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Japan leads the G7 in COVID shots without a mandate in sight

Japan has historically had an issue with vaccine hesitancy. You wouldn’t know by looking at its COVID-19 immunization stats.

Before the world’s third-largest economy started administering shots, it had one of the lowest rates of vaccine confidence in the world. Now, the country — which started doling out immunizations months after the United States — has the highest inoculation rate among the Group of Seven, and it did it without mandates of any kind.

Japan fully inoculated 75.5% of its population of 126 million people as of Sunday, according to Our World in Data, an online scientific publication that uses population statistics from the United Nations. The Asian nation this week pushed ahead of Canada, which previously had the highest rate among the G7 major advanced economies, with 75.3% of its population fully vaccinated.

“We thank all the people concerned, such as local governments and medical professionals, for their efforts,” Chief Cabinet Secretary Hirokazu Matsuno said during a briefing Tuesday.

The country has quietly made up for lost time. While France and other European nations mandated that citizens be vaccinated to get into restaurants, shopping malls, trains and planes, Japan has done relatively little nationwide to push the shots. Officials handed out gifts, vouchers and travel discounts as incentives in some places, but ultimately they let people make up their own minds.

It stands in stark contrast to the U.S. — a fellow member of the G7 that Japan streaked by on the basis of first shots in September — where vaccines have been mandated for those who work for large employers or the federal government.

Members of the medical staff prepare Moderna COVID-19 vaccines to be administered at a mass vaccination center in Tokyo in May. | POOL / VIA REUTERS
Members of the medical staff prepare Moderna COVID-19 vaccines to be administered at a mass vaccination center in Tokyo in May. | POOL / VIA REUTERS

Forged in the aftermath of World War II, Japan’s Constitution enshrines civil liberties. For practical purposes, that means it hasn’t deployed lockdowns or compulsory mask rules as part of its pandemic approach. It’s taken the same approach to vaccination, with the health ministry discouraging discrimination against the unvaccinated and shot requirements in the workplace.

“Even if your company asks you to get vaccinated, you can choose not to if you do not want to,” the ministry says in a question and answer section of the government’s COVID-19 response website.

People have lined up for COVID-19 vaccine shots, even though there is a long-standing wariness in the population toward other vaccines. A Lancet study last year found that fewer than 30% of people strongly agreed that vaccines were safe, important and effective, compared with at least 50% of Americans. Before the rollout began, 36% in a poll by public broadcaster NHK said they didn’t want to get the COVID-19 vaccine.

Experts say there are several reasons why the rollout in Japan turned out to be successful.

“The slow start and the shortage made people think that they had to get shots quickly,” said Kenji Shibuya, an epidemiologist and research director at the Tokyo Foundation for Policy Research, who also runs the vaccine program in the city of Soma, Fukushima Prefecture. “Elderly people were mindful of the health risks and had a strong sense of urgency to get it. Their experience gave a sense of security and encouraged the rest of their families to get it too.”

More than 90% of Japanese 65 and older have received both shots, while the rates for people in their 20s and 30s are 69% and 72% respectively, according to data from the Prime Minister’s Office. Teenagers have the lowest penetration at 65% fully inoculated. Of the some 194 million doses given out, about 10% — or 19 million shots — were rolled out in the private sector, it said.

Starting next month, Japan plans to begin giving boosters. It will begin with health care workers and older people, before expanding the effort to everyone. The country, one of the world’s oldest by average age, has a relatively good record on pandemic containment, with just 14.5 deaths per a million people, compared with about 230 per 100,000 in the U.S., according to data compiled by Johns Hopkins University’s Coronavirus Resource Center.

“There’s strong peer pressure in Japan,” said Kentaro Iwata, a professor of infectious diseases at Kobe University. “Also it wasn’t politicized here, like in the U.S.”

A high school student receives a COVID-19 vaccine shot in Ichinomiya, Aichi Prefecture, in September. | KYODO
A high school student receives a COVID-19 vaccine shot in Ichinomiya, Aichi Prefecture, in September. | KYODO

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