Challenges surrounding COVID-19 vaccination in Japan: Fraught history and current vaccine hesitancy

This article was exclusively written for The European Sting by Mr. Tai Nguyen Van, a forth-year medical student at the International University of Health and Welfare, Japan. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Japan is facing a third, biggest and most severe wave of COVID-19 and there is yet no signs of abating. COVID-19 vaccine is anticipated as the key strategy to contain the pandemic. However, while millions of people have already been immunized in the United States and European, Japan has not yet approved a single jab.

For a vaccine to get approved in Japan, it requires additional domestic clinical trials to ensure vaccine safety, which means that the process usually takes longer time, and the first vaccine may not be rolled out before late February, the latest among developed countries.

Japan’s current caution in the vaccine approval process has its root in the country’s bitter history when dealing with adverse events following immunizations. In the early 1990s, measles, mumps, and rubella vaccine was suspected to cause aseptic meningitis among children, leading to the vaccine withdrawal in the following years. The government was held liable for adverse reactions related to vaccines, even though there was no definitive link¹.

Another event was related to reports of chronic pain and walking abnormalities following human papillomavirus (HPV) vaccine immunization in 2013. Extensive media coverage on the adverse events and public outcry prompted the government to suspend the active recommendation for the shot afterward. However, the problem went on at the court when the anti-vaccine groups established by the parents of “HPV vaccine victims” raised a lawsuit against the government and pharmaceutical company for compensation for the adverse events².

Those past issues cause the government to be very cautious and passive in introducing new vaccines or taking initiative in vaccination, owing to the fear of being involved in lawsuits.

Vaccine hesitancy may also pose a threat to the COVID-19 vaccination campaign. Japanese’s confidence in vaccines is one of the lowest in the world. Only about eight to nine percent of people strongly agreed that vaccines were safe, according to a Lancet study³. A recent survey by Ipsos found that 31 percent of Japanese said that they did not want the jabs⁴.

Some medical experts also express doubts about the emergency approval of the vaccine. Dr. Tetsuo Nakayama, the director of the Japanese Society of Clinical Virology, said that despite showing effectiveness in clinical trials, it is uncertain that antibodies created by the vaccine remain a year or two after immunization. There are also concerns related to the vaccines’ long-term safety. The abbreviated development timeline means that there is little opportunity to identify adverse events that might occur in the longer term or only appear after massive administration of the vaccine.

Complacency is another significant factor. Japan’s COVID-19 death toll is about 5000, much smaller in the U.S. and Europe where the death toll has exceeded 500 000. The fact that the risk of developing a severe condition or dying from the disease is low, and most infected people only manifest mild symptoms may, ironically, become a major hurdle to a successful vaccine campaign. 

Reference

• Gomi, H., & Takahashi, H. (2004). Why is measles still endemic in Japan?. Lancet (London, England), 364(9431), 328–329.
• Okuhara, T., Ishikawa, H., Okada, M., Kato, M., & Kiuchi, T. (2019). Newspaper coverage before and after the HPV vaccination crisis began in Japan: a text mining analysis. BMC public health, 19(1), 770.
• de Figueiredo, A., Simas, C., Karafillakis, E., Paterson, P., & Larson, H. J. (2020). Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet (London, England), 396(10255), 898–908.
• Ipsos (2020). Global attitude on a Covid-19 vaccine, Ipsos survey for the World Economic Forum. Available at: https://www.ipsos.com/sites/default/files/ct/news/documents/2020-11/global-attitudes-on-a-covid-19-vaccine-oct-2020.pdf. (accessed: January 24^th, 2021)

About the author

Tai Nguyen Van is a forth-year medical student at the International University of Health and Welfare, Japan. He is the Director of Academics, AMSA Japan and a student peer reviewer at Journal-AMSA. He has an interest in immunization and vaccine hesitancy. He is the first author of the white paper “The HPV vaccine crisis in Japan”, which were selected as finalist of the academic competition, East Asian Medical Student Conference, Manila 2021.