Japan: From vaccine hesitancy to vaccine success

Japan made a dramatic turnaround in its vaccination rates in the space of several months

It seems hard to believe now, but at the beginning of June, I was seriously contemplating flying to the United States to get a Covid vaccine.

With just seven weeks to go until the Olympics, only 3.5% of Japan's population had been fully vaccinated. While friends in the UK were merrily posting vaccine selfies on social media, here in the capital Tokyo, we were joking we might not see a needle till Christmas.

With the Olympics about to open, it seemed astonishing the Japanese government had bungled the vaccine rollout so badly.

Six months later, it couldn't be more different.

Not only has Japan succeeded in overcoming the early chaos, it's managed to get a higher percentage of its population vaccinated than almost anywhere else on Earth. Some 76% of Japanese are now fully immunised.

The Olympics was key.

Remember, back in July, the large street protests demanding the games be cancelled? There was real anger and fear the games would turn in to a super-spreader event.

Horrified that their big event might be ruined, the politicians finally got their act together.

The army was called in and by the beginning of July, a million shots were being given each day.

But it's not just the logistical turnaround that's been a surprise; it's how willing Japanese people have been to get the vaccines. In the over-80 age group, 95% have now had their shots - no sign of vaccine hesitancy there.

But that is not what was predicted.

Fear vs hesitancy

Japan has a long history of vaccine hesitancy. In January, a survey showed a large majority were sceptical about the newly developed Covid vaccines.

So what happened?

Some experts think the early chaos actually helped.

"Early on, there was a real shortage of vaccine available," says Prof Kenji Shibuya, research director at the Tokyo Foundation for Policy Research. "That led to a kind of scarcity mentality prevailing, especially among the elderly."

Prof Shibuya thinks fear drove the extremely high uptake rate, especially among the elderly. They saw how old people in other countries were dying, and scrambled to get vaccinated, before supplies ran low.

The slow start also meant younger people had to wait, and watch, as hundreds of millions of people in other countries got shots, without dramatic side effects. That reassured them the vaccines were safe.

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Another key difference with America and Europe is that vaccines have not become political.

"We don't have any politicisation here," says Prof Shibuya. "It is not being viewed through the lens of freedom or individual rights. The general public hasn't gone in for any conspiracy theories."

As the vaccination rate has risen, the country has witnessed a dramatic fall in Covid infections and deaths.

On 20 August, Japan recorded nearly 26,000 new infections, the highest single day total since the pandemic began.

By last week, that number had fallen to just 150 a day. There has been a similar fall in deaths, with several days last week where no deaths were reported at all.

The vaccines have been extremely important. But they're not the only factor. Even before the vaccines were in people's arms, Japan's Covid death rate was dramatically lower than the US or Europe.

America's death rate from Covid is 233.8 deaths per 100,000 people. Japan's is just 14.52, according to Johns Hopkins University figures.

Obesity a factor?

Prof Testuo Fukawa is a sociologist at the Institution for Future Welfare in Tokyo. He says what we've seen in Japan is truly remarkable.

"The number of deaths is really low," he says. "In 2020, Japanese life expectancy even increased. It's really very special. In other countries - including the United States, UK, Germany, France - all these countries' life expectancy decreased in 2020."

Experts in Japan are investigating whether its low rate of Covid-related deaths could be linked to low obesity rates

Prof Fukawa thought there might be a connection between Japan's low Covid death rate, its long life expectancy, and its low rate of obesity.

"The Japanese have a very long life expectancy," he says. "Nobody can explain why. Japanese eating habits may contribute to that. And then there's the obesity rate."

Just 3.6% of Japanese people are classified as obese, among the lowest in the world.

Prof Fukawa compared life expectancy, obesity and Covid death rates across nine countries. The result: countries with low obesity rates have lower Covid death rates.

This will not be a surprise to those treating Covid patients in America, where obesity is increasingly seen as a key factor in making Covid worse. But Prof Shibuya says it's not the answer to why Japan is doing so well.

"Obesity is a risk factor," he says. "But at population level, it's not the most significant factor, it's not the factor X."

In fact, Prof Shibuya doesn't think there is anything exceptional about Japan's Covid record. He says the answer is simple, Japan has fewer deaths because it has fewer cases.

"Japan's case fatality rate is not good, but we succeeded in minimising the number of cases," he says.

In other words, if you catch Covid in Japan, your chances of dying from it are similar to those in Europe and America. But in Japan, you are much, much less likely to catch it. And the reason for that is behaviour.

Face masks are a common sight in Japan, whether on public transport, beaches or on the streets

I've heard from colleagues in London that on the streets these days, almost no-one is wearing a mask. Even in confined spaces, like the underground, it's becoming a rarity.

Not in Japan. Here, everyone wears a mask - at the park, even on the beach. Even lone car drivers can be seen wearing them as they speed past.

And then, there's the hand sanitiser. It's everywhere: at convenience stores, public toilets, train stations, restaurants and cafes; everywhere you go, you are expected to sanitise your hands before touching anyone or anything.

It can feel a little oppressive and at times illogical. But there is little doubt that it works.

"People behaved really well, with mask-wearing and social distancing," Prof Shibuya says. "But that is gone now."

The success of the vaccine rollout and the lifting of the state of emergency means people are returning to offices, and going out to pubs and restaurants again.

The sense of fear that kept people distanced for a year and a half is fading. And because of that, he thinks the very low infection rate Japan has now will not last.

"We are one to two months behind Europe" he says. "Very soon, we will see another wave developing."