Learning from the pandemic: A critical review of public health system evolution in China, India, and Japan

The COVID-19 pandemic has highlighted both the strengths and vulnerabilities of global public health systems (PHSs) and international cooperation. To identify key strategies for enhancing global health security, this research seeks to reveal crucial factors needed for resilient and integrated global health systems. In the absence of overseeing agencies in Asia, constructive policy recommendations for respective governments are required, with a combination of centralized policy directives and localized implementation strategies being the key. The sheer demographic size of China and India, shared challenges of depopulation of China and Japan, and the current or future issue of aging between China, India and Japan, make it necessary to have a comparative analysis of public health responses in China, India, and Japan. The novelty of the study lies in this comparative study on the evolution of PHSs in these countries since the 1990s using the WHO health indicators and their COVID-19 responses. Political economy must ensure public trust through equitable access to health care and transparent communication, while balancing public health needs with economic imperatives. The findings underscore the need for coordinated governance, preventive healthcare and livelihood efforts to prepare for future health crises and identify directions for international collaborative efforts to combat them.