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Clinical Infection & Immunity

Editorial

Volume 6, Number 3, September 2021, pages 69-70

Japan and COVID-19 Vaccines: When Playing It Too Safe May Mean Taking a Bigger Risk

The coronavirus disease 2019 (COVID-19) pandemic in Japan has shown some very interesting particularities. Despite being the third country to have the first COVID-19 case in January 2020, Japan’s COVID-19 incidence was much lower compared to many other countries during 2020 [1]. Japan also faced few deaths from the beginning, with only a 2.8% case fatality rate during the peak of the disease in April 2020. According to experts, Japanese healthy lifestyles and distinct cultures, which vary significantly from the USA or Europe, were the strength behind the early restraint.

Vaccination against COVID-19 is demonstrating to be the key protective measure against COVID-19 transmission around the world. Although achieving herd immunity through vaccination is considered vital in reducing the spread of COVID-19 and restoring normalcy in human activities, public perceptions of COVID-19 vaccines are still mixed [2]. These perceptions may affect the willingness to receive the vaccines, leading to lower vaccination rates, and placing vulnerable groups at greater risk.

All three types of anti-COVID-19 vaccines currently in use worldwide are based on new molecular biological technologies. Japan experienced a delayed vaccine roll-out compared to other countries. The Ministry of Health, Labour, and Welfare (MHLW) of Japan officially licensed Pfizer’s vaccine on February 14, 2020. The vaccine was approved under the Special Approval for Emergency (SAFE) system, on the basis that it had been approved in a foreign country that has an approval system of equivalent rigor to that of Japan [3]. To achieve herd immunity, the government recommends that citizens aged 16 and over be vaccinated with their consent but excludes pregnant women from mandatory efforts. In Japan, nurses and doctors are the sole personnel allowed to vaccinate the public. In order to have a sufficient number of workers administering the COVID-19 vaccine for mass inoculation, the government has established vaccination sites supported by provisional recruits and medical staff of the Self Defense Forces [4]. These constraints were relaxed in May, thus allowing other medical professionals such as pharmacists, dentist, and medical technicians to administer vaccines [5].

Japan has one of the lowest levels of trust and confidence in vaccinations in general [6]; hence, the people are less likely to be willing to receive COVID-19 vaccination. This skepticism may, thus, jeopardize the prospects of achieving the needed herd immunity in Japan. Initial epidemiological studies, conducted before the initiation of the COVID-19 vaccination program in Japan, showed high willingness of the population to be vaccinated (62.1-65.7%) [7, 8]. This percentage dropped to 46.62% after the deployment of the program, with 53% of the population hesitant or refusing vaccination [2]. Vaccine hesitancy in Japan has been historically built up after controversies surrounding the measles, mumps, and rubella (MMR) and, more recently, the human papillomavirus (HPV) vaccines [5].

Side effects, concerns about safety, or lack of effectiveness were main reasons for hesitating or not wanting to be vaccinated against COVID-19 [7]. A later study using rigorous analysis showed that men had a higher willingness and were less hesitant to receive vaccination than women, which were more concerned over the COVID-19 vaccine’s potential side-effects [2]. Initially, people living in rural areas were keener to be vaccinated than those in urban areas [7], challenging the notion that people living in urban areas may have more awareness about COVID-19 prevention, suggesting a higher elder population in rural areas in Japan as a possible explanation [7]. A subsequent analysis, however, showed that older working-age people, with low subjective health status, were less willing and were more hesitant to receive the vaccination [2]. Also having children and financial status variables were associated with willingness to take a COVID-19 vaccine [2].

Japan has a long-established no-fault compensation scheme for people who have adverse drug reactions from vaccines or drugs. Japan is unique in that it has a no-fault compensation scheme for drugs financed mainly by contribution from pharmaceutical companies [9]. The COVID-19 pandemic presents an opportunity not only for vaccines, but also for covering drugs under no-fault compensation schemes.

Although Japan is preparing to host the Summer Olympic Games in Tokyo, less than 10% of the population had been vaccinated as of June 26, 2021. Approximately 750,000 doses of the COVID-19 vaccine are currently given each day [5]. It will be necessary for its government to find innovative ways as soon as possible in order to solve the obstacles and achieve their vaccination goals.

Acknowledgments

None to declare.

Financial Disclosure

None to declare.

Conflict of Interest

None to declare.

Author Contributions

MM and JC wrote the manuscript.

Data Availability

The authors declare that data supporting the findings of this study are available within the article.

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Clinical Infection and Immunity is published by Elmer Press Inc.