Intended for healthcare professionals

Rapid response to:

Letters Covid-19: Equitable global access to vaccines

Ageism in Indonesia’s national covid-19 vaccination programme

BMJ 2021; 372 doi: (Published 02 February 2021) Cite this as: BMJ 2021;372:n299

Rapid Response:

Issues regarding the COVID-19 vaccination program in Japan Re: Ageism in Indonesia’s national covid-19 vaccination programme

Dear Editor

 The number of new SARS-CoV-2 infections in Japan and worldwide has yet to decrease sufficiently in 2021. We wanted to elucidate several issues concerning COVID-19 vaccination strategy in the countries that have already launched the COVID-19 vaccination program before kicking off the program in Japan. The BMJ article entitled “Ageism in Indonesia’s national covid-19 vaccination programme” [1] pointed out that there were different strategies, various tasks, and unknown contents from many aspects in such countries.

 Japan plans to approve a COVID-19 vaccine (a product of the U.S. pharmaceutical company Pfizer) in mid-February, 2021. A vaccination strategy is being explored: starting the vaccinations with ~10,000 medical personnel who consent to receive the vaccine in late February 2021; this should allow ~3 million medical personnel to be vaccinated in mid-March [2,3]. The public vaccinations would start April 1, with priority given to the elderly [3], followed by individuals with an underlying illness; the plan is to vaccinate the general public starting in May [2,3].

 Although municipalities in Japan have begun to prepare for the COVID-19 vaccination of their residents, several issues have arisen as those preparations continue: (a) The difficulty of allocating staff such as physicians and nurses to mass vaccination sites, and (b) the difficulty of establishing mass vaccination sites [2]. Issue (a) must be dealt with because having hospital physicians and nurses, who are caring for COVID-19 patients, also vaccinate the public would be difficult, and because clinic physicians and nurses are also providing routine care. (c) Funding the vaccination program is a third issue [2]. The national government needs to adequately fund the vaccination program, and municipalities must quickly develop adequate staffing with medical associations, nursing associations, and university hospitals in each region.

 For issue (b), numerous aspects must be considered. Vaccination sites must enable the vaccination of large numbers of people without crowding, and the potential occurrence of adverse reactions to the vaccination needs to be monitored on-site. There are also regions where vaccination sites cannot be operated for a prolonged period, and a regional system for cooperation and support in finding vaccination site locations is needed.

 Personnel and organizations in relevant fields need to unite and quickly determine the specifics for the implementation of a safe vaccination system in order to contain COVID-19 while also monitoring adverse reactions. Japan's national government must accurately ascertain the efforts spearheaded by municipalities in different regions and carefully explain the developing circumstances to the public.

Ken Inoue (1), Sadayuki Hashioka (2), Noriyuki Kawano (3), Haruo Takeshita (2), Yoshiyuki Ohira (4)

(1) Kochi University, 2-5-1 Akebono-cho, Kochi-shi, Kochi 780-8520, Japan
(2) Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane 693-8501, Japan
Email: (SH)
(3) Hiroshima University, Japan
(4) International University of Health and Welfare, School of Medicine, Japan

1. Lloyd-Sherlock P, Muljono P, Ebrahim S. Ageism in Indonesia's national covid-19 vaccination programme. BMJ 372: n299, 2021
2. Chugoku Shimbun, Japan. Nikkan 2021; 24 Jan: 1 and 2
3. NHK. 1. Last accessed 30 Jan 2021

Competing interests: No competing interests

11 February 2021
Ken Inoue
Professor and Doctor
Sadayuki Hashioka, Noriyuki Kawano, Haruo Takeshita, Yoshiyuki Ohira
Research and Education Faculty, Medical Sciences Cluster, Health Service Center, Kochi University, Japan
2-5-1, Akebono-cho, Kochi-shi, Kochi 780-8520, Japan