but often too sparse, information from individual testing and improves health care and public health preparedness for influenza A virus pandemics.

922. Cost-effectiveness of baloxavir marboxil versus oseltamivir or no treatment for the management of influenza in the United States

Abstract Background Influenza poses a significant burden that can be effectively mitigated with antivirals. Baloxavir marboxil is an oral, single dose first-in-class endonuclease inhibitor that improves influenza symptoms and rapidly reduces virus shedding, shortening the infectious period and potentially reducing viral transmission. This study used real-world data to inform a cost-effectiveness (CE) model of antiviral treatment with baloxavir vs oseltamivir or no treatment. Methods A decision tree CE model was developed for seasonal influenza between 2018 and 2020. Patients aged 12 and older could receive baloxavir, oseltamivir or no treatment (Figure 1). Outcomes included complications, recovery and death. Patient profile and characteristics, complications and costs were derived from the Merative™ MarketScan® Research Databases, including US commercial claims, Medicare and Medicaid Supplemental databases. Healthcare resource use included outpatient visits, hospitalizations and intensive care unit admissions. Clinical inputs, recovery rates and utilities were derived from the literature. The base case model used a lifetime time horizon with 3.0% discounting for costs and 2.7% for quality-adjusted life-years (QALYs), assuming no transmission reduction. A subgroup analysis was conducted for otherwise healthy (OwH) and high-risk groups; scenario analyses explored the impact of reduced viral transmission with baloxavir. Results In the base case analysis, baloxavir resulted in an incremental CE ratio (ICER) of $7788/QALY vs oseltamivir and $311/QALY vs no treatment; subgroup analyses showed even greater CE in the high-risk population (Table 1). Scenario analyses showed increasing net monetary benefit (NMB) with incremental reductions in viral transmission with baloxavir, where a 5% reduction in transmission yielded a NMB for baloxavir of $4153 vs oseltamivir and $13,098 vs no treatment (Figure 2). Conclusion This real-world evidence-driven model showed that baloxavir is cost-effective vs oseltamivir or no treatment from a US payer perspective. Transmission reductions with baloxavir can have a substantial health economic benefit, and baloxavir may play an important role in management of seasonal influenza and pandemic preparedness. Disclosures Svenn Hansen, n/a, F. Hoffman La Roche: Employee|F. Hoffman La Roche: Stocks/Bonds Shih-Chen Cheng, M.S., P.h.D, Genentech/F. Hoffman La Roche: Genentech Employee|Genentech/F. Hoffman La Roche: Stocks/Bonds Andy Surinach, MPH, Genentech/Roche: employee of Genesis Research which receives funding from Genentech/Roche for consulting services Vince Yau, PhD, Genentech/F. Hoffman La Roche: Genentech Employee|Genentech/F. Hoffman La Roche: Stocks/Bonds Jennie H. Best, PhD, Genentech: Stocks/Bonds Hassan Zaraket, PhD, F. Hoffman La Roche: Employee|F. Hoffman La Roche: Stocks/Bonds Hao Zhou, PhD, Genentech/F. Hoffman La Roche: Genentech Employee|Genentech/F. Hoffman La Roche: Stocks/Bonds Marie-Helene Blanchet Zumofen, PhD MBA, F. Hoffman La Roche: Employee|F. Hoffman La Roche: Stocks/Bonds

An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region.

Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research. We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer. We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization. While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.

Update on influenza epidemiology and vaccines

COVID-19 pandemic mitigation measures, including travel restrictions, effectively limited global circulation of influenza viruses for much of 2020 and 2021. Travel bans and quarantine requirements were lifted on 1 November 2021 enabling recirculation of influenza. In Victoria, follow up of early influenza cases detected Dec–Feb revealed a history of travel or contact with a recent traveller. Cases were few during the Omicron epidemic in January–February. However, in late March, there was a sharp increase in cases, which in Victoria was associated with an outbreak in university residential colleges. Genomic sequencing supported a likely point-source outbreak that spread throughout the state and to other jurisdictions. In the Northern Territory and New South Wales circulation of A(H1N1)pdm09 preceded circulation of A(H3N2) and was associated with a high rate of paediatric hospitalisations. Both the A(H1N1)pdm09 and A(H3N2) viruses that circulated were well matched to the vaccine, but the early onset of the epidemic meant that many cases were infected prior to availability of vaccines in April. Nationally, circulation declined sharply in June–July coincident with another COVID-19 wave. Circulation of influenza may continue to be disrupted by SARS-CoV-2 epidemics until it establishes a seasonal pattern, which may impact seasonal influenza preparedness.

Jordan's Pandemic Influenza Preparedness (PIP): A Reflection on COVID-19 Response.

The COVID-19 pandemic made it clear to the world that better preparedness for future pandemics is paramount. This study aims to explore how the 2018 Jordan’s Pandemic Influenza Preparedness (PIP) assessment plan (conducted utilizing a standardized tool of the CDC National Inventory of Core Capabilities for Pandemic Influenza Preparedness and Response) reflected on the initial COVID-19 response. A qualitative, single intrinsic case study design, utilizing interpretivist approach, was utilized to interview subject-matter experts and explore the potential reflection of PIP assessment on COVID-19 response. Utilizing a mini-Delphi approach, the interviews aimed at generating an in-depth understanding of how the Jordan’s PIP risk assessment reflects on the country’s response to COVID-19. The following 12 core capabilities, along with their reflections on COVID-19, were assessed: country planning, research and use of findings, communications, epidemiologic capability, laboratory capability, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community-based interventions to prevent the spread of influenza, infection control (IC), and health sector pandemic response. Jordan’s experience and preparedness for influenza may have served as a crucial guide to establishing success in COVID-19 control and mitigation. Surveillance, outbreak, and research activities were very well established in Jordan’s PIP, whereas surge capacity in human capital and health facility were identified as two high-risk areas. However, the limitation in these two areas was met during the COVID-19 response. Still, human capital suffered fatigue, and there was an evident lack of laboratory testing plans when COVID-19 cases increased. Jordan’s experience with PIP may have served as a guide for establishing successful COVID-19 control and mitigation. The established PIP principles, systems, and capacities seem to have reflected well on fighting against COVID-19 in terms of more efficient utilization of available surveillance, laboratory, outbreak management, and risk communications. This reflection facilitated a better mitigation and control of COVID-19.

Leveraging International Influenza Surveillance Systems and Programs during the COVID-19 Pandemic

A network of global respiratory disease surveillance systems and partnerships has been built over decades as a direct response to the persistent threat of seasonal, zoonotic, and pandemic influenza. These efforts have been spearheaded by the World Health Organization, country ministries of health, the US Centers for Disease Control and Prevention, nongovernmental organizations, academic groups, and others. During the COVID-19 pandemic, the US Centers for Disease Control and Prevention worked closely with ministries of health in partner countries and the World Health Organization to leverage influenza surveillance systems and programs to respond to SARS-CoV-2 transmission. Countries used existing surveillance systems for severe acute respiratory infection and influenza-like illness, respiratory virus laboratory resources, pandemic influenza preparedness plans, and ongoing population-based influenza studies to track, study, and respond to SARS-CoV-2 infections. The incorporation of COVID-19 surveillance into existing influenza sentinel surveillance systems can support continued global surveillance for respiratory viruses with pandemic potential.

Turkey’s response to COVID-19 pandemic: strategy and key actions

COVID-19 emerged at the end of 2019 in Wuhan, China, and spread rapidly around the world causing many deaths. Due to the intercontinental escalation in the epidemic, while WHO declared a pandemic on March 11, 2020, our country’s first case was diagnosed. Before this, the MoH established the Operations Center against possible risks regarding the Pandemic Influenza Preparedness Plan on January 10, 2020 and formed the Scientific Committee, which has a critical importance in epidemic management. National and Provincial Pandemic Coordination Boards were established within the scope of this plan. Fast, effective and frequently updated decisions were implemented. The epidemic was kept under control by stopping mutual flights to countries with cases, intermittent curfews, transportation restrictions, closure of schools, filiation, social isolation, use of PPE, social media communication, and intensive work of healthcare workers. Softwares were developed for analysis and data reporting, case and contact tracing. Various mobile applications were developed providing a safe social life in social areas and enabling filiation teams to intervene in the necessary areas in the fastest way and to record data instantly in the system. Prior to normalization process, “COVID-19 Epidemic Management and Working Guide” was prepared including epidemic measures for social life, institutions, organizations, and businesses. Variants of concern, recommended by WHO to be monitored, led to an increase in the number of cases around the world. In our country, the number of laboratories and tests were expanded to monitor variant viruses. Vaccination activities continue in line with the National Vaccine Administration Strategy. In the fight against pandemic, it will be possible to maintain and increase our country’s acquisitions so far, owing to the strong health infrastructure both in terms of manpower and institutions, free health care, success in the production of PPE and medical devices, and finally, rapid acceleration of the vaccination.

The Pandemic Influenza Preparedness Framework as a ‘specialized international access and benefit-sharing instrument’ under the Nagoya Protocol

The World Health Organization (WHO) is starting to come to terms with the public health implications of the United Nations’ Convention on Biological Diversity (CBD) and its supplementary Nagoya Protocol about genetic resource access and benefit-sharing (ABS). Since 2017 there have been calls to recognize the WHO’s Pandemic Influenza Preparedness (PIP) Framework as a specialized international ABS instrument under the Nagoya Protocol. This article will examine whether the PIP Framework meets the criteria of a specialized international ABS instrument as laid out in a 2018 study commissioned by the Subsidiary Body on Implementation to the CBD (CBD/SBI/2/INF/17). Our analysis concludes that while the PIP Framework meets the specialization criteria, it fails to meet the supportiveness criteria and does not provide legal certainty for pandemic influenza virus ABS. Furthermore, we demonstrate that recognition of the PIP Framework as a specialized instrument would not mean that the CBD and Nagoya Protocol no longer apply to influenza viruses with human pandemic potential as has been asserted, rendering the relationship between the three international agreements unclear. As the WHO grapples with how to regulate access to other (non-influenza) human pathogens and the fair and equitable sharing of benefits associated with their use, a full appreciation of what ABS means when applied to pathogens is essential.

Preventing Unequal Health Outcomes in COVID-19: A Systematic Review of Past Interventions.

Background: We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic.Methods: We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle–Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies.Results: We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups.Discussion: To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.

Editorial introductions.

Editorial introductions.

COVID-19 measures and human rights guaranteed by the Japanese Constitution

Since March 2020, the Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response has been a significant statute in dealing with COVID-19 in Japan. The Act mandates requests, instructions and orders for business suspension and shortened business hours, as well as stay-at-home requests. These measures limit freedom of movement and establishment, guaranteed rights under the Japanese Constitution. This article poses the following research question: "Does the Japanese Constitution allow measures against COVID-19 such as requests, instructions and orders for business suspension and shortened business hours, and stay-at-home requests?" It also asks: "Are measures with penalties allowed by the Constitution?" given the fact that the penalties were introduced in February 2021. This paper introduces constitutional concepts that guarantee or limit individual freedom. Concepts that guarantee individual freedoms include freedom of establishment and movement. These freedoms derive from the constitutional values of freedom to choose one's occupation and choose and change one's residence (Art. 22) and the right to own or hold property (Art. 29). Concepts that limit individual freedom include the right to life (Art. 13), welfare rights and public health (Art. 25), and public welfare (Art. 13). Individual freedom that threatens right to life, welfare rights and public health, and public welfare may not be guaranteed. This paper argues that the Constitution allows the measures against COVID-19 limiting freedom of establishment and movement from the perspectives of the right to life, welfare rights, public health, and public welfare, and the government is responsible for reducing the risk to life from COVID-19. It also argues that the Constitution permits measures with penalties, while proportionality needs to be considered.

The Effectiveness of Table-Top Exercises in Improving Pandemic Crisis Preparedness

The World Health Organization carried out a global survey in 2018 to ascertain the level of preparedness for pandemic influenza. It was discovered that simulation exercises to test national pandemic influenza preparedness plans were carried out in the previous 5 years, by 42 out of the 104 countries that completed the survey. The table-top exercise (TTX) being the preferred format, with 86% of the countries using them. Although no table-top exercise can convey a realistic picture of a pandemic, they can be used to assess plans, policies, and procedures, clarify roles and responsibilities, and identify resource gaps in an operational environment. However, table-top exercises are only effective if they are properly designed, carefully conducted, fully evaluated, and most importantly, the results and recommendations identified are actually implemented. TTXs used as part of preparedness for pandemics are not cost free, a failure to implement the lessons learned from them can have both human and economic consequences. To understand the value of TTXs, a sample of national and large scale TTXs are examined in an effort to identify the effectiveness of table-top exercises, as a part of improving pandemic crisis preparedness.

Assessment of Critical Care Surge Capacity During the COVID-19 Pandemic in Japan.

Japan has the highest proportion of older adults worldwide but has fewer critical care beds than most high-income countries. Although the COVID-19 infection rate in Japan is low compared with Europe and the United States, by the end of 2020, several infected people died in ambulances because they could not find hospitals to accept them. Our study aimed to examine the Japanese healthcare system's capacity to accommodate critically ill COVID-19 patients during the pandemic. We created a model to estimate bed and staff capacity at 3 levels of pandemic response (conventional, contingency, and crisis), as defined by the US National Academy of Medicine, and the function of Japan's healthcare system at each level. We then compared our estimates of the number of COVID-19 patients requiring intensive care at peak times with the national health system capacity using expert panel data. Our findings suggest that Japan's healthcare system currently can accommodate only a limited number of critically ill COVID-19 patients. It could accommodate the surge of pandemic demands by converting nonintensive care unit beds to critical care beds and using nonintensive care unit staff for critical care. However, bed and staff capacity should not be expanded uniformly, so that the limited number of physicians and nurses are allocated efficiently and so staffing does not become the bottleneck of the expansion. Training and deploying physicians and nurses to provide immediate intensive care is essential. The key is to introduce and implement the concept and mechanism of tiered staffing in the Japanese healthcare system. More importantly, most intensive care facilities in Japanese hospitals are small-scaled and thinly distributed in each region. The government needs to introduce an efficient system for smooth dispatching of medical personnel among hospitals regardless of their founding institutions.

Editorial introductions

Editorial introductions

Barriers and activities to implementing or expanding influenza vaccination programs in low- and middle-income countries: A global survey

IntroductionDespite considerable global burden of influenza, few low- and middle-income countries (LMICs) have national influenza vaccination programs. This report provides a systematic assessment of barriers to and activities that support initiating or expanding influenza vaccination programs from the perspective of in-country public health officials. MethodsPublic health officials in LMICs were sent a web-based survey to provide information on barriers and activities to initiating, expanding, or maintaining national influenza vaccination programs. The survey primarily included Likert-scale questions asking respondents to rank barriers and activities in five categories. ResultsOf 109 eligible countries, 62% participated. Barriers to influenza vaccination programs included lack of data on cost-effectiveness of influenza vaccination programs (87%) and on influenza disease burden (84%), competing health priorities (80%), lack of public perceived risk from influenza (79%), need for better risk communication tools (77%), lack of financial support for influenza vaccine programs (75%), a requirement to use only WHO-prequalified vaccines (62%), and young children require two vaccine doses (60%). Activities for advancing influenza vaccination programs included educating healthcare workers (97%) and decision-makers (91%) on the benefits of influenza vaccination, better estimates of influenza disease burden (91%) and cost of influenza vaccination programs (89%), simplifying vaccine introduction by focusing on selected high-risk groups (82%), developing tools to prioritize target populations (80%), improving availability of influenza diagnostic testing (79%), and developing collaborations with neighboring countries for vaccine procurement (74%) and regulatory approval (73%). Responses varied by country region and income status. ConclusionsLocal governments and key international stakeholders can use the results of this survey to improve influenza vaccination programs in LMICs, which is a critical component of global pandemic preparedness for influenza and other pathogens such as coronaviruses. Additionally, strategies to improve global influenza vaccination coverage should be tailored to country income level and geographic location.

Better Pandemic Influenza Preparedness through Adjuvant Technology Transfer: Challenges and Lessons Learned.

Adequate global vaccine coverage during an influenza pandemic is essential to mitigate morbidity, mortality, and economic impact. Vaccine development and production needs to be sufficient to meet a vast global demand, requiring international cooperation and local vaccine production capacity, especially in resource-constrained countries. The use of adjuvants is one approach to augment the number of available vaccine doses and to overcome potential vaccine shortages. Appropriately selected adjuvant technologies can decrease the amount of vaccine antigen required per dose, may broaden or lengthen the conferred protection against disease, and may even allow protective single-dose vaccination. Here we describe a technology transfer collaboration between Switzerland and Indonesia that led to the establishment of a vaccine formulation platform in Surabaya which involved the transfer of equipment and expertise to enable research and development of adjuvanted vaccine formulations and delivery systems. This new Indonesian capability aims to facilitate local and regional access to know-how relating to adjuvanted vaccine formulations, thus promoting their application to local vaccine developers. In this review, we aim to share the “lessons learned” from this project to both support and inspire future scientific collaborations of a similar nature.

COVID-19 measures and the Japanese Constitution

Since March 2020, the Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response has been a significant statute in dealing with COVID-19 in Japan. The Act mandates requests and orders for business suspension and shortened business hours, as well as stay-at-home requests. Although there have been no penalties as of January 2021, these requests and orders limit freedom of movement and establishment, guaranteed rights under the Japanese Constitution. This article poses the following research question: “Does the Japanese Constitution allow measures against COVID-19 such as requests and orders for business suspension and shortened business hours, and stay-at-home requests?” It also asks: “Are measures with penalties allowed by the Constitution?” This paper introduces constitutional concepts that guarantee or limit individual freedom. Concepts that guarantee individual freedoms include freedom of establishment and movement. These freedoms derive from the constitutional values of freedom to choose one’s occupation and choose and change one’s residence (Art. 22) and the right to own or hold property (Art. 29). Concepts that limit individual freedom include the right to life (Art. 13), welfare rights and public health (Art. 25), and public welfare (Art. 13). Individual freedom that threatens right to life, welfare rights and public health, and public welfare may not be guaranteed. This paper argues that since measures against COVID-19 are considered public welfare, the Constitution allows the limiting of freedom of establishment and movement. Furthermore, from the perspectives of the right to life, welfare rights, and public health, the government is responsible for reducing the risk to life from COVID-19. It also argues that the Constitution permits measures with penalties, while proportionality needs to be considered.

US Hospital Capacity Managers’ Experiences and Concerns Regarding Preparedness for Seasonal Influenza and Influenza-like Illness

The 2017-2018 influenza season in the US was marked by a high severity of illness, wide geographic spread, and prolonged duration compared with recent previous seasons, resulting in increased strain throughout acute care hospital systems. To characterize self-reported experiences and views of hospital capacity managers regarding the 2017-2018 influenza season in the US. In this qualitative study, semistructured telephone interviews were conducted between April 2018 and January 2019 with a random sample of capacity management administrators responsible for throughput and hospital capacity at short-term, acute care hospitals throughout the US. Each participant's self-reported experiences and views regarding high patient volumes during the 2017-2018 influenza season, lessons learned, and the extent of hospitals' preparedness planning for future pandemic events. Interviews were recorded and transcribed and then analyzed using thematic content analysis. Outcomes included themes and subthemes. A total of 53 key hospital capacity personnel at 53 hospitals throughout the US were interviewed; 39 (73.6%) were women, 48 (90.6%) had a nursing background, and 29 (54.7%) had been in the occupational role for more than 4 years. Participants' experiences were categorized into several domains: (1) perception of strain, (2) effects of influenza and influenza-like illness on staff and patient care, (3) immediate staffing and capacity responses to influenza and influenza-like illness, and (4) future staffing and capacity preparedness for influenza and influenza-like illness. Participants reported experiencing perceived strain associated with concerns about preparedness for seasonal influenza and influenza-like illness as well as concerns about staffing, patient care, and capacity, but future pandemic planning within hospitals was not reported as being a high priority. The findings of this qualitative study suggest that during the 2017-2018 influenza season, there were systemic vulnerabilities as well as a lack of hospital preparedness planning for future pandemics at US hospitals. These issues should be addressed given the current coronavirus disease 2019 pandemic.