Priority research and development areas for health crisis management including emerging infectious disease control: An expert questionnaire survey in Japan

Health crisis management is becoming increasingly important worldwide, as evident by the emergence/ reemergence of infectious diseases, such as the most recent COVID-19 pandemic, and the drug-resistant bacterial infection epidemic. In Japan, health crisis management in the event of natural disasters such as frequent earthquakes and typhoons is also an important issue. Given this situation, Japan has long since addressed health crisis management through regulatory and scientifi c frameworks. The latter comprises various research and development programs related to national strategies including the “Science and Technology (S&T) Basic Plan” [1].

more than 40 years [2], contributing to formulating the "S&T Basic Plan" to be renewed every 5 years. With the help of the survey, NISTEP/STFC has presented a wide range of future S&T strategies to address various social issues including health crisis management. For example, the survey conducted in 2014 demonstrated priority R&D areas for emerging/reemerging infectious disease control [3]. This paper introduces the outline and main results of the latest survey conducted in 2019 (the 2019 survey), focusing on health crisis management and providing information to design concrete R&D programs for management not only in Japan but also other countries.

Materials and methods
An online, two-round Delphi technique was adopted based on our previous survey method [2]. First, ten R&D topics (see Table 1 for its defi nition) related to health crisis management were selected by the expert panel comprising 10 Japanese medical Citation: Takahashi doctors and researchers. Second, the "S&T Experts Network" of approximately 2,000 persons operated by NISTEP/STFC and other experts from academic societies, private companies, and so on were asked to rank the importance of each R&D topic on a 5-point scale (very high, high, neutral, low, very low), as an indicator of its characteristics (Table 1 for

Results
The analysis results of the second round of the questionnaire are shown in Table 2. The number of respondents to each topic ranged from 124 to 157. The top 3 R&D topics that experts considered important are as follows: a control system for drug-resistant infections (Topic 6), followed by ultra-small sensor (Topic 1), and drug development using alternatives to animal models (Topic 2). The importance scores of topics related to modelling of infectious diseases (Topic 3), prediction and evaluation of the impact of emerging infectious diseases on humans (Topic 5), countermeasures against large-scale disasters (Topic 10), and artifi cial blood (Topic 8) were also relatively high.

Discussion
The top 3 R&D topics that experts considered important were related to infectious disease control, such as a control system for drug-resistant infections (Topic 6), ultra-small sensor (Topic 1), and drug development using alternatives to animal models (Topic 2). Considering the increasing number of drug-resistant infections worldwide, Topic 6 is characterized by incorporating not only medical but also social science approaches such as risk management according to the situation in different countries and regions. Topic 1 and 2 are considered to be commonly required S&T for controlling emerging infectious diseases including COVID-19. Topic 1 will accelerate biomedical engineering, as seen in the biosensor example, and Topic 2 will contribute to animal welfare by reducing the number and frequency of animal testing.

R&D topic
Key S&T strategies that are considered important until 2050 in Japan from various perspectives, such as responding to future social changes, creating S&T innovation, being a common basic technology, and contributing to the progress of S&T.

Importance
Present level of the topic's importance for Japan, in order to realize a desirable society 30 years from now. 10. Transport organization system for seriously injured people using artifi cial intelligence in large-scale disasters 124 0.85 * 1 R&D topics refer to key S&T strategies that are considered important until 2050 in Japan from various perspectives, such as responding to future social changes, creating S&T innovation, being a common basic technology, and contributing to the progress of S&T. * 2 The number of respondents varies because the experts answered each topic voluntarily. * 3 Present level of the topic's importance for Japan, in order to realize a desirable society 30 years from now. * 4 Scores were calculated based on the following point distribution: very high (+2), high (+1), neutral (0), low (-1), and very low (-2). For each topic, each point from "+2" to "-2" was multiplied by the number of respondents for that point and the value of each product was calculated. Finally the total value was divided by the total number of respondents for each topic.

Conclusions
An expert questionnaire survey in Japan reveals that infectious disease control is a major aspect of health crisis management. In particular, in order to control emerging infectious diseases such as COVID-19, not only biomedical approaches but also R&D in collaboration with IT and social science are required. The results of this study might support developing a R&D strategy for health crisis management not only in Japan but also other countries.