Within the last two decades, Japan has been grappling with an intense issue of antimicrobial resistance (AMR), yet managed to make significant strides in combating it. This country muted the alarming resistance of bacteria, viruses, fungi, and parasites to antimicrobial drugs, which was a matter of serious concerns.
Dr. Norio Ohmagari, currently the Director of the AMR Clinical Reference Center in Tokyo—a World Health Organization (WHO) supporting center for AMR prevention and response—describes the early stages of the struggle. With unsatisfactory hospital infection control measures, basic practices such as hand hygiene and usage of alcohol-based hand sanitizers were frequently overlooked, leading to surges in methicillin-resistant Staphylococcus aureus (MRSA) and other resistant infections.
As the Director of Infectious Diseases at the Shizuoka Cancer Center at the time, Dr. Ohmagari bore witness to the grim toll of these infections, with patients succumbing at a disturbing pace. Committed to changing this trajectory, Dr. Ohmagari and his team focused their efforts largely on formulating accurate infectious disease diagnosis and treatment methods, creating guidelines for proper antimicrobial use, and elevating awareness levels for AMR within medical facilities.
Initially, attempts to raise awareness were met with resistance. However, as hospitals started witnessing improved treatment outcomes, understanding and acceptance of the severity of AMR grew. Dr. Ohmagari and his team were able to present periods devoid of MRSA cases as evidence that well-executed infection prevention measures could ward off drug-resistant bacterial infections.
The fight against AMR gained increased traction in 2015 when WHO sparked global urgency by asking member countries to establish national action plans to counter AMR. The Japanese government, in response, rolled out its ambitious National Action Plan on AMR from 2016 to 2020, which targeted a comprehensive rise in awareness levels among health policymakers and the public, with a strong focus on AMR surveillance and enhanced antibiotic use within human and animal health sectors.
An essential component of the successful front-line battle against AMR was the government’s leadership, with Japan’s Ministry of Health, Labour and Welfare implementing a system of financial incentives for compliant hospitals through health insurance reimbursements. A productive collaboration among government organizations, healthcare institutions, and the private sector was fostered, leading to effective data sharing, resource allocation, and improved practices country-wide.
Just as the situation was improving, other challenges, such as the emergence of multiresistant bacteria like carbapenem-resistant Enterobacteriaceae, sprang up. Although healthcare environments surpass prior conditions, hospital-acquired infections remain a risk due to evolving resistant pathogens. Furthermore, the public consciousness about AMR within Japan requires further attention, necessitating ongoing efforts.
Optimistically looking towards the future, Japan launched its second National Action Plan for AMR, covering 2023-2027, drawing on lessons learnt from the first. The reimbursement scheme broadened to encourage proper use of antimicrobials and participation in AMR surveillance. Future steps involve establishing resources for infection control, upgrading healthcare worker training, and global collaboration to prevent resistant bacteria spread.
Dr. Ohmagari can’t more than emphasize the need for consistent education and support to ensure that front-line healthcare professionals understand and effectively implement best practices for infection control. Japan’s National Center for Global Health and Medicine has also joined hands with WHO’s Western Pacific Regional Office to publish a detailed document on Japan’s AMR Response 2013-2025, underscoring the need to infuse AMR response into health systems strengthening, the production of quality surveillance data, and fortification of antimicrobial supply chains.
Japan is dutifully committed to intensifying infectious disease control practices and fostering international cooperation with an aim to take the lead in the fight against AMR and safeguard the health of generations to come.