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Invest in health care, virus testing to revive economy: Japan Nobel laureate Honjo

Tasuku Honjo, deputy director and distinguished professor at Kyoto University Institute for Advanced Study, is seen in this file photo taken in Sakyo Ward, Kyoto, on April 6, 2020. (Mainichi/Ai Kawahira)

TOKYO -- It's been almost a year since the first coronavirus case was confirmed in Japan. Since then we've seen fast spreads of the virus in spring, summer and winter, with some 250,000 infections and more than 3,000 deaths. At the same time, vaccinations are set to begin in February at the earliest.

    So, what's needed for us to be able to contain the coronavirus and lead secure lives in 2021? To try and answer some of these concerns, the Mainichi Shimbun spoke to Tasuku Honjo, one of the recipients of the 2018 Nobel prize in physiology or medicine and distinguished professor of immunology at Kyoto University Institute for Advanced Study.

    Mainichi Shimbun: It's been almost a year since the first confirmed coronavirus case in Japan. What do you think of the responses during this period?

    Tasuku Honjo: I believe that the economy can only recover if the health system is protected and a safe society is fostered. The government mistakes this sequence. If first of all people can fulfill their activities securely, then economic activity will probably pick up naturally.

    The government tried to help the tourism industry with its "Go To Campaign" to stimulate demand last summer, but with people who are seeking tests unable to receive them, it doesn't really seem like the kind of conditions that make you want to travel in.

    MS: The spread of infections isn't stopping. What should we do to stop the virus?

    TH: I think a system providing thorough testing is required. A system of epidemic control upon entering this country is also important. It's not like the spread of the coronavirus is going to suddenly disappear with vaccinations. The government is still saying "if you test too much it'll bring down the health system," and testing numbers are, as ever, kept low.

    Though they offered support to the travel industry and eateries with Go To, what kind of backup did they provide to medical companies and institutions? A shortage in nurses and limits on the number of patients being seen has become an issue as it hurts medical institutions' business.

    They say, "health care is important," but what has actually been done up to now? In the government's budget, the amount allocated to strengthening the system for providing medical services is absolutely paltry compared to the sums for economic countermeasures. Why aren't they treating things that concern the people's safety and security properly? I have to say there is a facet of the pressure on the health care system which is man-made.

    MS: What do you think our lives will be like this year?

    TH: We need to make at least some progress in expanding safe and secure areas and protect society. For example, a certain area could have a wide-ranging testing program to secure the safety of the many people there, and a nursing home could receive regular once-monthly tests to guarantee a sense of security.

    It's a pity for university students to only do their lessons online, so they could come to school feeling safe if they were tested once a month. If we don't create this kind of basis for society, I think we can't carry on societal activities with confidence.

    MS: You're saying it's important to take pre-emptive measures?

    TH: Right. We should at least have a system where, if you think you might be infected, you can instantly receive a test. Early tests should be used as a defensive measure to prevent the virus spreading. Japan has cluster infection measures, but these are ultimately about sorting out the issue after it's happened, so they can't prevent coronavirus infections from spreading.

    What's necessary is the establishment of a wide-scale testing system administered from a preventative point of view, and the quarantine of people who do test positive. I also think that money invested in testing will bring about greater returns for society. The government's greatest role must be to ensure the people's safety so they can carry out their lives. The economy can return to vitality this way, but so far it hasn't been achieved. I think this is a foundational issue.

    MS: How do you see the situation in the U.S. and other countries where vaccinations have begun?

    TH: Because there is still a limited number of vaccines, all I can say is that it's difficult to see how it will go. The Pfizer-made vaccine approved in the U.S. introduces to the body a miniscule amount of ribonucleic acid (RNA), which carries the virus's genetic information, encouraging the production of antibodies which can combat the virus. Vaccines until now have inserted deactivated viral pathogens into the body, so theoretically RNA vaccines are thought to have a lower risk of side effects.

    Results from clinical trials so far have been on limited numbers of people, but it's said the risks of side effects are low. Of course, for humanity this marks our first experience with RNA vaccines, so to really appraise it we'll need to wait for an increase in vaccinations. But there is a chance they could be good vaccines which are both effective and have relatively few side effects.

    MS: Do you think these vaccines offer expectations for an early end to the coronavirus crisis?

    TH: Well, it is going to take time for the vaccine to be completely distributed in the U.S., Europe and then Japan. Even if the vaccine is effective, it's probably going to take about a year for the spread of the coronavirus to die down. Even at the earliest, it will come to Japan in February or March. Getting those vaccines out to tens of millions of people is going to take quite some time.

    Also, depending on factors including the infectivity of the virus, many people will have to be inoculated for the outbreak to be brought to heel. Vaccines are a type of societal protection, so if only half the population get it, the pathogen will continue spreading among the other half. If a significant proportion of people don't obtain immunity via these vaccines, then we as a society will not be able to reach a situation in which we can block infections.

    The U.S. and U.K. are at the forefront of beginning to administer the inoculations, and after a month or so we should see a considerable number of immunizations. But it will take several months after the vaccinations for the results to manifest. Whether we'll see an effect from all this by spring 2021 is something even the experts don't know. Because the vaccines will only be reaching Japan around the time we should be seeing an effect there, it's thought we probably won't be seeing that same effect in this country until around the summer.

    MS: Do you think it will be in time for the Tokyo Olympic and Paralympic Games?

    TH: I hope so, but the timing is quite narrow. Even if everything goes well, I think it's going to be down to the wire.

    MS: What do you think is going to happen with the new coronavirus in 2021?

    TH: If the vaccine is effective, has very few side effects, and can be distributed widely and comprehensively, then it's possible the coronavirus will become less of an issue. That's what I'm hoping for. However, the health care system, which is often said to be falling apart, should do more to be prepared for infectious diseases. This is because even if the new coronavirus is quelled, the risk from a new infectious disease is still present as normal.

    The Ministry of Health, Labor and Welfare -- which has failed to provide leadership -- and the universal public health insurance system born of the sacrifice of medical firms, each should seriously engage with reforms.


    Profile: Tasuku Honjo

    Tasuku Honjo was born in Kyoto in 1942. He graduated from the faculty of medicine at Kyoto University in 1966, and after study in the U.S., became a professor at Osaka University in 1979. In 1984, he transferred to Kyoto University, and took up his current post in 2017. He was awarded with the Order of Cultural Merit in 2013, and honored with the Nobel prize in physiology or medicine in 2018.

    (Japanese original by Eri Misono, Lifestyle and Medical News Department)

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