Japan’s response to antimicrobial resistance (AMR) showcases important lessons on the complexity of fighting one of the most significant threats the world is facing.
While twenty years ago Japan confronted serious concerns about bacteria, viruses, fungi and parasites becoming resistant to antimicrobial medicines such as antibiotics, the country has made remarkable strides forward – though the work to fully overcome AMR continues as an evolving priority.
Dr Norio Ohmagari remembers this time as if it were yesterday: “Hospital infection control measures were not adequate, allowing the spread of drug-resistant infections. Patients were succumbing to infections at an alarming rate,” he recalls.
Basic practices such as hand hygiene and the use of alcohol-based hand gel were often neglected, leading to outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) and other resistant infections.
At the time, Dr Ohmagari was Director of the Department of Infectious Diseases at the Shizuoka Cancer Center. Now Director of the AMR Clinical Reference Center in Tokyo – a WHO Collaborating Centre for Prevention, Preparedness and Response to AMR – Dr Ohmagari and his team have been determined to turn the tide on AMR.
Local, national and global efforts to tackle AMR
They focused on establishing proper infectious disease diagnosis and treatment protocols. They implemented guidelines for appropriate antimicrobial use and worked to raise awareness of AMR within hospitals. Awareness-raising efforts were initially challenging, but as treatment outcomes improved, understanding within the hospital grew. “Our collective efforts led to periods with no MRSA cases detected, demonstrating that proper infection control measures could prevent drug-resistant bacterial infections,” says Dr Ohmagari.
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Dr Norio Ohmagari, Director of the AMR Clinical Reference Center in
Tokyo, a WHO Collaborating Centre for Prevention, Preparedness and
Response to AMR. Photo credit: Dr Norio Ohmagari
An additional push came in 2015 when the World Health Organization (WHO) called on Member States to develop national action plans to combat AMR. This call raised global awareness and a sense of crisis towards the issue of AMR. The Government of Japan responded by launching its 2016−2020 National Action Plan on AMR, which set ambitious targets and focused on increasing awareness among health professionals and the public. The plan emphasized AMR surveillance and promoted appropriate antibiotic use in both the human and animal health sectors.
Government leadership was crucial in driving front-line action against AMR. Japan’s Ministry of Health, Labour and Welfare introduced a system of financial incentives through health insurance reimbursements for participating hospitals that met certain criteria, initially focusing on promoting infection prevention and control measures. The Government also fostered collaboration among government agencies, medical institutions and the private sector to enable effective sharing of data, resources and best practices, which led to improvements across the country.
However, new challenges emerged, including the rise of multidrug-resistant bacteria such as carbapenem-resistant Enterobacteriaceae. While health-care environments improved, hospital-acquired infections remain a threat due to emerging resistant pathogens. Additionally, public awareness about AMR in Japan remains low, highlighting the need for continuous efforts.
Japan’s accelerated efforts to fight against AMR for the health of future generations
Looking to the future, Japan launched its second National Action Plan for AMR covering 2023−2027, incorporating lessons learnt from the first plan. The scope of the reimbursement scheme was extended to encourage appropriate use of antimicrobials and participation in AMR surveillance. Future priorities include securing resources for infection control, enhancing health-care worker education and promoting global collaboration to prevent the spread of resistant bacteria. Dr Ohmagari emphasizes the need for education and ongoing support to ensure that front-line health-care workers grasp the importance of infection control and know how to implement best practices.
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The National Center for Global Health and Medicine Hospital in Tokyo, Japan, houses the AMR Clinical Reference Center. Photo credit: Dr Norio Ohmagari
As part of its global collaboration, the National Center for Global Health and Medicine of Japan joined forces with the WHO Regional Office for the Western Pacific to publish Japan’s AMR Response 2013–2025: Developing, implementing and evaluating national AMR action plans. This document highlights the importance of integrating AMR response into health systems strengthening, generating quality surveillance data and strengthening antimicrobial supply chains.
By continuing to strengthen infectious disease control measures and fostering international cooperation, Japan is determined to lead the fight against AMR and protect the health of future generations.