Preparedness for infectious diseases during the Tokyo 2020 Olympic and Paralympic Games: advancing the health system beyond the games

Mass international gatherings pose significant health security challenges and demand robust preparedness for infectious diseases. Though demanding, this process can leverage heightened political and social attention to fortify core capacities. Despite Japan's advanced public health system for infectious diseases, there were still areas of vulnerabilities. Preparation for the Tokyo 2020 Olympic and Paralympic Games (Tokyo 2020) strategically enhanced the national system for infectious diseases through a three-step approach: (i) assessing risks, readiness, and gaps; (ii) addressing the identified gaps by strengthening or establishing systems; and (iii) performing operational exercises involving multiple stakeholders. COVID-19, which led to the postponement of Tokyo 2020, brought the strict public health measures taken during the event into focus. However, these primary conventional steps need to be further highlighted. Emphasizing their applicability beyond games time, this approach is a model for countries that host large-scale gatherings.