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Emi Tanaka insists she is no anti-vaxxer. The Tokyoite has always followed the guidelines diligently when it comes to recommended jabs for her 10-year-old son, saying any vaccine that protects “provides peace of mind.”

When it comes to the subject of vaccinating against COVID-19, however, she feels less at ease.

Her concerns center around safety, particularly in the longer term. Unlike established vaccines, including those for children that are developed and tested over a decade or more, the coronavirus shots hit the market in a matter of months, making long-term side effects impossible to assess, she says.

Furthermore, the government has been sending out mixed messages — on the one hand talking up the vaccine’s efficacy, while on the other dragging its feet with the rollout, she adds.

“It makes me wonder if it’s really safe,” she says. “It concerns me to the point I don’t want to have it myself, so, when my son’s turn comes, how could I possibly make him have it?”

Tanaka may not need to make that decision anytime soon. Under-16s are currently excluded from Japan’s coronavirus vaccination program, which started with front-line medical workers in mid-February and the 36 million-strong elderly population on April 12, several months behind the United States and Britain.

Less than 2% of Japan’s 126 million population has received the first of the two-dose Pfizer vaccine to date, and a study by Mizuho Research Technologies Ltd. estimates it could be as late as June 2022 before Japan achieves the magic number of 70% — the stipulated ratio for herd immunity.

The decision on whether this would include any of the country’s under-16s will likely hinge on the results of ongoing clinical trials outside Japan — and follow-up tests conducted domestically — that target this age group, says Takahiro Inoue of the health ministry’s vaccinations office.

“Children under 16 are currently ineligible and no decision has been made yet on when, or if, that will change,” Inoue confirmed on Tuesday, shortly after the U.S. announced the authorization of Pfizer’s vaccine for its 12- to 15-year-olds.

This was also the same day that Chief Cabinet Secretary Katsunobu Kato announced Japan may amend guidelines and follow suit, though a spokesperson for Pfizer Japan Ltd. stated Wednesday that such usage was still under deliberation by the Pharmaceuticals and Medical Devices Agency, Japan’s vaccine screening body.

A baby has a routine vaccination at Muza Kawasaki Pediatric Clinic in Kawasaki, Kanagawa Prefecture. | ROB GILHOOLY
A baby has a routine vaccination at Muza Kawasaki Pediatric Clinic in Kawasaki, Kanagawa Prefecture. | ROB GILHOOLY

Medical experts offer contrasting views on how this could play out.

As children are more susceptible to infectious diseases — a vulnerability heightened by communal environments they inhabit, such as nurseries and schools — it could be argued that children should have the COVID-19 jab as soon as possible, says Takashi Nakano, professor and head of pediatrics at Kawasaki Medical School in Okayama Prefecture.

“In principle, however, vaccines are developed for children depending on the disease burden, for example, polio, where that burden is high,” explains Nakano, who is a certified infection control doctor and a specialist adviser for the Japanese Association for Infectious Diseases. “But in the case of COVID-19, the disease burden for children is low, especially compared with the elderly.”

Health ministry data indicates that, as of May 5, 61,000 children (about 9.5% of the total nationwide) have tested positive for COVID-19, with few severe cases and zero fatalities.

This compares favorably with many other developed countries.

According to the American Academy of Pediatrics, as of May 6 over 3.85 million children in the U.S., or 14% of the total, have tested positive for COVID-19 since the onset of the pandemic. Of those, 15,740 have been hospitalized (in the 24 states and New York City providing age distribution data in hospitals) and 306 have died (in 43 states, New York City, Guam and Puerto Rico).

With the vast majority of Japan’s child cases being mild and health data indicating the low risk of them becoming seriously ill or dying, “it’s difficult to say at this point if children need to be vaccinated or not,” Nakano says.

Ken Ishii, a professor in the vaccine science division of the University of Tokyo’s Institute of Medical Science, says that while clinical trials on children should be conducted “ethically and carefully,” concerned guardians should keep in mind the risk-reward mantra.

“My basic motto as a vaccination scientist is ‘haste makes waste,’ and it’s always better to wait longer to prepare for any long-term incidences, including side effects, that could affect children,” Ishii says. “But another thing I say is that the benefits of any vaccine outweigh the risks. Infections and the complications that can result (from contracting the illness) are always higher risk than vaccines.”

Ishii, whose institute is collaborating with pharmaceuticals company Daiichi Sankyo to develop a COVID-19 vaccine, says the key to convincing guardians lies with effective education to allay fears regarding the safety of the vaccines.

Nurses prepare vaccines from vials for a routine vaccination at Muza Kawasaki Pediatric Clinic in Kawasaki, Kanagawa Prefecture. | ROB GILHOOLY
Nurses prepare vaccines from vials for a routine vaccination at Muza Kawasaki Pediatric Clinic in Kawasaki, Kanagawa Prefecture. | ROB GILHOOLY

In recent years, the number of vaccines for children, in particular for newborns, has increased considerably, but information about them has been lacking, he says.

Consequently many parents remain unaware of the benefits that vaccines provide for their children. When they try to educate themselves, they often turn to the internet for help, he says.

“Google any vaccine for children and at least half the sites will be very toxic, giving negative information that appears reliable even though it’s bogus,” he says, adding that daytime TV shows often perform a similar disservice.

“So the real problem is there’s not enough education to get across the benefits of these important vaccines, which have been proven safe and effective since being introduced years ago,” he says.

Ishii believes popular approaches to education, such as the cartoon dog chatbot Corowa-kun recently created by medical doctors and the manga series “Hataraku Saibo” (“Cells at Work”) can help, though it may take more than a cute canine and clever cartoons to overcome some deeply ingrained skepticism that is a legacy of Japan’s sometimes difficult vaccination past.

Health complications resulting in disabilities and even some deaths have triggered the mothballing of several vaccines over the past 50 years, including the DPT (diphtheria/pertussis/tetanus) jab in 1975 and the MMR (measles/mumps/rubella) vaccine in 1993.

Thousands of lawsuits against the government ensued, resulting in an amendment to the Immunization Law in 1994 that relaxed formerly mandatory vaccination regulations, and the introduction of a compensation scheme that Ishii says is so shrouded in red tape, it “basically never happens.”

Today, children in Japan will likely have had around 26 so-called doryoku-gimu (literally “obligatory effort”), jabs that are “strongly recommended,” plus a number of other “voluntary” vaccines by the time they leave elementary school.

Among those voluntary shots is the annual influenza vaccines, which recent studies suggest may even protect against COVID-19 infection, but has a remarkably low administration rate in Japan (36.9% in 0-13-year-olds, compared to almost 70% in the United States).

While the shift from “mass” vaccinations in public health centers to an “individual” system conducted in neighborhood clinics has been applauded for respecting individual will, experts say it has also indirectly contributed to a society, and government, that is less informed of the dangers of forgoing inoculations.

This has been intensified during the coronavirus pandemic, when concerns about infection have discouraged guardians from taking children to medical facilities, says Rie Mitsui, director of the Muza Kawasaki Pediatric Clinic in Kawasaki, Kanagawa Prefecture.

Clinic director Rie Mitsui and her husband, Toshikatsu, sit in the waiting room at Muza Kawasaki Pediatric Clinic in Kawasaki, Kanagawa Prefecture, in May. Toshikatsu, who was formerly a vaccine researcher at Keio University School of Medicine's pediatrics department, joined his wife after she opened the clinic in 2016. | ROB GILHOOLY
Clinic director Rie Mitsui and her husband, Toshikatsu, sit in the waiting room at Muza Kawasaki Pediatric Clinic in Kawasaki, Kanagawa Prefecture, in May.  | ROB GILHOOLY

Vaccines are often very age sensitive, and delaying can be the cause of serious health complications, Mitsui says, adding data has revealed some children age 3 and above missing jabs for such diseases as Japanese encephalitis.

Coronaviruses, or any new infections to which there’s no immunity, are scary, but there are many other diseases that can affect a child’s healthy growth, result in permanent disability or even death, she says.

“The disadvantages of postponing routine vaccines are far greater than the advantages of avoiding coronas,” she says.

The same applies to those who are pregnant, with tests showing COVID-19 posing a greater threat to an unborn baby than the vaccination, the mother of three adds.

Her husband, Toshikatsu, who also practices at the clinic, points to scientific studies looking at the rate of spread of diseases, which are measured using the so-called “R0” number.

While the R0 for COVID-19 is between 1 and 2, for measles it is usually cited at 12-18, he says. In an unvaccinated population, this means that while each person with COVID-19 infects one to two new people, a person with measles infects 12 to 18 new people, he says.

“It’s difficult to make an assessment at this point, but judging by the COVID-19 infection situation alone, vaccinating children is probably not necessary,” he says after administering a Hib vaccine to a 4-month-old baby. “However, as the infection and overall societal situation worsens … that may change.”

One recent development that may precipitate that change is the spread of pernicious new variants, the proportion of which has been growing in the Kansai region and Tokyo, where they now make up 80% and 40% of new cases, respectively, according to the National Institute for Infectious Diseases.

Furthermore, data indicates that these mutant strains are particularly prevalent in children under 10 – three to four times higher, in fact, than conventional ones, though the National Institute for Infectious Diseases, which is attached to the health ministry, is quick to counter that this increase represents “no obvious trend.”

Another consideration is research showing children to be “silent carriers” who, even when appearing to be healthy, can be walking around with COVID-19 viral loads that are significantly higher than those of hospitalized patients.

Kayumi Fujimaki says such issues might have factored into decisions on future COVID-19 jabs for her five children, who are between 6 and 12 years old, but for nagging doubts about the trustworthiness of information regarding the vaccines that has been delivered so far.

Fujimaki, who works as a medical researcher, says that as a research student in the environmental sciences, she directly experienced government officials attempting to influence test results for their own purposes, and expresses concerns that the same thing might be happening with the COVID-19 vaccinations.

“I admit freely that a part of me doesn’t believe that vaccinations and medicines in general are as safe and good for you as we are led to believe,” she says, adding that, nonetheless, all her children have received the recommended routine jabs. “But I worry that (the government) might be cherry-picking data to assuage public concerns. For me, this puts a big question mark over the whole safety issue.”

While one recent survey indicated similar low trust in the government in its handling of the COVID-19 pandemic, other polls suggest a continuing low trust in the vaccines themselves.

One study published in September 2020 that looked at vaccination confidence across 149 nations found just 8.9% of Japanese strongly agree vaccines are safe — beating only Mongolia (8.1%) — while 42% of respondents acknowledged the importance for children to receive routine jabs, which placed Japan 12th from bottom.

Meanwhile, a poll conducted in late 2020 by national broadcaster NHK found 36% of respondents didn’t want to receive the COVID-19 vaccine.

However, according to a February poll by the market research firm Ipsos, 64% of respondents in Japan were in favor of vaccination — an increase of 4% from a similar survey conducted in December.

This uptick reflected a general global trend, with Britain (89%) and Brazil (88%) highest on the intent scale of the 15 countries polled. Nonetheless, Japan’s rate was the fourth lowest recorded.

The most common reason for not wanting to be vaccinated among Japanese related to concerns about adverse reactions, at 66% of respondents the highest by far of the countries surveyed.

Kaoru Houghton-Suzuki says she has been surprised by attitudes toward vaccines in Japan since moving back here from New York with her American husband and four children in January, pulling up a recent online poll on her phone indicating 40% of Japanese respondents have “no interest” in getting the coronavirus jab.

Kaoru Suzuki-Houghton plays with her 2-year-old twin daughters, Sophia and Malia, at a park in Tokyo in April. | ROB GILHOOLY
Kaoru Houghton-Suzuki plays with her 2-year-old twin daughters, Sophia and Malia, at a park in Tokyo in April. | ROB GILHOOLY

“I have been really surprised — COVID-19 is so serious now and it seems like the only hope of getting back to normal is the vaccine,” says Houghton-Suzuki, who cites experiencing racial attacks against her in the United States and the relatively undisrupted education system in Japan as reasons for moving back to her family home in Tokyo. “Generally, I believe in herd immunity, which not only protects yourself and your children from infectious diseases, but others, too, including those who can’t have vaccines for health or religious reasons. I feel like it’s a kind of responsibility to make society safe.”

Emi Tanaka, too, is desperate for life to return to normal. Since the start of the pandemic and Japan’s multiple lockdowns, her son has developed some behavioral disorders, including pulling out his hair and eyebrows, apparently due to stress.

While still skeptical about the jab, having one seems a small price to pay if it puts an end to the pandemic and the current “stifling” lifestyle that she says cannot be good for children.

“I’m sure I’m not alone in saying I want nothing more than to get back to how it was,” she says. “There’s a limit to what you can do, what measures you can take — washing hands, wearing masks is all very good, but it’s clear that alone isn’t going to get rid of the virus. Perhaps getting vaccinated is the only way — for everyone’s benefit.”

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