Why Japan took so long to start Covid-19 vaccinations, even as the Olympics approach

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In Japan, only about 18,000 doses have been administered, according to the Japanese government.

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

The government says it has been deliberately careful. After a string of vaccine scandals stretching back 50 years, Japan has one of the lowest vaccine confidence ratings in the world – so convincing a skeptical public is crucial.

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

Medical staff await consultations after receiving a dose of the Covid-19 vaccine in Tokyo on February 17, 2021.

Careful approval process

Pfizer-BioNTech conducted extensive Phase 3 clinical trials of its vaccine over several months late last year at approximately 150 clinical trial sites in the United States, Germany, Turkey, South Africa, in Brazil and Argentina.
On November 19, the companies announced that the vaccine was 95% effective in preventing Covid-19 infections. Two weeks later, the UK became the first Western country to approve the vaccine for emergency use, followed by the US on December 11.
On December 31, 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 of 160 participants showed results consistent with international trials. By Japanese standards, this approval came quickly – normally the process can take anywhere from one to two years. But critics say the delay has cost the government precious time.

“With a sample of 160 people, that doesn’t give you any scientific proof of the efficacy or safety (of a vaccine),” said Shibuya of King’s College.

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

“I think it is more important for the Japanese government to show the Japanese people that we have done everything possible to prove the efficacy and safety of the vaccine – to encourage the Japanese to take the vaccine,” Kono said. . “In the end, maybe we would have started slower, but we thought it would be more efficient.”

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 Japanese strongly agree that vaccines are safe, important and effective – up from 50 % in the USA.
Japan’s vaccine resistance dates back to the 1970s, when two infants died within 24 hours of the combined diphtheria, tetanus, and pertussis (pertussis) vaccination. The vaccine was temporarily suspended but confidence had already been shaken. For several years, infant immunization rates have declined, leading to an increase in pertussis cases.

In the late 1980s, the introduction of a Japanese vaccine against measles, mumps and rubella (MMR) caused another concern. Early versions of the vaccine were linked to aseptic meningitis or swelling of the membranes around the brain and spinal cord. The problem was attributed to the mumps component of the MMR vaccine, which led to legal action and the payment of substantial damages.

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

After the MMR scandal, Shibuya says the Japanese government became “aware of the risk” and its national immunization program became voluntary.

Dr Yuho Horikoshi, an infectious disease expert, says the lawsuits have led to a “vaccine gap,” where no vaccine has been approved in Japan for about 15 years.

More recently, in 2013, Japan added the human papillomavirus (HPV) vaccine to the national schedule to protect girls against the sexually transmitted virus, which is known to cause cervical cancer. However, videos of girls allegedly suffering from adverse reactions began circulating on YouTube, leading the government to remove it from the national program.

The Adverse Vaccine Reaction Review Committee investigated the incidents and found no evidence to suggest a cause and effect relationship between the adverse reactions and the HPV vaccine. But the reports, and the withdrawal of the vaccine from the Japanese government program, have caused a sharp drop in the number of girls vaccinated – from more than 70% in 2010 to now less than 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.
WHO recommends giving the vaccine to girls aged 9 to 14 to prevent cervical cancer, which kills 311,000 women worldwide each year. According to a study published in the Journal of Infectious Diseases, cervical cancer rates in England are dropping due to the vaccine. And Australia is on track to eliminate cervical cancer by 2028, according to another recent study, also thanks to the vaccine.

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

“Most people who don’t want to be vaccinated fear the possible side effects and don’t believe (what they consider) to be ‘fake’ science,” Tsuchida said. “The old cases of side effects from vaccination in Japan, especially the case of HPV, mainly affect the minds of these people.

Effort to reassure a skeptical public

Japan’s resistance to vaccinations poses a problem for the government when it comes to rolling out the coronavirus vaccine.

The first Covid-19 vaccinations in Japan are given to 3.7 million frontline health workers, with the aim of vaccinating the elderly in April.

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

Although the vaccine rollout is underway, the medical community remains concerned about vaccine resistance. This has led a group of doctors, including New York-based Yuji Yamada, to launch a promotional campaign encouraging Japanese people to get vaccinated against Covid-19 – and they are using a cartoon dog to do so.

Dressed in a white doctor’s coat, Corowa-kun is a Shiba 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 app – 70% of them are women – its creators said. According to Yamada, the Japanese media initially reported on the potential side effects of the vaccine. “These could have been triggers for women who tend to think more seriously about the risks of vaccines and, as a result, women used (the app) more,” he said.

Vaccination Minister Kono has supported the app, but the government has yet to release its own public message.

In preparation for the Olympics, Shibuya says the government must focus on promoting to the public that the Covid-19 vaccine is safe, important and essential. He says the government must also do more to suppress the virus.

“Remove, delete and delete to eliminate community transmission – otherwise Japan will repeat the state of emergency over and over again, given a very slow rollout of the vaccine,” Shibuya said.

“Their basic motivation and incentive is to reorganize the economy. If they really want to host the Olympics, they really have to cut transmission, so there is potentially almost zero.”

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