TOKYO -- The effects of international competition for coronavirus vaccines has left Japan with a noticeably slow immunization rollout. Domestic development is yet to catch up, and the safety-net of vaccine procurement from abroad has been rendered unstable by EU export controls. To prepare for future issues, some government officials and ruling party lawmakers are looking for ways to rebuild the current national vaccination system.
"There are limited numbers (of vaccines). From a perspective of fairness, we decided to distribute on a first-come-first served basis," said Takayuki Ishimori, mayor of the Tokyo suburban city Hachioji, during a March 18 press conference. At the event, he wore a stern expression while seeking understanding over the start of vaccinations on April 12 for elderly people.
At present, the actions of municipal governments across Japan are restrained by lower than expected vaccine supplies. The Tokyo Metropolitan Government has distributed its first shipment from the national government to Setagaya Ward and the city of Hachioji, which both have large elderly populations.
In Hachioji, where around 160,000 people aged 65 and over live, the first round of vaccinations was enough for just 1,950 doses. A city official admitted, "We were really concerned." Although there were plans to begin shots at care facilities for older people, they are also used by individuals who are not residents in the city, so instead a first-come-first-serve system was introduced.
Compared to similar efforts abroad, Japan's domestic vaccination development is significantly behind, and for the time being the country will continue relying on imports of foreign-made inoculations. The "outside cause" having such a dire effect on municipal governments' vaccination plans is the EU's export controls.
At a March 12 press conference, Minister in charge of Administrative Reform Taro Kono said that he expects Japan will by the end of June secure about 100 million doses (enough for some 50 million people) or more of the vaccine developed by U.S. pharmaceuticals firm Pfizer and manufactured in countries including Belgium. But he included a caveat: "The circumstances are still predicated on the EU giving approval." Whether the plans go ahead as envisaged is apparently down to the EU.
In the finalized contract between the European Commission and drugmakers that have signed a pre-purchase agreement, vaccines produced within the EU can only be exported with the approval of member states and the European Commission. Six firms at the vanguard of vaccine development are affected by the export controls, including Pfizer Inc., which the Japanese government has a procurement contract with, the U.K.'s AstraZeneca PLC, and U.S. firm Moderna Inc.
Issues around Pfizer's ability to produce the vaccine and the export controls have played a significant part in delays to a full start in vaccinations for elderly people in Japan. Some senior government officials have admitted to some resentment over the circumstances, and described it as "a miscalculation."
Data collation site Our World in Data, managed by the U.K.'s Oxford University and other organizations, showed that as of March 22 just 0.5% of people in Japan had received their first coronavirus vaccination. Export controls were initially expected to be lifted by the end of March, but have now been extended into late June. An official at the Ministry of Foreign Affairs said with concern, "We can't say for sure there won't be another extension."
What has been made abundantly clear is the danger of relying on other countries. On Feb. 17 at the House of Representatives Budget Committee, Prime Minister Yoshihide Suga said, "I fully understand the voices asking why Japan doesn't have its own (vaccine)," and went on to emphasize, "An established system to develop and produce them domestically is hugely important for crisis management."
On March 18, the project team to strengthen and cultivate pharmaceutical creation capability (PT) was established at the headquarters of the ruling Liberal Democratic Party. Japan Pharmaceutical Manufacturers Association Chairperson Joji Nakayama attended the meeting, and explained, "Domestic companies are working tirelessly on development, but it will still be some time until approval."
All of the fast-produced vaccines abroad have made use of new technology developed to respond to other infectious diseases in the last five to 10 years, and the United States has continued to invest in the work. Based on this, Nakayama maintained, "A prevention plan in place in peaceful times is necessary."
The necessity of supporting domestic vaccine development has been debated countless times in the past, but still ended with no progress. In the event of a pandemic, the government makes moves to support development and production, but in quiet times demand is limited just to vaccinations for children and other sections of society. There are also risks of demand cratering if there are continued reports of adverse reactions, making it a difficult field for drugmakers to try their hand at.
Now, four domestic firms are going ahead with clinical trials, but with vaccinations progressing across the world, the late-developing group is having trouble getting together a large-scale pool of test subjects, and senior staff at companies involved in development have said, "If the government doesn't soon come up with a response that hits the nail on the head, no one will continue (to develop vaccines)."
The Ministry of Health, Labor and Welfare intends by June to issue policies to strengthen its response, but if they don't guarantee consolidation, government procurement or other support, there's a strong sense the changes will be a disappointment. But factors, including that senior figures at the PT are looking at the events of the past and saying that the issue can't be dealt with easily, appear to show no clear path to a resolution.
(Japanese original by Ai Yokota, Lifestyle and Medical News Department, and Yusuke Tanabe, Political News Department)