Transcript: COVID-19 and Vaccine Hesitancy in Japan

Vaccine Hesitancy and the COVID-19 Pandemic in Japan

Kamila Szczepanska

Yoko Demelius

 

Opener (00:00:02)

 

This is the Nordic Asia Podcast.

 

Satoko Naito (00:00:09)

 

Welcome to the Nordic Asia Podcast, a collaboration sharing expertise on Asia across the Nordic region. My name is Satoko Naito, from the Centre for East Asian Studies at the University of Turku in Finland. I am very happy today to welcome back to the podcast two colleagues. Dr. Kamila Szczepanska and Dr. Yoko Demelius, both from the Centre for East Asian Studies.

 

Their two previous episodes covered the impact of COVID-19 on Japan from various angles. And today they have generously agreed to come back to discuss vaccine hesitancy in Japan.

 

So thank you so much Yoko, thank you so much Kamila, for being here.

 

Kamila Szczepanska (00:00:50)

 

Thank you.

 

Yoko Demelius (00:00:51)

 

Thank you.

 

Satoko Naito (00:00:52)

 

So vaccine hesitancy, that has been around since as long as we’ve had vaccines. But of course now,  because of the ongoing pandemic, those expressing such attitudes have become much more vocal, much more visible, and really pose a true threat to public health on a global scale. So it’s obviously a big deal.

 

In the US and Europe, there has been a lot of coverage on so-called anti-vaxxers, but the issue, as we might assume, is not confined to those regions. So of course today we’d like to talk about what’s going on in Japan.

 

But before we get to the current situation, can you give us some background? How have vaccines, inoculations in general, been regarded historically in Japan? Have they been met largely with skepticism, or have they been largely welcomed?  

 

Kamila Szczepanska (00:01:44)

 

Right, thank you very much, Satoko, for your question.

 

So I think I have to say, that Japan has a complex history in terms of vaccination acceptance and vaccination hesitancy.

 

The history of modern vaccination endeavor in Japan starts after the Meiji Restoration, so 1868, with public health efforts to popularize vaccination against smallpox by Japanese authorities being of special importance here.

 

After the end of the Asia-Pacific War, and in the context of wide-spread wartime destruction, public health crisis, and outbreaks of infectious disease, the Allied Occupation authorities introduced strict mandatory vaccination legislation. This strict legal framework was revised in 1994. The government shifted its approach from obligatory/mandatory immunization to immunization as a civic duty, or individuals’ societal responsibility, where the authorities strongly recommend vaccination.

 

So these legislative changes opened what some commentators have been calling a “vaccination gap” between Japan and the rest of the developed world.

 

And in the early postwar period, the pressure for quick vaccination, and the lack of adequate supervision and quality control on the side of authorities occasionally led to tragedies such as the diphtheria vaccine scandal in the late 1940s, where some batches of vaccination were faulty due mistakes in the manufacturing process.

 

On the other hand, the polio outbreaks in the late 1950s and the early 1960s led to the increasingly vocal public demand for vaccinations to beat the disease. And additionally further efforts were asked for to create domestic alternative for foreign polio vaccinations. So this was a success story.

 

However, in the following decades, we see an increasing level of distrust towards vaccines in Japan. This was prompted by the emergence of both real and also alleged damage caused by vaccinations. This, for example, was the case with the vaccinations against Mumps and influenza in the 1980s and 1990s. And of course the most recent case involves backlash against HPV vaccine. And such cases undermined popular trust in health authorities, pharmaceutical companies and, I would say also vaccination effort in general.

 

Satoko Naito (00:03:57)

 

I see, so there’s been some mistrust in the case of some mistakes in manufacturing processes that you mentioned. Of course these are understandable reasons for having such mistrust in the vaccines.

 

But you just mentioned HPV vaccines. So from what I understood, at least in the American context, the arguments against the HPV vaccine is very different from those against things like MMR, the Measles, Mumps, Rubella, the polio vaccine, the seasonal flu vaccines.

 

Aside from general suspicion, anxieties against vaccines, what are different arguments against various vaccines?

 

Kamila Szczepanska (00:04:38)

 

Right, so perhaps we can just focus on the HPV example that you just mentioned.

 

So in this particular case, after initial successful introduction of this vaccination to Japan, and quite high level of acceptance, in 2013 the Ministry of Health, Labour, and Welfare suspended  proactive recommendation for the vaccination, and this was done due to concerns about its safety. So those concerns emerged in the wake of media reports on pain, motor impairments and also neurological side-effects allegedly caused by the vaccination, and also subsequent claims from a section of Japanese medical establishment that legitimized the validity of such claims.

 

Since then, despite the pressure from the medical community in Japan and the 2015 WHO recommendation of HPV vaccination, Japanese government has only recently reversed its decision.

 

Satoko Naito (00:05:31)

 

Thank you. Clearly it's important, obviously, to understand historical developments that are particular to Japan.

 

So currently, I just checked out numbers this morning, and I understand that almost 77% of the population in Japan is fully vaccinated, meaning they have had two doses. But this high number is very heartening because I remember that Japan did have a rather slow rollout, especially compared to much of the EU or the US. And to give some context, I saw that in Finland today the rate is about 72 %, of fully vaccinated people from the population. Some other numbers, South Korea is very high at 79%, Germany is 68%, US is 58%.  And these numbers by the way are from University of Oxford’s Our World in Data project, and checked today, so that’s the 25th of November, 2021.

 

So these are, in Japan especially, quite high vaccination rates, but they don’t tell us everything. For example, there are those who have been vaccinated themselves, but still have some anxieties about the vaccinations they’ve received. Or those who have already decided that when it is available to their children, that their children will not receive the vaccination. So even those who are vaccinated can be vaccine hesitant.

 

So in terms of these people, who tends to be such people who have reticence towards vaccines? As I mentioned, the vaccination rate again is quite high, but is that because of the relatively aged population?

 

Yoko Demelius (00:07:07)

 

Yes, thank you Satoko, it’s a very good point. The sociodemographic factors play important roles in people’s sentiment toward the vaccine.

 

By reviewing some studies and media discussions, I have noticed some distinct characteristics in sociodemographic factors, such as age and gender.

 

In general, older people with or without underlying diseases tend to accept vaccines. A study based on a large-scale survey suggests that doctors and nurses are important information sources for people. For those who are unsure, medical personnel’s recommendations are the key influence to opt for vaccination.

 

In Japan, access to medical services is relatively easy. People often don’t have to make appointments to see a physician. Town doctors and neighborhoods’ general practitioners can easily disseminate important information. That’s why I believe that elderly population and high-risk groups who have closer contact with medical staff are likely to get vaccinated. Considering that Japan’s percentage of the population aged 65 years and above is about 28.4%, Japan as an aging society alone may push up the immunization rate.

 

A study shows that younger people tend to be more vaccine hesitant. At the same time, they’re more likely to get information from the Internet and social media.

 

Satoko Naito (00:08:38)

 

Sorry, if I could jump in and ask, when you say younger people, what age group is that?

 

Yoko Demelius (00:08:42)

 

Basically below 65. 20 to 64. Working age group.

 

Satoko Naito (00:08:50)

 

I see, thank you.

 

Yoko Demelius (00:08:51) 

 

Another distinct characteristic is gender.

 

In general, women tend to be more vaccine hesitant. The possible side effects of the COVID vaccine, the safety and the efficacy of the vaccine, distrust of public authorities, seem to be the dominant reasons for vaccine hesitancy.

 

A study shows that the higher trust people have in information sources such as television, the Internet, social media, and family members, the higher the odds of vaccine hesitancy.

 

This also suggests that there is a lot of information circulated in the media that influences people’s willingness to get vaccinated. There is even a report indicating that working-age women’s vaccine hesitancy is influenced by information on the Internet written by doctors who are against the COVID vaccine.

 

The mask-wearing practice is relatively easy to enforce, because the practice is visible, and people tend to conform to the norm. However, the invisibility of vaccine hesitancy may allow people to hold onto their beliefs.

 

I have had a few chances to discuss with women in Japan who are skeptical of vaccination. The impression I had from our conversations was that these women intend to protect their family members, especially their children. In their minds, the risk of vaccination exceeds the risk of the disease.

 

I also talked to one ethnic minority vaccine hesitant woman. According to her, she and her colleagues do not trust the Japanese government, and it was the reason for her and her friends not to get vaccinated. Of course I can’t prematurely conclude from this small sample size, but there may be some correlations between ethnic minority’s distrust of the government and vaccine hesitancy.

 

 

Satoko Naito (00:10:48)

 

Right. Distrust of government is of course huge in, I’m going to go back again to the US example which I’m most familiar with, there is a lot of distrust of government and government mandates. But we’ve seen distrust also in big pharma and big tech companies. Of course, there’s the infamous example of Bill Gates somehow trying to implant microchips or nanochips in all of us. Things like that. So what about in Japan? You spoke again, of distrust in government. Is there anything similar, distrust in big companies?

 

Kamila Szczepanska (00:11:21)

 

Yes, in Japan we see some similarities in that respect. The disinformation circulating on the internet and social media in Japan concerning vaccines have included arguments that we know from other countries too, such as the US, for instance vaccine’s connection with 5G technology and that vaccines somehow cause changes in your genetic make-up, as well as they might be able to cause infertility.

 

Satoko Naito (00:11:47)

 

I see. You mentioned social media, so of course that’s had a huge impact on spreading misinformation throughout the world, so how is it in Japan?

 

Kamila Szczepanska (00:11:56)

 

Of course Japan and Japanese citizens are not immune to fake news, disinformation and falsehoods that have been circulated via variety of information dissemination channels, including social media.

 

Having said that, this problem of fake news has not been considered to be a major issue until relatively recently. For instance, it has been suggested that the popularity of printed media and the existing legal framework for traditional media in Japan ensures sufficient protection against the spread of un-factual reporting and also provides a basis for correction measures, to be implemented if necessary.

 

Of course, this does not prevent the flourishing of disinformation on the internet and on social media.

 

And I would like to add that the creation of initiatives such as the Fact Check Initiative Japan, which is active since 2017 and 2018, demonstrate the growing awareness of the problem and pro-active approach for combating disinformation. During the pandemic Fact Check Initiative Japan actually started a project of debunking incorrect information on COVID-19 that have been circulating on the internet, social media included.

 

And then when we look at the level of government, the Study Group on Platform Services that was created in 2018 within the Ministry of Internal Affairs and Communication has been looking into the state of fake news and online abuse and slander in Japan.

 

So overall, I think that we can say that the problem is growing in the country, as it does everywhere else.

 

But going back to the COVID-19 vaccination issue specifically, a recent large-scale online survey study that tackles the problem of vaccination hesitancy in Japan confirms that internet news sites, search engines, YouTube and social media are significant sources of information for those who are hesitant or unwilling to vaccinate. And here Twitter and LINE are quite prominent channels of sourcing the information. For instance, those who were either hesitant or resistant to vaccinations were apparently more likely to use information from Twitter.

 

So misinformation that those people find would definitely have an impact on their vaccine-related choices.

 

And I know that we are speaking here about social media but I would like to add that the anti-vaccination scene remains also active also outside of social media, spilling into the real world.

 

For instance, in summer last year, Masayuki Hiratsuka, an anti-mask and anti-vaccination activist, who claimed that COVID-19 is “just a cold,” actually encouraged organizing anti-mask events in Tokyo—those were called Cluster Protest or Cluster Festivals - and called on people to not to wear masks while traveling on Yamanote Line.

 

Yoko Demelius (00:14:45)

 

Yeah. On a similar note, Mainichi Shimbun was carrying a report about an anti-vaccination film screening in one cultural center in Tokyo called Koto Cultural Center, that gathered a few hundred people with a clear view of propagating anti-vaccination views among members of the public.

 

Incorrect information and examples concerning situation in Europe and USA was invoked to support the anti-vaccination arguments and references were made to reasoning used by conspiracy theorists in Europe and USA.

 

Satoko Naito (00:15:20)

 

Clearly there’s some examples of real-life protests and there’s not just virtual campaigns online. So that’s really, Kamila as you said earlier, that’s very important.

 

Going back to this film screening in Tokyo, Yoko you mentioned that there was information and examples from Europe and the US, so going back to influence from those regions. In the US at least, there was or perhaps still is disbelief in COVID itself. And Kamila, you also mentioned that this activist says that COVID-19 is just a cold. So I understand that there is at least some people who think that. But is that a minority? Is it largely the people who are vaccine hesitant? Are they bearing a suspicion of the vaccines themselves, rather than the virus?

 

Kamila Szczepanska (00:16:10)

 

Well, the earlier opinion polls on COVID-19 vaccination acceptance in Japan were rather sort of a worrying perhaps in that respect. However, the current high vaccination rates in Japan that you mentioned earlier, they do seem to suggest that this was more the case of hesitancy and mistrust, which perhaps was successfully dispelled, or perhaps disappeared after speaking with family and friends, rather than outright disbelief in COVID-19 as something which is real and palatable danger to us.

 

However, I think that it has to be also mentioned that after the vaccination roll-out in Japan started, there were cases emerging that could have damaged the vaccination effort and sow mistrust towards vaccines among the populace.

 

So for instance in summer this year, three batches of Moderna vaccine were recalled due to being contaminated with stainless steel particles, and in the following weeks more reports concerning the presence of suspicious particles in some Moderna vaccine vials in different Japanese prefectures emerged, or were reported.

 

Around the same time the media also reported on the deaths of three men, who did not suffer from any significant underlying or chronic diseases and who died after receiving their second Moderna shot. No link was established between their deaths and vaccination. However, I think it’s quite easy to imagine that such widely reported happenings and cases could have had  dampening effect on the readiness to accept vaccine by others.

 

Satoko Naito (00:17:37)

 

Right, definitely. I could have asked this much earlier, but what vaccines are we talking about? You mentioned Moderna, but is it mostly Moderna, Pfizer, Johnson and Johnson? I realize now that Kamila, I think early on you mentioned that there were some efforts for domestic vaccine production earlier, before COVID, but I’m not aware of Japan-produced vaccines. What vaccines are being administered in Japan?

 

Yoko Demelius (00:18:01)

 

Japan’s domestic production is rather limited, and most vaccines used in the country are imported. There are many different factors. First of all, past vaccine scandals proved extremely costly.

 

The pharmaceutical industry is cautious to invest funds into research and development, since the high demand of vaccines is the only way to recover the investment and reduce the costs of vaccines per unit, a small production volume doesn’t make sense.

 

In the recent years, many infectious diseases, such as SARS, Ebola Virus disease or MERS emerged. R&D for new vaccines became a potential goal in the pharmaceutical industry in Japan. However, these diseases were rather exotic from a Japanese perspective.

 

Although some research centers had potential of continuing its research for developing vaccines for these viruses, the institution couldn’t organize necessary funds from the state and companies, and the research was terminated. In a country where people are already hesitant to vaccinate, even if domestic vaccines were to be available, they are simply not cost effective. Currently, only standard vaccines that do not require R&D are being produced domestically.

 

Satoko Naito (00:19:22)

 

So now that we are approaching our time, I would like to ask you both, what have you so far found significant or surprising in terms of vaccine hesitancy in Japan?

 

Kamila Szczepanska (00:19:36)

 

Well, I think that for me personally, taking into account the fates of MMR and HPV vaccines, and also the opinion polls conducted prior to the vaccination rollout in Japan, which indicated that a significant percentage of, especially younger, Japanese citizens were hesitant about vaccinating, I was surprised with the vaccination rates in the country.

 

And I think that the new frontier is vaccination for children aged 5-11, which will most probably be offered from early next year. And also, the advisory expert panel to Ministry of Health, Labor and Welfare recommends the booster shot with Pfizer, I think for now, to be offered to citizens. And I think that the level of popular acceptance for those two measures will tell us more about the level of societal acceptance for COVID-19 vaccines.

 

I think that it is perhaps still too early to speculate whether the initial success of the vaccination campaign to fight the ongoing pandemic in Japan is a critical juncture in the broader history of vaccination in the country, but I would like to think that if successful, it could help to further foster societal trust in vaccines in Japan. 

 

Satoko Naito (00:20:44)

 

Right. Yoko, would you like to add anything?

 

Yoko Demelius (00:20:46)

 

Yes, following up on Kamila’s point, it is going to be interesting to see how mothers would react when small children will be offered to get vaccinated. Once again, mothers usually act as gatekeepers of vaccines and health-related interventions by the state.

 

Just last month, the government has introduced new trials to use vaccination certificates and proofs of negative test results upon entries to restaurants and public places such as stadiums and music venues. Of course, the government would like to ease the restrictions to bring back social and economic activities. If these experiments work well, the new requirement of showing vaccination certificates might entice some skeptical individuals to get vaccinated to conform to the norm.

 

We’ll find more accurate picture of how the remaining hesitancy will change when such requirement would become official. Considering that Japan has been historically one of the most vaccine hesitant countries, rationalizing and convincing the population to get vaccinated may prove challenging. But if practical incentives such as gaining access to public venues and to transportation systems exceeds the burdens of restricted lifestyles, skeptical individuals might decide to get vaccinated, although reluctantly. This may open up of course new issues of protecting individuals' choices.

 

Satoko Naito (00:22:18)

 

I’m heartened to hear from both of you, Yoko and Kamila, some hope for the future in terms of  less hesitancy about vaccines in general, and some way to allow for less restricted lifestyles going forward. Thank you both.

 

Is there anything you would like to look into further?

 

Kamila Szczepanska (00:22:36)

 

Well, yes, for instance, from my side again, in Japan we have seen the rise of small but vocal pro-Trump groups, supportive of the former president’s argument on “STOP the Steal”. And in November and December 2020, and also in January 2021 there were protests organized in support of Trump’s ultimately failed presidential bid in Tokyo, Osaka and also Fukuoka.

 

Parallel to this we have also observed the rise of QAnon supporters in Japan, or J-Anon, as they are called. And opinions, I think, are divided on whether J-Anon will transform into any broader movement in Japan, but still its emergence is quite concerning.

 

As “COVID is a hoax” statements and anti-vaccination and anti-mask agenda is a part of what Trump and QAnon supporters preach, it would be perhaps interesting to learn how far this has also trickled down to Japan.

 

Yoko Demelius (00:23:29)

 

Yes, following up on Kamila's point on the influence of US's anti-vaccination climate, there are some examples of US influences in Japan. There is a book written by a Japanese physician, which includes an interview with Robert Kennedy Jr. who has been pushing the anti-vaccination propaganda. This book has supposedly sold over 130,000 copies during the first two months since its launch in June this year. Stories about this book have been controversial. For example, the book denies the effectiveness of mask use. A report says that the Tokyo Metro had to remove the ad for this book, since the company received a complaint that the book's claim was against the mask-wearing request of Tokyo Metro.

 

Another influence of US's anti-vaccination propaganda is through some translated news media that enter Japan. Some news articles do not overtly support anti-vaccination propaganda but provide some impression that anti-vaccination claims are legitimate.

 

Considering that multiple anti-vaccination publications are selling well in Japan despite the current high immunization rate, it would be interesting to explore the impact of such transnational media influences.

 

Satoko Naito (00:24:52)

Yeah, as you say this is truly a global issue and impacts all of us. So this has been very educational for me, I learned a lot. Thank you so much, both of you for taking your time and speaking with us today.

 

Yoko Demelius (00:25:06)

 

Thank you

 

Kamila Szczepanska (00:25:07)

 

Thank you very much, Satoko.

 

Satoko Naito (00:25:09)

 

Thank you again to Dr. Yoko Demelius and Dr. Kamila Szczepanska.

And to our listeners, thank you for joining the Nordic Asia Podcast, showcasing Nordic collaboration in studying Asia. Thanks again.

 

Closer (00:25:21)

 

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