In anticipation of a surge in demand in some municipalities for doctors and nurses eligible to administer COVID-19 vaccines, Japan will enlist the help of dentists for its nationwide inoculation program, which is currently progressing at a very slow pace.
After gaining approval from a panel of experts, the health ministry decided Friday to allow dentists — who are deemed ineligible to give COVID-19 vaccines under the Medical Practitioners’ Law — to administer the shots under some circumstances.
Japan rigidly controls who can administer coronavirus vaccines, contrasting sharply with countries such as the United States and the United Kingdom, where an array of health care personnel besides doctors and nurses — including dentists, pharmacists, medical students and emergency medical technicians — have been deployed to help staff the inoculation program. In the U.K., even volunteers from all walks of life who have no medical qualifications have been trained to administer the Pfizer-BioNTech and AstraZeneca vaccines.
Currently, less than 1% of Japan’s population has been fully vaccinated, one of the lowest levels among developed countries. Vaccinations for health care workers started in February, with some local governments having moved forward with people age 65 or older, the next priority group, earlier this month.
Health ministry officials chiefly blame the delay on insufficient vaccine supplies, denying that the strictly limited pool of vaccinators is responsible for the slow pace at which the rollout is proceeding.
The planned deregulation targeting dentists, they say, is more of a pre-emptive measure meant to address a dearth of vaccinators, an issue that some municipalities might start grappling with in the coming months.
“Since the amount of vaccine available remains in short supply, it’s not like there are many municipalities at this point that are struggling to secure enough vaccinators,” health ministry official Megumi Nozawa told reporters. The deployment of dentists, she said, is reserved for “when vaccine supply increases to the point where a greater number of people can get the shots.”
In some areas, though, the crunch is already surfacing. A probe by the health ministry in March showed that about 20% of municipalities nationwide felt there were not enough doctors or nurses being mobilized for mass vaccination venues.
As things stand, anyone with a doctor’s license is permitted to administer COVID-19 vaccines on their own, regardless of their specialty. Nurses are allowed to do so under the guidance of doctors. Dentists, who are categorized differently from doctors, don’t have the license needed to perform what are considered medical practices, including COVID-19 vaccinations.
But dentists are deemed the most suitable to substitute for doctors and nurses: Their profession has to deal with intramuscular injections, a technique needed for COVID-19 vaccinations, and anaphylaxis, a rare but potentially fatal allergic reaction to the shots.
Administering COVID-19 shots is “a relatively easy process, but still has the risk of nerve damage or complications if executed wrongly,” said an official at the health ministry’s Health Service Bureau, who asked not to be named.
“So I think the question is to what extent each nation is willing to deregulate” the scope of eligible vaccinators at the possible risk of compromising safety, the official said, adding that the ministry at the moment doesn’t intend to go beyond dentists to involve other health care professions, such as pharmacists and emergency medical technicians.
Since dentists giving shots is technically illegal, they will only be permitted to do so under some exceptional circumstances.
Their involvement, for example, will be contingent upon municipalities not being able to secure enough doctors and nurses to go ahead with mass vaccinations at public facilities. In cases like that, dentists will be asked by their municipality to travel to various places repurposed as vaccination sites, including local gymnasiums, community centers and shopping malls. Unlike doctors, they won’t be able to perform vaccinations at their own clinics.
Those willing to cooperate will also be required to undergo a few hours of training on intramuscular injections if they have no prior experience performing the procedure. Identifying themselves as dentists and obtaining consent from those about to be vaccinated will be mandatory, too.
But even if their help is called for, questions remain over how motivated dentists will feel to contribute to the vaccination program.
For one thing, intramuscular injections, which typically involve a needle going deep into the muscle of an upper arm, are an unorthodox practice in Japan that “even we doctors rarely perform these days,” Takako Shimizu, adviser to Seirei Social Welfare Community in Shizuoka Prefecture, said during a health ministry panel meeting Friday.
This is even truer of dentistry, given its focus on oral health care — although those specializing in dental surgery or anesthesia at university hospitals generally have more experience than local dentists performing such a procedure.
Dentist Yoshiaki Udagawa, who runs his own clinic in Tokyo’s Edogawa Ward, says his routine practice doesn’t ever involve them.
“I can see how some dentists might balk at doing this because the procedure is something we don’t perform at all,” Udagawa said.
“Even when there is a procedure coming up that has to do with oral treatment, my specialty, I don’t deal with an actual patient unless I do some meticulous preparation first, if it’s something unfamiliar.”
At the moment, with his neighborhood not facing a severe shortage of vaccinators, Udagawa says he doesn’t feel particularly incentivized to sacrifice his business hours by making a trip to a vaccination site — even though it’s most likely to be a paid gig.
But if the situation grows urgent enough to justify his cooperation, “I would definitely do it for the sake of my community, with a sense of mission,” he said.
Dentists face tougher times in pandemic
Like elsewhere in the world, dental businesses in Japan have been hit hard by the economic fallout from COVID-19, due in part to concerns over their perceived high-risk nature.
In guidance issued last year, the World Health Organization identified oral health care workers as “at high risk of being infected with SARS-CoV-2 or passing the infection to patients,” citing their prolonged face-to-face communication with patients, “frequent exposure to saliva, blood, and other body fluids” and handling of sharp instruments. The organization also urged the avoidance of nonessential trips to dentists, such as for oral health checkups, dental cleanings and preventive care.
“When the news went around that dentistry is high risk, visits to dental clinics plummeted,” said Hideki Endo, vice chairman of the Japan Dental Association.
But few reports have since emerged of virus clusters at dental clinics in Japan. Add to this the growing public awareness that maintaining oral hygiene actually helps battle the spread of the virus, and the industry is now on course to recover, Endo said.
Tokyo dentist Yoshiaki Udagawa recalled the initial dread he felt at the spread of a novel pathogen that defied every “standard precaution” against infections he had implemented at his clinic for the last 20 years.
Prior to COVID-19, “our anti-infection measures were primarily about preventing blood-borne diseases such as AIDS and hepatitis B. But when I learned COVID-19 was transmissible via saliva, I thought, ‘Well, this is going to be one heck of a battle,’” he said.
Omnipresent at his clinic now, he says, is plastic wrap that covers common touch points and equipment, and gets discarded with every new patient. Staff now guard themselves with gloves, masks, protective gowns, surgical caps and face shields.
“The pandemic was a blow to us, but it also allowed us to take our anti-infection measures — which have always been at the core of our profession — to a next level,” Udagawa said.
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