Japan’s vaccine rollout is set to start in less than two weeks. But with the rollout in other countries, including the U.S., not going as smoothly as authorities would have wanted, there are worries that it could be chaotic for Japan, too.

The rollout in Japan is the last among the Group of Seven nations, with the health ministry set to formally approve U.S. drugmaker Pfizer Inc.’s mRNA vaccine, developed jointly with Germany’s BioNTech SE, on Feb. 15. The start of vaccinations for medical professionals will follow two days later, local reports say.

Prime Minister Yoshihide Suga’s administration aims to secure enough vaccines to cover all residents by the end of June. The government has not given a timetable for vaccinations beyond those for older people starting as early as April 1, but a growing number of local governments including Osaka Prefecture are planning to complete inoculations of all willing residents by the end of September.

Here is a look at the plan for the rollout, including for foreign residents in Japan, and some of the challenges there are in setting up the logistics for effective delivery:

What is the schedule for the rollout?

The government is planning to provide free coronavirus vaccinations to all residents age 16 and older. About 10,000 to 20,000 front-line health care workers at about 100 state-run hospitals will be vaccinated first, followed by a further 3.7 million health care workers. Vaccination tickets are set to be sent to about 36 million people age 65 and older within the second half of March, with the inoculations slated to kick off from April, according to a government schedule.

Other priority groups include 8.2 million people with chronic conditions, 2 million nursing care workers for older people and 7.5 million people age 60 to 64. Vaccinations for the general public are expected to start from around July. The government has signed contracts with Pfizer Inc., fellow U.S. pharmaceutical firm Moderna Inc. and British drugmaker AstraZeneca PLC for a total of 314 million doses.

AstraZeneca filed for fast-track approval of its vaccine with the health ministry on Friday, while approval of the Moderna vaccine is unlikely until May.

A worker holds a vial of water during a vaccination simulation in Kawasaki in January. | BLOOMBERG
A worker holds a vial of water during a vaccination simulation in Kawasaki in January. | BLOOMBERG

What could delay the vaccine rollout?

One of the concerns is export restrictions in Europe. Facing severe vaccine shortfalls, the European Union last week announced export controls on coronavirus vaccines, requiring drugmakers to gain export authorization, thereby prioritizing shipments to EU countries. AstraZeneca, which has signed a contract to supply 120 million doses to Japan, was set to export 30 million shots to Japan by the end of March, but Taro Kono, the minister in charge of the vaccination drive, has expressed concerns about delivery delays. The firm is considering manufacturing the remaining doses in Japan.

The government has been making final arrangements for the first batch of Pfizer vaccines to arrive in Japan from Belgium as early as Feb. 14, local reports have said, but the government has not made such information public due to concerns about unexpected circumstances such as acts of terrorism.

Securing storage for the vaccines, which need to be kept at a low temperature, could also be a problem.

The government has secured 20,000 freezers to store vaccines, and the distribution of deep freezers to store Pfizer’s vaccine, which need to be kept at minus 75 degrees Celsius, to municipalities began this week. The government plans to distribute 3,370 deep freezers for Pfizer vaccines by the end of March, but no plans for deploying freezers for Moderna vaccines have been set as of now.

Will foreign residents in Japan be eligible for the vaccinations?

Any foreign national registered with their local municipality will be issued a vaccination ticket.

“Expats and other foreign residents in Japan who are registered with a municipality of residence, and Diplomats are eligible for the COVID-19 vaccination,” Kono said on Twitter, adding that the inoculation questionnaire will be translated into multiple languages.

Foreign residents age 65 and older will be on the same priority list as Japanese in that age group and should start receiving the vaccination tickets from mid-March, said Shigenori Doi, a vaccine rollout manager for Tokyo’s Minato Ward. The ward is home to nearly 19,000 foreign residents and has one of the highest percentages of foreign residents in Japan, at 7.2%.

A healthcare worker holds an empty syringe during a vaccination simulation in Kawasaki in January. | BLOOMBERG
A healthcare worker holds an empty syringe during a vaccination simulation in Kawasaki in January. | BLOOMBERG

Once received, they would need to make reservations either via smartphone, PC or by contacting a call center. The instruction will likely not be written in multiple languages, but people who speak English, Chinese or Korean will be deployed at the call center, Doi said.

Meanwhile, those who are not registered with their municipality will need to contact their local government.

“There is a sizable population of diplomats in Minato Ward who do not have a residence certificate due to their diplomatic privilege,” he said. “But if they come to us and make a request, we will provide the vaccinations once the confirmation of their residence is made.”

Where will it be possible to get vaccinated?

In principle, eligible people need to get the shots in the city where they have registered their address. But company workers or students living away from home or people hospitalized outside their municipality can ask their current city or town to get the shots there if it is difficult to return to their home.

Some local governments, such as Tokyo’s Shinagawa Ward, have been making arrangements to secure large venues for mass vaccinations that provide enough room for people to stay for 15 to 30 minutes. Most severe reactions, known as anaphylaxis, start manifesting symptoms within half an hour of vaccination.

Nerima Ward in Tokyo, meanwhile, has been gaining national attention for its plan to give the shots mainly at primary care offices. A high-ranking government official says that the Nerima model could be an example to follow for many municipalities nationwide, as it would allow residents to be given the shots by family doctors more quickly because they are already familiar with their existing chronic conditions.

A tray of empty syringes during a vaccination simulation in Kawasaki in January | BLOOMBERG
A tray of empty syringes during a vaccination simulation in Kawasaki in January | BLOOMBERG

Who should and should not get the vaccines?

Anyone under age 16 is excluded from the vaccination program. The government does not recommend giving shots to people who have a history of allergic reactions to vaccinations, as they are considered to be at a higher risk of having adverse reactions.

The World Health Organization recommends that pregnant women avoid taking the shot due to a lack of sufficient data in clinical trials, while Japan has not set a clear guideline for pregnant women so far. But given the higher risk that they would suffer severe symptoms from COVID-19, the government is unlikely to categorically remove them from the program but instead urge caution when inoculating them, the Mainichi Shimbun has reported.

The Japan Society of Obstetrics and Gynecology has asked for pregnant women not to be removed from the vaccination drive outright, instead recommending that they avoid the jabs during the first trimester.

Two shots are required for the vaccines developed by Pfizer, Moderna and AstraZeneca at a few weeks’ interval. How will the government track the progress of the vaccination drive and make sure the shots are given at correct intervals?

The government has been working hard to install a new uniform database of coronavirus vaccinations that has real-time data on the details of the shots people receive, based on the QR code on the vaccination coupon and the unique 12-digit My Number issued to every resident in Japan, including foreign nationals. The system will, for example, help send alerts to people who do not show up to get a second dose, local reports have said.

In a time of both misinformation and too much information, quality journalism is more crucial than ever.
By subscribing, you can help us get the story right.