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Japan’s current wave of COVID-19 infections has mostly affected its younger generations, reflecting both the efficacy of its vaccination program among the elderly and the pitfalls of a delayed rollout that still hasn’t reached most of the youth population.

Those in their 20s and 30s in Tokyo now make up a larger proportion of new infections than the previous wave in January, before the vaccination program started. Past surges have started with infections concentrated in younger people — who are more mobile — and later spread to the elderly. But the current wave in Japan, which has taken nationwide daily cases to more than 25,000 in the worst numbers reported yet, has largely remained a scourge among the young. In many wards of Tokyo, less than 20% of those in their 20s and 30s are fully vaccinated.

Japan’s vaccination rollout, which started late compared with other developed nations, has progressed quickly since early summer. About 46% of the population is fully vaccinated, including nearly 90% of those 65 or older. Local governments decide who gets priority, and most have made shots available in successive age brackets, causing a large difference in coverage between age groups.

A no-reservations-needed clinic for those 16 to 39 in the Shibuya district of Tokyo opened last week. With a capacity of about 300 shots a day, it was quickly inundated. A Tokyo government official told national broadcaster NHK they hadn’t expected such demand among the youth. Over the weekend, a line of those who wanted vaccinations stretched from the Shibuya clinic into the trendy Harajuku area — nearly a 20-minute walk away.

Although Japan has guaranteed supplies of the Pfizer Inc. and BioNTech SE shots coming in, it had issues earlier this year with distributing shots to where they’re needed most, resulting in uneven situations across the country. In more rural areas, governments have started offering incentive programs to get the youth inoculated. Gunma Prefecture, where Subaru Corp. vehicles are manufactured, started a lottery for people in their 20s and 30s who get fully vaccinated by the end of September to win one of the cars.

Further compelling young people to get a shot is the way those in their age cohort are now getting seriously ill, unlike in previous waves. As cases peaked in Tokyo at the end of August, the number of serious patients also hit a record. The demographic makeup of serious patients is now mostly those in middle age and younger — very different from the spike in January, which had essentially zero serious cases in their 20s and 30s.

Despite the number of serious cases and the record number of new cases, deaths have remained low in Japan. The government has long pointed to the relatively low mortality as a measure of its success in the pandemic, but that is losing luster among the public. Over the past week, deaths of patients in their 20s and 30s have made news headlines.

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