From Response to Resilience: Sustainable Sub-national Government Crisis Communication

Abstract Background Health crises have intensified globally due to disease outbreaks and disasters. Sub-national governments serve as critical first responders with essential information on community demographics, vulnerabilities, and resources. They must adapt national guidelines while maintaining transparency in decentralized health systems. Establishing a system that can seamlessly respond to the transition between normal times and crises is imperative, but evidence of effective and sustainable communication systems is lacking. This research aimed to examine communication systems and practices of local governments during health crises, explicitly focusing on COVID-19 response experiences in Japan. Methods Semi-structured interviews were conducted with COVID-19 response personnel from five Japanese local governments between December 2024-March 2025. Thirty-two participants included medical supervisors, health department directors, and staff from various divisions. Interviews focused on information sharing methods, systems, and communication structures. Data was analyzed by categorizing into internal and external communication dimensions. Results Social media platforms became vital communication tools. Local governments established consultation centers, provided multilingual support, and maintained regular meetings with medical associations. Regional collaboration enhanced resource sharing while specialized information tools facilitated internal data management. Challenges included excessive administrative notices, difficult ICT systems, initial response delays, and departmental silos that impeded coordination. Conclusions For sustainable communication systems, priorities should include: developing pre-crisis community engagement, utilizing diverse media, analyzing community feedback, implementing cross-organizational information sharing, considering regional characteristics, and establishing response systems that address staff continuity and knowledge retention. Key messages • Sub-national governments used diverse communication during COVID-19, but sustaining this requires pre-crisis engagement and preserving knowledge despite staff changes. • Successful crisis communication balances digital innovation with traditional media, prioritizes cross-organizational information flow, and adapts strategies to regional characteristics.