Japan’s bitter vaccine history creates obstacles in the COVID-19 fight

With agreements to secure more coronavirus vaccines than it needs and legislation to distribute it for free, Japan may seem to have its inoculation plans in place. Nevertheless, a tense general history with vaccines and a cautious approval process have some concerns about how quickly the country can return to normal.

Japan has one of the lowest rates of vaccine confidence in the world, according to a Lancet study, which showed that less than 30% of the population agreed that vaccines were safe, important and effective, compared to at least 50% of Americans. A recent survey by NHK found that 36% said they did not want to take a COVID-19 vaccine.

The government is now facing a tricky balancing act: trying to go fast to approve jabs to restore the economy to full health, while avoiding creating the impression of a drug job – which could help turn an already skeptical public from being inoculated.

“Japan is very careful with vaccines, because historically there have been problems with potential side effects,” said Haruka Sakamoto, a public health researcher at the University of Tokyo. “The government has been involved in several lawsuits related to the issue, which increases their deep caution.”

Careful timeline

The skeptical attitude takes precedence over the more recent Western “anti-wax” view that has flourished on social media, with its roots instead in previous vaccine-linked events and legal decisions that encouraged the government to take a passive approach to vaccination.

And ironically, Japan’s relative success in dealing with the pandemic means that an urgent rollout of the shot is less of a priority. The country has avoided a second state of emergency, although cases have risen to record levels.

As a result, Japan’s launch will be slower than some other nations, which has led to frustration among those counting on vaccines to eradicate the virus. To date, Pfizer Inc. alone has applied for local approval for its coronavirus shot, although the United Kingdom and the United States have both administered more than half a million doses, mostly to the elderly and healthcare professionals.

Local media have reported that vaccines will be rolled out in Japan from the end of February, when the government aims to inoculate about 10,000 frontline health workers. The ministry is then preparing to vaccinate general medical staff, after which it will be gradually administered to the wider population. Japan has not indicated when it intends to complete its vaccination program.

Ginza shopping district in Tokyo.  Japan's skeptical attitude towards vaccines takes precedence over the newer Western one
Ginza shopping district in Tokyo. Japan’s skeptical attitude towards vaccines is haunting the newer Western “anti-wax” sentiment that has flourished on social media. | AP

While figures such as US Vice President Mike Pence and President-elect Joe Biden have received the dose, and leaders such as Indonesian President Joko Widodo are voluntarily the first to receive it in their countries, Prime Minister Yoshihide Suga has said he will wait for his lucky.

Health Minister Norihisa Tamura said on Friday that he had asked relevant bodies to prioritize the review of Pfizer’s application, but did not provide a timeline for approval. A spokesman for the Ministry of Health also declined to comment on the reported timeline.

MMR problem

Japan’s modern vaccine problems have their roots in measles, mumps and rubella vaccination, some of which are suspected to lead to higher rates of aseptic meningitis in the early 1990s. Although no final link was established, the shots were interrupted and on this day, Japan does not recommend a combined MMR shot.

Another catalyst was a 1992 court decision that not only made the government responsible for any side effects related to vaccines but also prescribed that suspected side effects should be considered as side effects, says Tetsuo Nakayama, professor at Kitasato Institute for Life Sciences whose research focuses on vaccines. Two years later, the government revised a vaccination law and abolished compulsory vaccinations.

These events helped send a message that vaccinations should be taken at your own risk and diluted awareness of vaccination as a greater public benefit, says Mikihito Tanaka, a professor at Waseda University who specializes in science communication.

“Japan has a strong health insurance system and an available medical system,” he said. “Compared to places like the United States, it makes the incentive to play their health with a new vaccine very low.”

The use of the human papillomavirus (HPV) vaccine is also widespread in public memory. Following media coverage of allegations that the vaccine’s side effects included severe headaches and seizures, the Ministry of Health in 2013 withdrew its recommendation on the shot, which has been shown to be safe and effective in preventing cervical cancer. Although it remained available on request, the vaccination rate dropped from 70% to less than 1% at present. That could have led to another 5,700 deaths, according to a study.

‘Wide shows’

Japan’s drug approval requires clinical trials with Japanese people, but an emergency condition based on data from other countries is allowed. Vaccines for the H1N1 2009 flu pandemic received emergency approval after approximately three months of review.

The government still has to deal carefully with how the public experiences a rapid approval process. The economic consequences of the pandemic and the upcoming Olympics in Tokyo may lead to faster approval, but also raise suspicions as to whether the shots have been thoroughly investigated.

How the public will perceive some typical side effects also applies, Nakayama said. Initial data from the vaccines show local pain in 80% of cases and fatigue and headaches in up to 50%, but “there has never been a vaccine in Japan that has caused reactions at these levels,” he said. The question begs questions that will ultimately determine public opinion on the scope of the launch.

Tanaka said he was particularly concerned about the influence of various news programs, which serve as both news and entertainment and are hugely influential in shaping the public, which will ultimately determine the extent of the launch.

“The final decision to take the vaccine or not will be made by the people,” Health Minister Tamura said on Friday.

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