Why did Japan take so long to start vaccinations against Covid-19, even with the upcoming Olympics?

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In Japan, only about 18,000 doses were given, according to the Japanese government.

Like the United States, Japan uses the Pfizer-BioNTech vaccine as part of its program. However, it took the Japanese regulators another two months to approve its use.

The government says it was deliberately cautious. After a series of vaccine scandals spanning 50 years, Japan has one of the lowest vaccine confidence rates in the world – so gaining a skeptical audience is crucial.

However, the decision to move slowly has been criticized by some medical professionals, including Dr Kenji Shibuya, a professor at King’s College London, who says Japan’s delayed launch and lack of its vaccination strategy will cost the last lives.

Medical workers are awaiting consultations after receiving a dose of Covid-19 vaccine in Tokyo on February 17, 2021.

Careful approval process

Pfizer-BioNTech conducted extensive Phase 3 clinical trials of their vaccine over several months late last year at approximately 150 clinical trial locations in the United States, Germany, Turkey, South Africa, Brazil and Argentina.
On November 19, the companies announced that the vaccine had been shown to be 95% effective in preventing Covid-19 infections. Two weeks later, the United Kingdom became the first Western country to approve the emergency vaccine, followed by the United States on December 11th.
On 31 December, the World Health Organization (WHO) also approved the Pfizer-BioNTech vaccine for emergency use.

Japan’s approval came six weeks later, on February 14, after a smaller test in the country with 160 participants showed results compatible with international tests. By Japanese standards, approval came quickly – normally, the process can take one to two years. But critics say the delay has cost the government valuable time.

“With a sample of 160 people, it gives you no scientific evidence of the effectiveness or safety (of a vaccine),” said Shibuya of King’s College.

Taro Kono, the minister responsible for launching the coronavirus vaccine in Japan, said the country’s clinical trial was conducted to build public confidence in the program.

“I think it’s more important for the Japanese government to show the Japanese people that we’ve done everything we can to prove the effectiveness and safety of the vaccine – to encourage the Japanese to get the vaccine,” Kono said. “At the end of the day, we could have started slower, but we thought it would be more effective.”

Scandal and skepticism

According to a study published in the medical journal The Lancet, which mapped vaccine confidence in 149 countries between 2015 and 2019, less than 30% of people in Japan agreed that vaccines were safe, important and effective – compared to 50% in the USA.
Vaccine resistance in Japan dates back to the 1970s, when two infants died within 24 hours of receiving the combined vaccine against diphtheria, tetanus and whooping cough (whooping cough). The vaccine was temporarily suspended, but confidence had already been shaken. For several years, vaccination rates in infants have declined, leading to an increase in whooping cough cases.

In the late 1980s, there was another scare with the introduction of a measles, mumps and rubella (MMR) vaccine produced in Japan. Early versions of the vaccine were linked to aseptic meningitis or swelling of the membranes around the brain and spinal cord. The problem was followed up to the mumps component of the MMR vaccine, which led to lawsuits and a strong damages payment.

The National Institute of Health Sciences discontinued the combined vaccine in 1993 and replaced it with individual vaccines.

Following the MMR scandal, Shibuya says the Japanese government has become “risk-conscious” and that its national vaccination program has become voluntary.

Dr. Yuho Horikoshi, an infectious disease expert, says the trials have led to a “vaccination gap” in which vaccines have not been approved in Japan for about 15 years.

More recently, in 2013, Japan added the human papillomavirus (HPV) vaccine to its national program to protect girls against the sexually transmitted virus, which is known to cause cervical cancer. However, videos of girls who allegedly suffered side effects began circulating on YouTube, prompting the government to remove her from the national program.

The Vaccine Adverse Event Review Committee investigated the incidents and found no evidence to suggest a causal relationship between the adverse events and the HPV vaccine. But reports and the withdrawal of the vaccine from the Japanese government’s program have caused a sharp drop in the number of girls vaccinated – from more than 70% in 2010 to now below 1%.
This low rate could lead to nearly 11,000 preventable deaths from cervical cancer in Japan over the next 50 years, according to a study published in The Lancet.
The WHO recommends that the vaccine be given to girls between the ages of nine and 14 to prevent cervical cancer, which kills 311,000 women each year. According to a study published in the Journal of Infectious Diseases, rates of cervical cancer in England are falling due to the vaccine. Australia is also on track to eliminate cervical cancer by 2028, according to another recent study due to the vaccine.

Professor Shoji Tsuchida, an expert in social psychology at Kansai University, says that despite Japanese resistance to vaccination, there is no widespread “anti-vaxxer” movement in the country.

“Most people who don’t want to get vaccinated are afraid of possible side effects and not the believer (what they consider) to be ‘false science,'” Tsuchida said. “Japan’s previous side effects of vaccination, especially HPV, mainly affect the minds of these people.”

The effort to reassure the skeptical public

Japan’s resistance to vaccinations is a problem for the government when it comes to launching the coronavirus vaccine.

The first Covid-19 vaccinations in Japan are administered to 3.7 million health workers in order to vaccinate the elderly in April.

The Japanese government has asked half of the first round of doctors and nurses to keep an “observation log” to monitor for possible side effects for seven weeks after receiving both doses of the vaccine.

Although the launch of the vaccine is now underway, the medical community remains concerned about vaccine resistance. This prompted a group of doctors, including New York-based Yuji Yamada, to launch a promotional campaign encouraging people in Japan to receive Covid-19 photos – and use a cartoon dog to do so.

Dressed in a white doctor’s coat, Corowa-kun is a Shb Inu-inspired chatbot tasked with reassuring a skeptical audience by answering questions about the vaccine. The name Corowa-kun comes from the Japanese words for “coronavirus” and “vaccine”.

So far, more than 55,000 people have signed up for the application – 70% of them are women – said its creators. According to Yamada, the Japanese media initially reported on the possible side effects of the vaccine. “These could have been triggers for women who tend to think about the risk of the vaccine more seriously, and therefore women have used (the application) more,” he said.

Vaccination Minister Kono has shown support for the application, but the government has not yet announced its own public message.

In the process of organizing the Olympic Games, Shibuya says that the government must focus on supporting the public that the Covid-19 vaccine is safe, important and essential. He says the government must do more to suppress the virus.

“Suppress, suppress and suppress to eliminate community transmission – otherwise Japan will repeat the state of emergency again and again, given the very slow release of the vaccine,” Shibuya said.

“Their motivation and fundamental motivation is to revive the economy. If they really want to host the Olympics, they really have to suppress the transmission, so there is almost zero potential.”

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