December 18, 2020

Article at Washington Post

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Japan had ordered enough vaccines for the whole country. Now it has to overcome a history of vaccine mistrust.

TOKYO — Japanese long-distance runner Hitomi Niiya doesn't want to take a coronavirus vaccine ahead of the Summer Olympics in Tokyo.

She’s worried about side effects and has faith in the precautions already underway. The 32-year-old elite athlete isn’t alone.

Japan’s government has preordered 290 million doses of the Pfizer, AstraZeneca and Moderna vaccines, more than enough to cover its population of 126 million, and says it aims to vaccinate everyone by the middle of next year — in time for the pandemic-delayed Olympics in July.

But the government’s haste to put an end to the pandemic, repair the economy and pave the way for the Games stands in contrast to the public’s caution.

A global study published in September in the British medical journal the Lancet showed that Japanese people were among the world’s least confident in vaccine safety, alongside people in France and Mongolia, with fewer than 10 percent of respondents strongly agreeing with the idea that vaccines are safe.

“Athletes take managing our physical conditions as seriously as our results,” Niiya told reporters after being selected by Japan’s athletics federation to compete in the 10,000 meters at the Games.

This is not a land of anti-vaxxers and conspiracy theorists, but a country where the public is often deliberate and careful, especially about foreign drugs. Layered on that is a memory of past vaccine safety scares, dating to the U.S. occupation after World War II.

The challenge for Japan — as for many other countries, including the United States — is to overcome skepticism and mistrust as the vaccine effort moves onto the global stage. Failure in Japan to reach a critical mass of vaccinations could not only put the Olympics in danger, but also slow the country’s return to the global economy and international tourism when the post-pandemic recovery gets underway.

A study in October by the international research group Ipsos found that 69 percent of Japanese people “agree” or “somewhat agree” that they would take a vaccine against the coronavirus when available. That’s down from 75 percent recorded in August, but above the U.S. score of 64 percent.

But a closer look at polls in Japan shows much more caution than enthusiasm — reflected in sharply lower vaccination rates for diseases such as the human papillomavirus, or HPV, a common sexually transmitted infection.

A December survey of 1,000 people by Japan Trend Research showed that fewer than 11 percent of respondents wanted to get a vaccine immediately, compared with almost 27 percent who said they didn’t want to get a shot.

By far the largest group, nearly 63 percent, said they didn’t want to get a vaccine immediately but would do so “eventually.”

“It’s a little scary,” she said, citing a lack of information and the fact that the vaccines were made overseas. “I’ll wait until other people have got them.”

Vaccinations were made compulsory in Japan after World War II as the U.S. military tried to suppress epidemics raging through a destitute and malnourished population. Armed soldiers rounded up civilians who did not comply.

But the Japanese government’s confidence was shaken in 1993 when the measles, mumps and rubella vaccine led to cases of aseptic meningitis and a significant compensation bill for the Health Ministry.

In 1994, the government changed the immunization law, replacing compulsory childhood vaccinations with a “strong recommendation” to get protection.

“The ministry has become hesitant about advocating vaccines since then,” said Kentaro Iwata, a professor of infectious diseases at Kobe University. “A vaccination program exists, but they don’t really show off how good vaccines are.”

Japan controversially abandoned a national program to administer the HPV vaccine to adolescent girls in 2013, after side effects were reported including muscle pain, sleep disorders and light and sound sensitivity.

Although coverage for childhood vaccines remains high in Japan, as it is in all high-income countries, HPV vaccination rates have tumbled from more than 70 percent to less than 1 percent, already leading to more than 5,000 preventable deaths of cervical cancer, a study published in April found.

Japan normally requires vaccines and drugs to undergo trials in the country rather than automatically accepting overseas trials, citing concerns that ethnicity can affect drug efficacy.

In 2003, however, the authorities approved leflunomide, a rheumatoid arthritis drug, without conducting a late-stage trial here. At least 22 people later developed interstitial pneumonia and nine died — a problem that has barely been observed in the West.

“It was later discovered that the dose of the drug used in Japan was a little too high for the Japanese people,” said Masayuki Miyasaka, an emeritus professor of immunology at Osaka University.

Pfizer and AstraZeneca have both conducted small-scale clinical trials of their coronavirus vaccines in Japan, but a large-scale final-phase trial is impractical given the relatively low incidence of the coronavirus in the country.

Takashi Nakano of Kawasaki Medical School, a member of a Health Ministry advisory board on vaccines, said the vaccination program could begin in March.

“This is the dilemma, between the need for intervention as soon as possible, and the need for more time to convince people the vaccine is safe and effective,” Iwata said.

Japan’s parliament amended the vaccination law this month to make the coronavirus vaccine free to residents. The government also promised to cover medical costs and disability allowances in case of serious side effects, and shoulder any damages on behalf of vaccine suppliers.

The problem is that Japan’s government doesn’t enjoy high levels of public trust, especially over its coronavirus policy.

“Openness and transparency are things the government lacks,” said Iwata. “They try to avoid discussion, and they are very good at avoiding criticism.”

Meanwhile, the International Olympic Committee will strongly encourage athletes to get inoculated before competing in the Games. The Japanese government is likely to encourage spectators to do the same, especially if they are coming from abroad.

Confidence may rise if vaccines work well in the West. Impatience to return to a normal life may also motivate people to get vaccinated, and some companies might encourage employees to do so.

Still, experts say it will be tough to get enough people vaccinated to stamp out the pandemic by the time the Games take place.

Nakano said the Olympics can still go ahead in that environment, based on frequent and rapid testing of athletes and spectators.

“Maybe you will have a limited number of people in the stadium or gymnasium,” he said. “Otherwise the Games can’t be held.”