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Distribution of COVID-19 vaccines has featured significantly in discussions about whether the Tokyo Olympics can be held safely this summer.

Experts, however, say organizers should prepare for the Games regardless of the vaccine rollouts, and instead make sure that they have enough polymerase chain reaction (PCR) tests to conduct on athletes, coaches and staff on a daily basis.

Vaccination rollouts have already begun in several countries, with medical workers, older people and those with underlying medical conditions frequently being prioritized. The process is expected to begin in Japan later this month.

So where do Olympic athletes fit in, and should vaccinating them be a priority?

Last week, there were reports the International Olympic Committee (IOC) was working with the World Health Organization (WHO) to get all Olympic-bound athletes vaccinated. Yet a couple of days later, the WHO said athletes shouldn’t expect to jump to the front of the line.

The IOC also said last week that it was recommending athletes and officials be vaccinated before arriving in Japan for the games, which were postponed by a year due to the pandemic.

A pair of medical experts who spoke recently with The Japan Times both questioned why these discussions were even taking place, because whether or not the games can be held and the availability of vaccines are subjects that, in their view, should be discussed separately.

Tetsuo Nakayama, a project professor at Kitasato Institute for Life Sciences and director of the Japanese Society of Clinical Virology, said it wouldn't be ideal to prepare for the games under the assumption vaccines will be available for athletes.

There are also reports saying countries are scrambling to obtain vaccines, and that the vaccination schedule in Japan could be delayed as well.

Nakayama doesn’t think vaccinating athletes before the general public will be a priority.

“It’s only a problem for those who are associated with the Olympics,” Nakayama told The Japan Times in a Zoom call last week. “And when it comes down to the Olympics, it’s not just the athletes who are participating but others — like people who support the athletes, and people working at the Athletes Village. So I think it’s strange to think of hosting the Olympics assuming there would be vaccinations (for all those people).”

While some may think vaccines will eradicate the pandemic, Nakayama cautions that they won’t necessarily bring about a quick resolution because the safety of the vaccines has to be evaluated.

Judging from past precedents, their safety and effectiveness are not something that can be determined until at least a year after a massive number of vaccinations have been administered, experts say.

In a worst-case scenario, antibodies could worsen the disease by essentially helping the infection of cells — a phenomenon called antibody dependent enhancement (ADE) — rather than fighting the virus.

Jin Kuramochi, director of the Kuramochi Clinic Interpark in Utsunomiya, Tochigi Prefecture, expressed similar sentiments, stressing that vaccinations need to be performed with care until data collection and clinical trials can confirm their safety and assess the prospect of harmful side effects. Vaccines for the novel coronavirus have also been developed much faster than usual.

The government should first gather sufficient information on coronavirus vaccines overseas, make its own assessment and offer it to the public, Kuramochi says.

“If the response to the vaccines is similar in Japanese people to that seen overseas, then we can say they’re safe to use,” Nakayama said. “But often Japanese people experience stronger side effects, depending on the vaccine. Even when they’re confirmed to be safe at clinical sites overseas, sometimes they’re not as effective in Japan.”

Japan is one of the very few countries that require additional clinical trials within the country to ensure safety. But given the spread of the pandemic, the Japanese government is expected to grant a special vaccine approval around mid-February by applying a fast-track system. Pfizer had submitted data to the government from the first two phases of the drug's three-phase clinical trial, on 160 Japanese people age 20 to 85, by late January, according to media reports.

Skipping the late stage trial in Japan comes at the expense of a potential hazard in rare cases, however. Japan approved the Arava rheumatoid arthritis drug in 2003 without conducting a late-stage trial in the country. The drug was administered to around 5,000 patients but 25 of them died, Masayuki Miyasaka, professor emeritus of immunology at Osaka University, said in a Lower House committee in November. It was later found that the dosage should have been lower in Japan than it was overseas, he added.

Nakayama said that even if athletes get vaccinated, it’s not clear what kind of side effects they may have or how that may affect their performance during the Olympics, which are set to begin on July 23.

“So there’s no such thing as how early to be vaccinated to be safe,” he said. “Those who will be competing at the Olympics take a longer time to tune up for the event, right? Would they want to be vaccinated knowing they’re not 100% safe? It’ll be up to each athlete to think about.”

Both Nakayama and Kuramochi agree the distribution of vaccines will also fall short of a guarantee of safety because the world probably won’t achieve herd immunity through just vaccinations alone.

The two experts actually think Tokyo can host the event safely even without vaccines by implementing detailed protocols and countermeasures against the virus.

"What's most important is to arrange a safe situation — where you have athletes and everybody else that's coming from overseas — to host the games," Nakayama said. "The discussions of the vaccines should come after that.

“If the games are to be held, you have to come up with the situation that will ensure safety, by doing PCR tests for those closely associated with the event,” Nakayama added. “It's not like there's no risk you’ll be infected after being vaccinated."

“To be extreme,” Kuramochi noted, “if you can prepare a system where (the participants) will be tested every day, you can host the Olympics. If you’re careful, such as by not allowing the athletes to have meals together and giving them PCR tests every day, I think it’s possible to lower the chance of infections during the games.”

Kuramochi also stated that the central government needs to provide financial aid — not compensation — for high-level medical institutes in areas that are impoverished and that also have a high number of cases, so they can secure enough medical workers for the games.

Right now, many who have tested positive for the virus in Japan haven’t been admitted to a hospital. Kuramochi added that the public should have better access to hospital care, and that the government needs to put in the effort to seek drugs that work against COVID-19 as the Olympics get closer.

Staff writer Osamu Tsukimori contributed to this report.

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