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The government is scrambling to begin the rollout of coronavirus vaccinations as early as the end of February. But in a nation where many people are skeptical about vaccines in general, Japan may face a daunting challenge in trying to convince people to get the shots even when they are available.

There is a scientific consensus worldwide that the COVID-19 vaccines are highly effective and that they will help achieve herd immunity — a light at the end of the tunnel.

Polls have shown recently that nearly 70% of Japanese are willing to get a coronavirus vaccine. But still, skepticism against vaccines is deeply rooted in the country.

In a 2016 EBioMedicine study of 67 countries, 31% of Japanese were skeptical of vaccine safety, ranking third-highest following France (45.2%) and Bosnia and Herzegovina (38.3%). The global average was 13%.

While conventional vaccines inject a weakened or inactivated form of a live virus to trigger an immune response, the messenger RNA (mRNA) vaccines developed by U.S. firms Pfizer Inc. and Moderna Inc. do not.

Once injected, the mRNA gives instructions for cells to make a spike protein found on the surface of the coronavirus that the immune system recognizes and makes antibodies against. In the process, mRNA does not enter the nucleus of the cell, where DNA is kept, and breaks down soon after the mRNA gives the instructions, according to the U.S. Centers for Disease Control and Prevention (CDC).

Vaccine skeptics

A small group of doctors have expressed concerns about the state-of-the-art mRNA vaccines or a vaccine using a double-stranded DNA developed by British drugmaker AstraZeneca. Among them is Dr. Masahiko Okada, professor emeritus of Niigata University, 74. He’s in favor of influenza and other vaccines in general, but said he would not get a coronavirus vaccine, citing possible side effects of vaccines that use a piece of genetic code over the long term.

“There have been many deaths and cancer cases reported in relation to gene therapy,” Okada said. “When an artificially produced gene enters the body, it’s not possible to predict where in the genes it will be embedded. It may activate the gene that fosters cancer. The cancer latency period can be five years or more, so there’s no knowing whether there’s a serious side effect unless it’s tracked for at least five to 10 years.”

People wait to see if there are any reactions after receiving coronavirus vaccine shots in Beijing on Friday. | KYODO
People wait to see if there are any reactions after receiving coronavirus vaccine shots in Beijing on Friday. | KYODO

Okada also said he harbors mistrust for the pharmaceutical industry, as Western firms in the sector have a history of being slapped with billions of dollars in punitive penalties for manipulating data or fostering the off-label promotion of medical products, among other things.

“The biggest reason I have doubts about the coronavirus vaccine is that I cannot trust the data announced by the pharmaceutical companies,” he said.

“I’m not an ‘anti-vaxxer’ myself and I’m for influenza and HPV vaccines. I’m only against the coronavirus vaccine because I see no scientific basis (on safety),” said Okada, using a term for those opposed to vaccinations.

It is unclear whether vaccination rates in Japan will reach the 65% or higher necessary for herd immunity, thereby allowing our lives to return to normal again. But the resistance to vaccinations among fringes of the population will likely be here to stay for now.

“It’s hard to predict the coronavirus outlook, but humans and viruses have always coexisted during the past tens of millions of years,” Okada said. “The mortality rate from the Spanish flu a century ago was pretty high but it was gone completely in three years. What I fear most is that even though things may return to normal in a few years, we could have a horrifying scenario where the side effects of the vaccines remain in all human beings.”

Scientific consensus

Dr. Kentaro Iwata, professor and head of infectious diseases department at Kobe University Hospital, brushes aside such vaccine skeptics, saying that there’s no controversy regarding vaccines in general among infectious disease experts globally and that the matter has long been settled.

“The data shows good efficacy and high safety,” Iwata said. “To curb the pandemic, avoiding human contact is essential, but that alone is not enough. The vaccine is the only game changer, as there’s no other alternative because no effective therapeutic drugs are available.”

But the fact that there is still such debate on safety signifies that Japan is far behind other countries with regards to vaccines in general, he added.

A Brazilian health worker prepares a dose of a coronavirus vaccine in Sao Paulo on Sunday. | AFP-JIJI
A Brazilian health worker prepares a dose of a coronavirus vaccine in Sao Paulo on Sunday. | AFP-JIJI

“Japan has had a negative history with vaccines for the past 30 years, with the government lacking sufficient efforts to enlighten the public,” he said. “Mass media is also to blame for overemphasizing the risks of vaccines and all but ignoring the benefits brought about by them.

“So it’s not easy to change people’s mindset all of a sudden, but if you look at the data, it’s as clear as day that it’s better to have the shots.”

The concerns about side effects are small, although the U.S. CDC has so far detected 21 cases of severe allergic reactions, or anaphylaxis, after vaccinations, at a rate of 11.1 cases per million doses. Iwata is aware of the worries raised by the vaccine skeptics about any side effects over the long term but says there’s no use debating the side effects that may or may not materialize five to 10 years from now given attitudes toward other medical treatments.

In Japan, patients flock to new medicines, and some medical practitioners dispense new drugs marketed by pharmaceutical companies, Iwata said. He added, however, that he prioritizes using drugs used successfully for the past 30 to 40 years.

A woman gets vaccinated against the novel coronavirus in Miami on Tuesday. | GETTY IMAGES / VIA KYODO
A woman gets vaccinated against the novel coronavirus in Miami on Tuesday. | GETTY IMAGES / VIA KYODO

“Patients are willing to take these drugs every day, not questioning their health impact 10 years from now, while they suddenly worry about long-term side effects when it comes to vaccines. This, I think, is a double standard,” he said.

“If you have allergies, you should use discretion when getting the vaccinations, but people with no allergies would have a far better chance of getting the benefits, as the risks are extremely small.”

Overcoming the coronavirus pandemic will depend on each individual getting vaccinated to protect other people, Iwata said.

“Basically, there’s no other solution to the coronavirus crisis than reducing the number of patients,” he said. “But this message has not been conveyed effectively. As cases rise, so do the number of serious cases and deaths.”

When it comes to the pandemic, there is no point in discussing whether the government should prioritize containing the virus or keeping the economy going, he said.

“Conquering the coronavirus comes before everything else,” Iwata said. “If you don’t like the lockdown or other measures that severely restrict our social lives, then the best thing would be to get a vaccine.

“That would be the only remedy.”

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