『保健医療科学』 2022 第71巻 第4号 p.280-291（2022年10月）
特集：新型コロナウイルス感染症の教訓―パンデミックにいかに対峙し何を学んだか―
新型コロナウイルス感染症に対する日本政府の対応 ＜解説＞
正林督章
ベトナム保健省政策アドバイザー
前厚生労働省健康局長
Measures against COVID-19 by the Japanese government
SHOBAYASHI Tokuaki
Health Policy Advisor to Ministry of Health of Vietnam
Former Director General of Health Service Bureau of Ministry of Health, Labour and Welfare
抄録
日本における最初のケースは2020年1月15日に発生した神奈川県の感染事例だが，その後武漢からの帰国者やダイヤモンド・プリンセス号への対応など主に水際対策を中心に対策を行ってきた. また，サーベイランスシステムの構築や積極的疫学調査のガイドラインの策定，検査体制や医療提供体制の構築のための準備などを行った. 厚生労働省内には新型コロナウイルス対策本部が設置されるとともに政府全体での対応が必要なことから総理を本部長とする政府の新型コロナウイルス対策本部も設置された. さらにアドバイザリーボードや新型コロナウイルス感染症専門家会議など専門家の助言組織も設置されるなど初動対応を講じた.
4月に入っても感染拡大は収まる気配がなく，4月7日には最初の緊急事態宣言を発出し，東京や大阪など一部の都道府県において緊急事態措置を講じた. 4月15日に緊急事態措置の対象を全国に拡大したが，4月11日に1日感染者数644人とピークを迎えた後，減少に転じ，5月25日には緊急事態宣言を解除した.後にこの感染拡大は第1波と呼ばれることとなった.
その後8月には第2波，冬には第3波，2021年春には第4波，夏には第5波，2022年冬から春にかけて第6波，夏に第7波が到来した.この間，ウイルスは変異をとげながら世界中に広がった.
2020年当初からワクチンや医薬品の開発にも力を入れていたが，ワクチンについては各国の争奪戦になることが予想されたため，夏の段階から海外のワクチン製造業者と協議を重ね，契約を締結した. その結果，2021年2月から医療従事者を対象に接種が始まり，その後，市町村において接種体制を整備しながら高齢者や基礎疾患を有する方などに接種を拡大していき，多くの国民に2回目，3回目，4回目と接種を進めていった.
人口当たりの感染者数や死亡者数はこれまでのところ他の先進諸国と比較して大幅に少ない数で推移してきた. 本稿では，政府の実施してきた，初動対応，組織やガバナンス，水際対策，サーベイランス，積極的疫学調査，保健所体制，検査体制，医療体制，ワクチン，医薬品，広報・リスクコミュニケーションなど様々な対応について振り返り，得られた教訓などをまとめた.
キーワード: 初動対応，水際対策，サーベイランス，検査体制，医療体制，ワクチン
Abstract
The first case of infection in Japan occurred on January 15, 2020, in Kanagawa Prefecture. Since that time, measures have primarily focused on borderline control, including those for returnees from Wuhan and the Diamond Princess. In addition, the Ministry of Health, Labor and Welfare (hereinafter, MHLW) established a surveillance system, formulated guidelines for proactive epidemiological surveillance, and prepared for the establishment of a PCR testing system and a medical care supply system. The Headquarters for COVID-19 Control within the MHLW, as well as the Prime Ministerʼs Office headed by the Prime Minister was established. In addition, an Advisory Board and the Expert Council on COVID-19 were set up to obtain advice from experts.
In April, the spread of the infection showed no sign of abating, and on April 7, the first state of emergency was declared, and emergency measures were implemented in some prefectures, including Tokyo and Osaka, etc. On April 15, the scope of the emergency measures was expanded nationwide. After reaching a peak of 644 daily cases on April 11, the number of cases began to decline, and on May 25, the emergency declaration was lifted. This outbreak was later referred to as the first wave.
The second wave arrived in August, the third in winter, the fourth in spring 2021, the fifth in summer, the sixth in winter to spring 2022, and the seventh in summer. During this period, the virus mutated and spread throughout the world.
From the beginning of 2020, efforts were made to develop vaccines and medicines. Since it was anticipated that there would be a battle among countries for the vaccine, discussions with foreign vaccine manufacturers began in the summer and a contract was concluded. As a result, vaccination of healthcare workers began in February 2021, followed by the expansion of vaccination to the elderly and those with underlying diseases, while establishing vaccination systems in municipal governments, and the second, third, and fourth doses were administered to a large number of citizens.
The number of cases of infection and deaths per population has thus far remained significantly lower than in other industrialized countries. This paper reviews the various responses implemented by the government, including the initial response, organization and governance, borderline control measures, surveillance, proactive epidemiological investigation, public health center system, laboratory system, medical supply system, vaccines, drugs, and public information and risk communication, and summarizes the lessons learned.
keywords: initial response, borderline control measures, surveillance, laboratory system, medical supply system, vaccines
