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When the Asia Pacific Initiative compiled a report in October on the government’s COVID-19 response, there was a quote from a staff member at the Prime Minister’s Office that symbolized how Japan dealt with the pandemic.

“The makeshift response turned out to be all right.”

The quote was used in the report — which I was involved in putting together — as a conclusion not because we thought it was good that the government’s response worked out, but to raise the alarm that makeshift measures always come with risks since there is no guarantee that the government can respond similarly in the future.

Nevertheless, the government repeated the same mistake regarding governance on COVID-19 vaccinations, taking makeshift crisis management measures at the very last minute.

Vaccine development cannot be done overnight. Yet despite the race against time, the government continued acting in a haphazard manner to approve, procure and manage the rollout of vaccines. As a result, Japan lost another chance to use what was learned from past crises.

To avoid having to take desperate measures after a problem arises, we should get prepared for a crisis beforehand. Japan was not ready for a possible pandemic, as it lacked the capability to produce vaccines.

There are three key reasons why the country was not prepared to manufacture vaccines despite the fact that the country is a leading pharmaceutical producer.

Firstly, companies have been reluctant to focus on vaccines because vaccine manufacturing is a high-risk business. Even if they develop vaccines, it may not lead to sales once infections settle down.

Due to this reluctance, such firms did not nurture sufficient human resources and environments for vaccine development, putting Japan behind in terms of vaccine development.

Secondly, approval processes for drugs had become stricter as a result of past incidents — including claims of side effects from human papillomavirus (HPV) vaccines, leading to lawsuits, as well as the scandal concerning transfusions of HIV-tainted blood products — making it harder for authorities to be flexible in cases of emergency.

Thirdly, because the government’s initial COVID-19 response worked to reduce infections, there arose an ironic situation in which it became difficult for vaccine developers to gather patients necessary for clinical trials.

While Japan was lagging behind in developing vaccines, other countries created effective products, making it even more difficult for the nation to hold clinical trials.

Long way to go

If vaccines cannot be developed domestically, the only other option is to import them.

But if the imported vaccines have not been approved, they cannot be used in the country.

Therefore, swift approval was necessary to import COVID-19 vaccines from companies in Western countries and distribute them. But Japan was, again, not prepared and took time to issue the approval.

In the United States, the Food and Drug Administration can issue an emergency use authorization (EUA) to allow the use of unapproved medical products or the unapproved uses of approved medical products in the event of a public health emergency.

The European Union also has a system for granting conditional marketing authorization for medicines on less comprehensive clinical data than normally required, based on which its member nations’ health authorities can issue emergency usage approval.

These systems are designed to prioritize their administration of drugs after their safety and efficacy are confirmed, even if there are some remaining risks.

Japan does not have such a system.

Moreover, since the nation was not included in Pfizer Inc.’s multinational clinical trials, authorities requested trials for 160 Japanese people when the firm applied for approval of its vaccine in Japan in October.

Although Japan took last-minute special action to fast-track the approval in February, it came two months later than in Western nations.

On June 1, the Cabinet approved a strategy to strengthen vaccine development and production to enable swift approval, but the government’s stated target is to “come up with a direction on the policy by the end of this year,” indicating a long way to go before any reform will come.

Sense of crisis

Japan was relatively quick in negotiating to procure COVID-19 vaccines.

By as early as the end of July last year, it had reached a basic agreement with Pfizer to receive a supply of 120 million doses to cover 60 million people, leading the way to swift procurement.

But as the second wave of infections in the summer of 2020 settled down, the urgency of the need to get people vaccinated decreased, and because it took time for the government to decide on how to compensate people who had suffered adverse reactions to the vaccines, the bill to revise the immunization law to enable vaccinations against COVID-19 was not submitted until November.

Since the revised law did not take effect until December, the approval and procurement of the vaccines were largely delayed.

Prime Minister Yoshihide Suga's pledge to have the authorities administer 1 million vaccine doses per day has been met, but the overall vaccination rollout has progressed slowly. | KYODO
Prime Minister Yoshihide Suga’s pledge to have the authorities administer 1 million vaccine doses per day has been met, but the overall vaccination rollout has progressed slowly. | KYODO

Japan’s vaccine procurement sped up afterward, with Prime Minister Yoshihide Suga putting administrative reform minister Taro Kono in charge of vaccine rollout in January and holding phone talks with Pfizer CEO Albert Bourla during his visit to the U.S. in mid-April to ask the company to provide additional supplies.

Having a sense of crisis, the government managed to obtain sufficient doses by fully utilizing its diplomatic sources, successfully negotiating to receive imports from the EU even as it was restricting vaccine shipments outside the region.

But all these efforts came too late.

Haphazard approach

Even if the government approved COVID-19 vaccines and obtained enough doses, all that would be meaningless if they were not administered. But Japan’s vaccination program also came with inbuilt problems.

First of all, there is the problem of coordination between the central and local governments — an issue also mentioned in the API report on the coronavirus response.

The central government procures the doses and supplies them to local governments, but it is up to individual municipalities to decide on how to vaccinate residents.

As many municipalities adopted a system of accepting reservations on a first-come-first-served basis to ensure fairness, many people faced the problem of not being able to access overwhelmed booking centers.

The government attempted to reduce the local governments’ burden in a haphazard way, setting up mass-inoculation sites operated by the Self-Defense Forces in Tokyo and Osaka Prefecture to increase the numbers of vaccinations.

Major cities in the nation followed suit, setting up mass-vaccination centers to accept more reservations and help accelerate the vaccine rollout.

The government also allowed companies and universities to launch vaccination programs to offer people different routes to get inoculated.

While the government provided municipalities with Pfizer vaccine doses, a vaccine developed by Moderna Inc. has been used for vaccination programs at workplaces.

But workplace vaccinations faced a new problem, as the government received more applications than it expected, leading to a shortage of Moderna shots.

One issue that is hampering further acceleration of Japan’s vaccine rollout is the shortage of medical workers who can administer the shots.

Only doctors and nurses can give injections under Japan’s medical practitioners’ law. Because of this, vaccinations are going smoothly in municipalities where the local medical association is willing to cooperate, but not all municipalities have enough staff able to perform the task.

The government said in its basic policy on economic and fiscal management and reform released in June that it would consider legal measures to enhance the nation’s vaccination scheme.

Whether the government’s policy will lead to a revision in the medical practitioners’ law remains to be seen.

Belated actions

API criticized the government’s belated response to COVID-19 in its report, but the government was also slow in its vaccination rollout, which is key to fighting the pandemic.

One reason for the slowness was that the original COVID-19 measures largely worked, leading the government to be less aware of the need for vaccines compared with Western nations facing many more infections.

Such low awareness has been a common problem among East Asian and Southeast Asian countries which had been relatively successful in containing the virus.

Japan is making the same mistake again and again, despite the fact that it has been criticized for lacking crisis management preparedness and taking belated actions in the past.

It is, of course, difficult to be prepared for all possible crises, and sometimes governments are forced to take measures at the last minute.

Some of the government’s belated moves did work out well, including assigning Kono to be in charge of the vaccine rollout and setting up SDF-run mass-vaccination centers.

However, while the API report concluded that Japan has a responsibility to learn how to learn, it is clear that the government has not fulfilled the responsibility.

The nation’s vaccinations appear to be progressing smoothly, with around a million shots per day now being administered, as Suga had pledged.

But in order to give two doses to each adult living in the country, 200 million shots are necessary, equating in simple terms to 200 days for completion.

If inoculations are performed at the current pace, only a portion of the population will get vaccinated before the closing ceremony of the Tokyo Olympics.

If the government was aiming to achieve a “safe and secure” Olympics, why couldn’t it have prepared for vaccinations around the same time as the U.S. launched Operation Warp Speed in May 2020 to accelerate the development and distribution of COVID-19 vaccines, or when Japan signed a basic agreement with Pfizer on vaccine supply in July 2020, or when Western nations approved COVID-19 vaccines in December?

Although there were various opportunities, the government, opposition parties, the health ministry and the Japanese people failed to make the best decisions to contain the pandemic.

The government in particular did not have the strategy nor the commander to compile the necessary steps to hold the Olympic Games in a safe and secure manner, share relevant information and work toward the goal.

The government must learn that it cannot achieve the results it seeks if it continues to respond with makeshift measures.

Kazuto Suzuki is a professor at the University of Tokyo and senior consulting fellow at Asia Pacific Initiative, an independent think tank based in Tokyo. API Geoeconomic Briefing is a series that looks into geopolitical and economic trends, with a particular focus on technology and innovation, global supply chains, international rule-making and climate change.

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