Officials in Japan say a successful coronavirus vaccination drive is vital to the country’s ability to host the delayed 2020 Olympic Games in Tokyo this summer. Yet the country has been far slower than many of its peers to begin rolling out vaccines, only approving its first one this past weekend.
Now, with just five months to go before the games are scheduled to take place, Japan’s government is racing against time to get its population vaccinated.
In November, the American pharmaceutical giant Pfizer and the German biotech firm BioNTech reported the results of the phase 3 trial of their Covid-19 vaccine, which found it to be more than 90 percent effective at preventing infection. Within weeks, several countries, including the United States and the United Kingdom, issued emergency use authorizations for the drug.
But Japan didn’t accept the results of the Pfizer study. Instead, it asked Pfizer to do additional trials with Japanese participants. Japan’s request was meant to help alleviate concerns that not enough Asian, and particularly Japanese, candidates had been included in Pfizer’s trial.
Finally, on February 14, Japan approved Pfizer’s vaccine, two months after the US and the UK began their campaigns. While some have argued that the additional wait time, which only led to testing 160 Japanese participants, wasn’t worth the trouble, Japan’s vaccination point person Taro Kono defended the delay at a press conference on Tuesday.
“It was more important for the government to show the Japanese people that everything was done” to get everyone on board with getting vaccinated, Kono said.
Kono’s comment underscores the importance of gaining public trust in Japan, a country ranked among the lowest in the world for vaccine confidence.
And right now in Japan, confidence in the vaccine is seriously needed.
Last month, Japanese Prime Minister Suga Yoshihide declared a state of emergency for 11 areas including the cities of Tokyo and Osaka as the number of cases in those places reached their highest levels of the pandemic.
At the time, Suga stated his unwavering commitment to safely holding the Olympic Games. “I am determined to hold safe and secure games by taking all possible measures against the infection,” he said.
As of February 16, Japan has recorded more than 400,000 coronavirus cases and 7,000 deaths since the start of the pandemic. Tokyo, where the games are to be held, has been the epicenter of those deaths.
When the Olympics were first postponed in March 2020, then-Prime Minister Abe Shinzo said the rescheduled games would be a celebration of humankind’s victory over the coronavirus.
Suga, who took over after Abe stepped down in September, continues to echo that sentiment. “I am determined to realize a safe and secure Tokyo Games as proof that mankind will have overcome the virus,” Suga told his country’s parliament on Friday, according to the Washington Post.
But with just over 150 days left before the Olympic Games are supposed to begin on July 23, the coronavirus still raging in the country, and the government only now starting its vaccine rollout, victory seems distant.
Japan has a complicated recent history with vaccines
Suga’s government has faced intense criticism over the perceived slowness of his coronavirus response. According to a poll by Japan’s Asahi newspaper, the approval rating for Suga’s cabinet plummeted to 33 percent in January, down from 65 percent when Suga took office in September.
But when it comes to the delay in approving the Pfizer vaccine, it seems the Japanese government chose to move slowly on purpose, in order to help overcome vaccine skepticism in the country.
According to a September study in the Lancet medical journal, Japan ranks among the countries with the least vaccine confidence in the world. An opinion poll conducted in January by the Japanese public broadcaster NHK found only half of the respondents wanted the vaccine, while 38 percent said they did not want it.
The Lancet paper points to two events in Japan’s recent history that contributed to this public mistrust of vaccines, particularly foreign-made ones.
In 1993, the country banned the three-shot MMR (measles, mumps, rubella) vaccine when surprisingly high rates of a type of meningitis commonly associated with a strain of the mumps were reported in those who had taken the vaccine. Many children were also left reeling from adverse effects as serious as blindness. Eight children died.
After public outcry, the Japanese government stopped mandating shots for children in 1994. But the damage to public opinion of vaccines was already done. Since the vaccine was banned, several outbreaks of rubella have happened in Japan.
More recently, in 2013, the Japanese government suspended recommendations for the HPV vaccine following frenzied media reports of adverse effects. The HPV vaccine remains suspended in Japan despite a local investigation that found no link between the mysterious ailments and the HPV vaccine. Untreated HPV can cause cervical cancer, which kills 3,000 Japanese women each year. But if administered at the right time, the HPV vaccine can prevent most cases of cervical cancer.
The MMR and HPV cases did serious damage to public trust in the government’s approval of vaccines. That mistrust now poses a big challenge to Japan’s coronavirus vaccination drive.
“I am concerned about weak health communication in Japan,” Dr. Kazuki Shimizu, a public health researcher at London School of Economics and Political Science, told me, referring to the risk that misinformation could get in the way of Japan’s coronavirus rollout.
“As the preparedness for vaccine deployment is insufficient, I expect that many reactogenicity symptoms (adverse effects) will be reported, which may lead to suspension of the vaccine campaigns in the future,” he said. He added that he hopes reports of side effects don’t get in the way of Japan’s vaccine drive.
Beyond skepticism, Japan faces other logistical hurdles in rolling out the vaccine
Japan began its vaccination drive Wednesday at the Tokyo Medical Center. Dr. Araki Kazuhiro, the center’s director, was the first to receive the shot.
Under the rollout plan, 40,000 health care workers from 100 government-run hospitals will be the first to receive the vaccine. Half of those workers are participating in a study, waiting a week after receiving each shot to see if there are any side effects to the vaccine. After that, 3.7 million additional hospital workers will become eligible.
By April, 36 million people 65 or older will become eligible. People suffering from conditions like heart disease that can complicate the virus will be next, with vaccination of the greater public expected to happen in July.
So far, Japan has signed contracts to get 344 million total vaccine doses for vaccinating its population of roughly 127 million people. Of that total, 144 million doses came from Pfizer.
The Japanese government secured 120 million doses of the AstraZeneca vaccine and 50 million doses from Moderna. Japan expects to have enough doses for its entire population by late June.
But there are already some troubling signs for Japan’s vaccination drive. So far, the country has failed to secure enough of the special syringes that can get six shots out of each Pfizer vaccine vial. The regular syringes, which the Japanese government has stocked up on, can only get five shots, wasting an inoculation shot in each vial.
Reuters reported on Monday that a Japanese health official and Pfizer Japan representative didn’t comment on if the 144 million doses slated to arrive by the end of the year were based on five or six doses per vial. If the 144 million is based on six shots per vial and the Japanese government can’t get the special syringes fast enough to meet the demand, a lot of doses could go to waste.
For now, Japan’s vaccination efforts largely rest on successful inoculation using Pfizer’s vaccine while other vaccines await testing and approval. On January 21, Moderna started its clinical trials in Japan with a group of 200 people over the age of 20. The approval process for the AstraZeneca vaccine began earlier this month. Although Japan is a pharmaceutical giant, its homegrown vaccine, AnGes, won’t enter trials until later this year.
And no matter how many vaccines are available — or where they’re made — health experts have repeatedly emphasized that additional, “non-pharmaceutical interventions” like testing, contact tracing, and social distancing will still be needed for years to keep the coronavirus in check.
The Covid-19 pandemic will not be over until every country has access to vaccines, which will take time, yet there’s a misconception that the vaccine will make ending the pandemic possible in a year.
“There has been an over-reliance on Covid-19 vaccines for ending the pandemic in Japan, especially among the government and several scientific advisers to the government,” Shimizu, the public health researcher, told me.
Being too positive in communication about the vaccine could actually have a negative impact on public faith among Japanese citizens in the long run. If adverse effects of the vaccines appear in the news, as they did in the case of the HPV vaccine, the Japanese government could have a tougher time convincing the public that everything’s okay.
To effectively roll out the vaccine and end the pandemic requires “openness and transparency, and sharing both positive and negative facts is warranted,” Shimizu said.
When it comes to the delayed Tokyo Olympics, the same couldn’t be more true.