TOKYO (BLOOMBERG) - In the race to vaccinate citizens against Covid-19, Japan should be a front-runner. It has nearly universal health care coverage and pharmaceutical prowess, not to mention a pending national election, a large elderly population and the looming Olympics to motivate political leaders to move fast.
Yet it has the dubious distinction of being among the worst performers when it comes to inoculations. Japan has given enough doses to cover just 1.1 per cent of its population, the lowest among the 37 members of the Organisation for Economic Cooperation and Development, according to Bloomberg's vaccine tracker. That compares to 36 per cent in the US and nearly 35 per cent in the UK.
Within Asia, it trails China, India, Singapore and South Korea and is only slightly ahead of lower-income nations like the Philippines and Thailand.
Following Prime Minister Yoshihide Suga's declaration of a state of emergency in some areas on April 23 to tamp down a new wave of infections, some frustrated Japanese are looking enviously at vaccine programmes elsewhere and asking why their government hasn't moved as quickly.
After a year of watching devastating scenes unfold in places like the US while the pathogen was relatively contained at home, it now seems like the tables have turned.
"I want vaccinations to proceed at warp speed," billionaire Hiroshi Mikitani, CEO of e-commerce giant Rakuten, tweeted on Tuesday. "Like America."
Until recently, the Japanese could take comfort knowing their country had responded better to the pandemic than its peers in the West. Since there was never a dizzying surge in cases and deaths, they didn't clamour for Covid-19 shots. But with the Olympics in three months and a third state of emergency upon them, public frustration appears to be growing, raising the pressure on Suga's government to move more quickly.
He's now instructed the Defence Minister to use the military to build a mass vaccination site in Tokyo, the capital city, the first time the national government has directly engaged in the vaccination process - which had been devolved to municipal officials to carry out. Suga faces a party leadership poll in September and must call a general election by October.
It's too little, too late, for some citizens.
Ray Fujii, a Tokyo-based partner at L.E.K. Consulting whose clients include health-care companies, blames the government's lacklustre preparation for the delay. While a slow supply of vaccines from Pfizer was to blame early on, that's no longer the case, he said. Japan has likely received more than 15 million doses of the Pfizer shot, according to figures and estimates provided by the government in March.
"It's not about Pfizer not shipping enough vaccines or we don't have enough vaccines yet," he said, instead putting the blame on poor distribution and lack of preparation. "It delays everyone's business opportunities in Japan, so that pushes back the economic recovery from Covid-19." Domestic polls conducted in recent months show as many as 80 per cent of residents want to be immunised, and nearly half of those in a global survey by Ipsos and the World Economic Forum said they would get the shot within a month if it were available to them.
No made-in-Japan vaccine
Japan's slow roll-out stems from several factors. The nation has a history of vaccine scepticism, dating back to an unproven scare about the safety of MMR shots in the 1990s, which made officials tread cautiously.
It also has a conservative medical culture, with people trusting only doctors and nurses to administer vaccines. A recent proposal to have dentists join in the effort created a debate over whether they were qualified.
A law that hands the responsibility of vaccinations to local municipalities resulted in uneven progress and frustration with the glacial movement of some community authorities. "Testing" of a new online reservation system added weeks to the delay.
Spared the rising death rates of other countries, Japan's politicians and regulators also moved more carefully in greenlighting immunisations. So far, Japan has only authorised the vaccine developed by Pfizer and BioNTech.
Like India and China, Japan has always required pharmaceutical companies to conduct clinical trials locally before applying for approval, rather than accept data from studies done elsewhere, a rule that slows the process down substantially. Unlike India and China, Japanese companies didn't develop homegrown Covid-19 vaccines.
"From a crisis management perspective, I do think this will kick off a discussion about the need to have a made-in Japan vaccine," said Tetsuo Nakayama, a professor at the Kitasato Institute for Life Sciences, whose research focuses on vaccines. "Coronavirus won't end, it will likely continue into next year and the next, and people will want a made-in-Japan vaccine."
While Japanese companies like Tokyo-based Daiichi Sankyo are working on vaccine trials, they are far behind Western rivals. Daiichi has started the first phase of a local trial for an mRNA vaccine and will need to conduct a larger study before the shot can be approved.
"In Japan, vaccine development is very difficult," said Masayuki Yabuta, executive officer for Daiichi Sankyo's biologics division, citing nervousness around the experimental technology. The Covid-19 pandemic is the first time that the mRNA platform has been used in a vaccine; it's now proven to be extraordinarily effective.
The delay in rolling out vaccines "has made us question how advanced Japan is in the context of adopting new technologies or accelerating even the development of Japan-originated innovation," said John W. Carlson, co-chair of the health-care committee at the American Chamber of Commerce in Japan.
Vaccinations are expected to speed up in May as municipalities get the hang of the process, said Taro Kono, the Cabinet Minister in charge of the vaccination roll-out.
Still, even an increased pace won't result in covering a significant percentage of the population before the Olympics. Kono has said the Games do not factor into his planning.
Instead of inoculation, the government has laid out strict measures to protect the country from infection risks when more than 10,000 athletes and their entourages from around the world arrive in July. Foreign tourists are banned from attending, while a decision is due likely by June on whether locals can watch the sporting events.
Meanwhile, Suga's government says it wants to complete vaccination of senior citizens by the end of July. That could require an average of about 740,000 shots per day, according to Citigroup economists Kiichi Murashima and Katsuhiko Aiba in a report published April 25.
"This goal strikes us as quite ambitious," they wrote. "We note that some experts are rather sceptical about the attainability."
Even if the Olympics are pulled off without any virus spread to the community, Japan's lagging vaccine roll-out will have consequences as G-7 peers race to re-open their economies and global business activity resumes. For some, it's also partially erased the goodwill from Japan's relatively effective containment of the virus that managed to avoid prolonged lockdowns or large-scale fatalities.
L.E.K. Consulting's Fujii is looking into getting a vaccine when he has to travel to the US for business later this year.
"It's unbelievable that I actually have to think about it as an option," he said. "That's ridiculous."