Intended for healthcare professionals


Covid-19: Extended emergency and Olympic concerns overshadow Japan’s accelerated vaccine rollout

BMJ 2021; 373 doi: (Published 16 June 2021) Cite this as: BMJ 2021;373:n1546

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  1. Mun-Keat Looi
  1. The BMJ

After a slow start, Japan is racing to vaccinate its healthcare workforce and its most vulnerable citizens before the start of the Tokyo Olympics on 23 July.

The drive comes as a spike in infections led to an extension of the country’s third state of emergency in Tokyo and eight other prefectures until 20 June. The southern islands of Okinawa will stay in full emergency, but seven, including Tokyo, are moving to a “quasi” state of emergency, with some restricted hour openings allowed.

The situation has left hospitals in dire straits, particularly in Osaka, where over 90% of beds reserved for patients with covid-19 were occupied throughout May.1 Japan had 18 649 new cases and 603 deaths in the week to 8 June. To date it has recorded 760 323 cases and 13 523 deaths.2 Testing showed that around 80% of positive tests in Tokyo, Osaka, and Hyogo prefectures were the alpha variant.

Since the country’s vaccination programme started on 17 February this year, over 25 million doses had been given as of 15 June, including 20 million in the past four weeks and covering about 10% of the population.3 Japan is currently administering around 750 000 doses a day. The UK’s figure from the same day was 236 000, with over 72 million total vaccinations in a programme that started in December.

Vaccine approvals

Two vaccines—Pfizer and Moderna—are currently approved, and domestic manufacturing is lined up for the AstraZeneca jab, although approval is still pending. The Asahi Shimbun newspaper reported that the Japanese government had secured 194 million doses of the Pfizer vaccine, 50 million doses of Moderna, and 120 million doses of AstraZeneca, enough to cover the entire adult population by the end of 2021.4

However, critics have rounded on the slow approvals and rollout, as the government has insisted on domestic trials of vaccine candidates. But there is historical caution over foreign made vaccines after high profile controversies surrounding the measles, mumps, and rubella (MMR) and human papillomavirus (HPV) vaccines in the 1990s and 2000s,5 which have led to high levels of vaccine hesitancy.6

Covid-19 vaccinations are being prioritised for medical workers and over 65s, although as of 15 June some sites had started accepting other people over 18. Authorities have opened mass vaccination centres in several cities, providing free shuttle bus services. The city of Fukuoka is set to open 24 hour vaccination centres by July.7 The government has also outlined plans to provide vaccinations at workplaces and university campuses from 21 June to speed up the national rollout.

Although the central government oversees procurement, the rollouts have been left to local authorities, which has led to a number of hiccups. In May a major vaccination booking system crashed,8 and journalists later uncovered a glitch that allowed anyone to reserve a slot with false information.9

The country’s bureaucracy has also been a hurdle. Under Japanese law, doctors are technically the only people legally allowed to administer the vaccine jab. Not until May were the rules relaxed to allow dentists, pharmacists, laboratory staff, and emergency medical technicians to help.10

The bottleneck has led to a scramble for doctors among local authorities. TV Asahi reported that some were paying doctors US$1500 (£1060; €1240) a day, plus expenses including meals, transport, and hotel accommodation11—although the central government is picking up the bill, at least until vaccination of over 65s is completed. Government data released on 8 June showed that 23% of the nation’s elderly people had received at least one shot, and nearly 3% had had their second.12


The race is on for the capital to host the summer Olympics in just five weeks’ time, amid public fears of it becoming a “superspreader” event. Thousands of athletes and delegates will enter the country despite Japan remaining ostensibly closed to foreign visitors. The International Olympic Committee says that it will provide vaccines for 20 000 people working or competing in the games.13

No foreign spectators are allowed, and a decision on domestic spectators is not expected until the end of June. The government is reportedly considering keeping Tokyo in a “quasi” state of emergency, with smaller fines and shortened opening hours for restaurants and bars, for the duration of the games.14

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