Public health responses in mitigating influenza pandemics include enhanced surveillance, quarantine, patient
management, and social distancing. This manuscript summarizes non-pharmaceutical public health responses in Japan and
identifies 10 lessons learned from pandemic (H1N1) 2009.
Pandemic (H1N1) 2009 can be classified into five phases: I) prepandemic; II) overseas, when swine influenza A (H1N1)
was identified in Mexico and the United States; III) early localized, when domestic clusters of patients were identified in
Japan; IV) smoldering; and V) widespread.
Ten lessons were learned and identified: in the prepandemic phase, 1) the initiatives of high-level decision-making bodies
must be enforced effectively and comprehensively, and 2) planning must be flexible and based on a range of scenarios. In
the overseas phase, 3) difficulties in decision-making and require the public’s trust, 4) human rights must be protected,
especially for infected individuals, and 5) efficient response operations are essential because of limited resources. In the
early localized phase, 6) acceptance of local governments’ initiatives, 7) assumption of the identification of the first
domestic patients without overseas travel, 8) strategic public communication for minimizing anxiety, and 9) timely
resource allocations with termination of unnecessary responses are necessary. In the widespread phase, 10) criteria for
school closures are essential. The implementation of these measures could create greater efficiency in public health
responses in the face of another epidemic.