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Yutaro Ueguri, owner of an organic bagel shop in Tokyo’s Edogawa ward, can’t recall when he last ate at McDonald’s.

Nor has he indulged in a boxed lunch from a convenience store for as long as he can remember — these prepackaged meals, he says, look to him less like food than just a “slab of additives.” He also shuns shampoo when washing his hair, dismissing it as detrimental to his health.

It is this avoidance of what he views as unhealthy — junk food, additives and chemicals — that is at the crux of Ueguri’s staunch opposition to vaccines. The 48-year-old is adamant that he and his family, including two young daughters, won’t get vaccinated against COVID-19.

“I have this faith that I’m healthiest when I’m my natural self or the way I was made to be,” Ueguri said. “At the foundation of all this is the idea that I don’t want to take in anything unnecessary for my body. To me, one example of that is a vaccine.”

His wife, Mami, 48, feels the same. She also avoids taking in artificial substances, a sentiment that means she typically goes without makeup in her daily life. Like her husband, Mami is determined to give COVID-19 vaccines a wide berth.

“I just don’t feel comfortable with the idea of letting something mysterious into my body,” she said. “Instead, I’m choosing to protect myself against the virus by eating healthily, so that we, as a family, can increase our immune strength.”

Syringes filled with doses of the Moderna Inc. vaccine in Tokyo | BLOOMBERG
Syringes filled with doses of the Moderna Inc. vaccine in Tokyo | BLOOMBERG

The Ueguris’ belief in natural health and holistic well-being makes the couple part of a demographic that is highly unlikely to get vaccinated, even as the nation frantically forges ahead with its inoculation programs just weeks ahead of the pandemic-delayed Tokyo Olympics and Paralympics.

The extent to which they are against vaccines is a sobering reminder of how difficult it will be for Japan to persuade certain groups to get the shots once its rollout, currently gaining traction, has moved past the phase of vaccinating those most cooperative.

Those as strongly skeptical of shots as the Ueguris only represent a small portion of the population in Japan, where vaccine hesitancy stems mostly from general concerns about side effects and where those opposed to inoculations are nowhere near as vociferous, robustly funded or highly organized as those in the United States.

But like elsewhere in the world, the pandemic has given rise to some anti-vaccine figures in Japan. The growing influence of their rhetoric is a worrisome trend in a nation where the public, experts say, can easily be scared into a reluctance to take vaccines.

Healthier lifestyle?

Distrust of vaccines is relatively high in Japan, where a spate of past lawsuits over side effects and heated media coverage of post-vaccination ill health have made authorities wary of touting the safety and effectiveness of new vaccines compared with other countries.

The public attitude toward them is consequently lukewarm. A global survey by Imperial College London and polling company YouGov showed in May that Japan, alongside South Korea, had the lowest share of respondents who said they trust COVID-19 vaccines among the 15 countries polled, at 47%.

How much of that low confidence translates into an unwillingness to get vaccinated remains to be seen.

One recent survey by a research firm, however, indicated that those most determined to refuse vaccines are all but a fringe in Japan, dwarfed by those on the less extreme end of the spectrum, such as the reluctant and the cautious.

The poll, conducted in May by Cross Marketing Inc., found the percentage of those who said they “definitely don’t want to get vaccinated even if their turn comes” stood at 4.7%, versus the 12.7% who “don’t want to get vaccinated very much even if their turn comes” and the 33.4% who “want to get vaccinated after they wait and see how it goes.”

Another study by Keio University School of Medicine, meanwhile, pointed to the prevalent fears of side effects among the vaccine-hesitant in Japan.

An overwhelming 79.1% of those unsure of whether to receive the shots said in the March poll that they were concerned specifically about COVID-19 vaccines in terms of side effects and safety risks, followed by 46.3% who voiced skepticism toward vaccines in general.

Fumio Ota, a Chiba-based pediatrician, said that during his career he has encountered some Japanese mothers so enamored with the concept of homeopathy — a scientifically unsupported form of alternative medicine using diluted substances — that they refused to get their infants vaccinated. | TOMOHIRO OSAKI
Fumio Ota, a Chiba-based pediatrician, said that during his career he has encountered some Japanese mothers so enamored with the concept of homeopathy — a scientifically unsupported form of alternative medicine using diluted substances — that they refused to get their infants vaccinated. | TOMOHIRO OSAKI

The Ueguris, for one, echoed concerns about side effects, but their stance has more to do with them being conscious of what they eat or absorb into their bodies.

Not that the couple have always been like this: Ueguri says that in his youth, he would gobble down nutrient-poor instant noodles — his nemesis now — almost every day.

But his experience studying in the U.S. at age 30 gave him a new perspective on Japan along with an epiphany on how a better dietary lifestyle could benefit his country. His shop, Tokyo Bagel B-guri, an embodiment of that ethos, is stocked with an array of additive-free bagels and salads.

“Instead of paying for drugs and medicine to recover from an illness, I wanted to create an alternative option where you eat healthy and do a good amount of exercise so that you won’t get sick in the first place,” Ueguri said.

While the Ueguris dismiss vaccines as unnecessary, the pair aren’t in denial of COVID-19 per se. The two wear masks, adhere to social distancing, eschew crowds and offer hand sanitizers for their customers.

But when it comes to vaccines, their opposition stands firm. In fact, anti-vaccine sentiment stemming from a devotion to alternative medical philosophies isn’t entirely uncommon in Japan.

Fumio Ota, a Chiba-based pediatrician who is also a core member of a nonprofit that promotes understanding of vaccine-preventable diseases, said that during his career he has encountered some Japanese mothers so immersed in homeopathy — a scientifically unsupported form of alternative medicine using diluted substances — that they refused to get their infants vaccinated.

“It’s one of the factions of those strongly opposed to vaccines in Japan,” Ota said. Ueguri said he is aware of homeopathy but doesn’t use the supposed treatments himself.

Zero-risk bias

But it’s not just in Japan where the idolization of alternative medicine forms part of an anti-vaccine mentality.

In the U.S., home to a much bigger, more established anti-vaccine movement than in Japan, natural or alternative health gurus and entrepreneurs are among a dozen leading individuals opposed to vaccines that the Center for Countering Digital Hate, an international nongovernmental organization, has identified as responsible for 70% of anti-vaccine content shared on Facebook during the pandemic.

A recent CCDH report estimated that the U.S. anti-vaccine industry represented by these 12 figures alone is worth at least $36 million in annual revenue, shedding light on their vast clout on social media platforms and the highly systematic nature of their affiliate marketing schemes.

The large market makes it easy for even the most die-hard members of the movement, including those driven by conspiracy theories, to operate in the U.S., said Saki Ikeda, a pediatrician board-certified both in Japan and the U.S who specializes in infectious diseases.

“I’d say there are more hardcore anti-vaxxers in the U.S. than in Japan, partly because in the U.S. anti-vaxxers have a solid history of activism and vocal lobbying,” said Ikeda, referring to those opposed to vaccinations.

In contrast, vaccine hesitancy in Japan is not so much an expression of activism as it is an instinctive fear of safety risks, said Ikeda, who is also the vice chair of CoV-Navi, a group of doctors that fights disinformation surrounding the pandemic.

In the U.S., parents are used to confronting the risks of vaccines — which they weigh against the benefits — and deciding for themselves whether to get their children vaccinated. Hence their tendency to form strong opinions for or against inoculation.

But in Japan, “it’s more that if they are assured a vaccine has a good track record of safety and that ‘everyone else is getting it,’ they oblige easily,” Ikeda said.

Saki Ikeda, a pediatrician, board-certified both in Japan and the U.S, who specializes in infectious diseases | COURTESY OF SAKI IKEDA
Saki Ikeda, a pediatrician, board-certified both in Japan and the U.S, who specializes in infectious diseases | COURTESY OF SAKI IKEDA

In fact, despite their globally low confidence in COVID-19 shots, Japanese people are generally comfortable with vaccines for children that are billed as routine, including those against measles, rubella, tuberculosis and pneumococcal diseases. All of these boast an impressive inoculation rate of about 95% every year, according to health ministry statistics.

But sentiment changes completely once this bubble of safety is punctured. A case in point: the 2013 debacle over a human papillomavirus (HPV) vaccine against cervical cancer.

A series of reports about adverse events that followed the HPV vaccine shots led to the government suspending its “highly recommended” status just a few months after it joined the ranks of other routine vaccines — even though the cause and effect was not scientifically proven. A media frenzy also ensued, fueling public fears about its risks.

Despite having once hovered around 70%, the inoculation rate for the HPV vaccine in Japan has since fallen precipitously, to now less than 1%, with some experts calling the situation a potential time bomb of cervical cancer.

This points to the almost contradictory nature of Japan’s relationship with vaccines, Michael R. Reich, a professor of international health policy at Harvard University, said.

“Japan does not have a simple history of vaccine hesitancy … sometimes engaging enthusiastically with vaccines, sometimes engaging reluctantly and sometimes outright rejecting,” Reich told an online symposium hosted by the University of Tokyo last month. “On the one hand, high acceptance of the routine recommended vaccines, and on the other hand, low acceptance and slow authorization of some new vaccines.”

Force to be reckoned with

This “zero-risk worship” in Japan, as pediatrician Ikeda put it, makes her and her fellow CoV-Navi doctors all the more concerned about the impact that a fringe — but potentially influential — community of outspoken vaccine opponents could have on the public as they spread scaremongering disinformation on vaccines.

From a traditional Chinese medicine doctor to a manga artist and a minor weekly newspaper publisher, those who propagate fears about COVID-19 vaccines are slowly amassing influence online in Japan. They actively use social media and often translate claims by prominent global vaccine opponents such as Michael Yeadon, a former vice president of Pfizer Inc., into Japanese for their like-minded audience.

“Most of the fake information about vaccines that is circulating in Japan has been imported from countries like the U.S.,” said CoV-Navi member Kosuke Yasukawa, an assistant professor of medicine at Georgetown University School of Medicine. “It’s a reflection of how Japan isn’t immune to influence from overseas.”

Anti-vaccination activists protest against the proof of vaccination requirement to get into a concert in New York on June 20. | GETTY IMAGES / VIA KYODO
Anti-vaccination activists protest against the proof of vaccination requirement to get into a concert in New York on June 20. | GETTY IMAGES / VIA KYODO

Typical examples include rumors about female infertility, altered DNA and “vaccine shedding,” in which inoculated individuals release viral particles, as well as theories about vaccines being microchipped or turning human bodies magnetic — all of which have been debunked by scientific authorities.

“What I think is happening is just a tiny group of people speaking very vocally about topics they know have a high chance of instigating fears, such as pregnancy, women’s health and children’s health,” Ikeda said. “There may only be a few of them, but their words, once out, spread nonstop.”

Which is exactly what CoV-Navi has set out to prevent.

Since its launch in February, CoV-Navi doctors have utilized platforms such as YouTube, Instagram and Twitter along with tie-ups with media outlets to communicate scientifically accurate information about vaccines, as well as holding seminars and even reaching out to vaccine rollout minister Taro Kono.

CoV-Navi’s aim is to “shoot for the movable middle,” rather than focus on trying to persuade those on the extreme end of the vaccine-hesitancy spectrum.

“When it comes to vaccines, there are always a certain number of hardcore people where no amount of explanation will persuade them to be inoculated,” Ikeda said.

But even so, “it’s important for us to acknowledge their feelings, explain science and tell them ‘when you’re ready, I’ll be always here available for you to discuss further,’” she said.

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