Risk-Informed Decision | Toru Takebayashi, Dean, Graduate School of Health Management
2021.01.12
During a winter break marked by calm, sunny weather, in stark contrast to the surging number of COVID-19 cases, I found myself watching various sporting events on TV. From a pile of books I had set aside, the first one I picked up was Hiroshi Nishiura's "Protect Lives from the Novel Coronavirus!" (Chuo Koron Shinsha).
As a practitioner of mathematical modeling for infectious disease epidemiology, a rare expertise in Japan, Nishiura became widely known to the public as the "80% uncle" (Hachi-wari Ojisan). He dedicated all his energy to controlling this pandemic with a sincerity that reflected his straightforward character and should be praised for brilliantly demonstrating his competence and conscience as an expert. However, for that very reason, he was also plagued by the ambiguity typical in Japan regarding the division of roles and responsibilities among science, politics, and society. The book, which includes behind-the-scenes stories like the origin of the term "Three Cs" (Sanmitsu), clearly conveys Nishiura's true character and thoughts, and I finished it in no time. After reading it, as a fellow public health expert, I felt proud of him and the members of his response team.
What emerges, especially in the latter half of the book, is the question of how science communication should be handled when facing such sudden health risks. Nishiura concluded that the conventional approach, where the national government paternalistically decides policies for local governments to follow, is inadequate for dealing with an explosively spreading pandemic. He went beyond merely making predictions, using real-world data and mathematical models to scientifically forecast and present the epidemic's trajectory, aiming for society to decide on policies based on this risk perception.
To what extent will this approach be accepted in Japan? The public's reaction to the "80% uncle's" messaging, especially in the media and on social media, was truly varied. A risk that does not materialize because it has been prevented and controlled is, in most cases, not properly recognized and can even become a target of later criticism for supposedly exaggerating the risk. As he himself reflects in the book, there might have been a more skillful way to handle things. One could also argue that, from the perspective of science, he should not have crossed a certain line. However, we must not underestimate the fact that Japan's first wave was controlled to a level that surprised the world precisely because Nishiura and the experts around him strategically and boldly carried out what they called "risk-informed decision" activities back in April.
Now, as we face a third rapid expansion of COVID-19 infections on an unprecedented scale, the question is whether Japan can truly make risk-informed decisions this time.