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Housebound elderly at risk of being left behind in Japan vaccine drive

Many bedridden older people struggle to leave home to go to vaccination venues. (Image provided by Care Service Hikari)

TOKYO -- While the Japanese government is expediting work to meet its target of administering 1 million COVID-19 vaccination shots per day, some elderly people including those who are bedridden and receiving care at home appear to be getting left behind.

    Municipal government-led vaccination programs concentrate primarily on individual inoculations at medical facilities and group shots at large-scale venues. Consequently, few local authorities are engaging in vaccinations administered during home visits. The lack of help for bedridden people who struggle to leave home has given rise to questions of how shots can be fully provided.

    "If you take a thorough look at the city's brochure, you'll see there's nothing written about how elderly people with difficulties leaving the house should go about receiving vaccinations," said a 74-year-old man who has cared for his wife, 82, for 23 years since a brainstem hemorrhage left her bedbound, as he sighed. His wife requires the highest of Japan's 7-tier nursing care grades.

    The couple live in a city in western Tokyo where vaccinations are administered at a single venue. For her to attend, he would have to move her onto a stretcher and take her to the location in a specialized taxi. A round trip would take about three hours. The man said, "My wife's body can't handle long excursions. We've given up going to the vaccination center."

    When they asked the city government about the possibility of a vaccination at home, they were told, "That kind of method is not being taken." Later, the municipal government changed its stance and began investigating whether they could treat it as an exceptional case and have the vaccine administered at a nearby clinic. But in the meantime, noting the greater risk of severe symptoms developing if a bedridden person of advanced age contracts the coronavirus, the couple remain anxious.

    The Ministry of Health, Labor and Welfare website urges: "Individuals receiving care at home can also be vaccinated. If you are not sure how you can be vaccinated, please consult with your local municipal government." But the reality is that everything is left to the discretion of municipal governments, and only a few are reviewing home vaccinations for elderly residents.

    An official at the city of Kobe divulged, "We're going ahead with individual inoculations (at medical facilities) and group ones, but we haven't decided on a response if people cannot have vaccinations under either system."

    Meanwhile, the Kitakyushu Municipal Government is working with the local medical association to investigate the feasibility of home vaccinations by family doctors. But an official said, "Presently we're offering group vaccinations at dedicated venues, and we cannot yet cover older people who have difficulties showing up."

    Even in places where home vaccinations for elderly people are going ahead, a minimal number of shots are completed in a day.

    Tokyo's Arakawa Ward is considering convening a team of doctors and nurses who would do rounds of elderly residents' addresses to administer home vaccinations from mid-June. The medical professionals would observe the patients for a period following incoluation before setting off for the next home. But the Pfizer vaccine currently distributed to municipal governments needs to be administered within six hours of dilution, leaving issues over how to efficiently inoculate people. An official told the Mainichi Shimbun that it is "ideal to be able to perform multiple vaccinations in a day."

    In future, the ward intends to have its welfare department partner with medical facilities offering home care to issue calls for people who wish to be vaccinated at home.

    A health ministry official told the Mainichi Shimbun, "Vaccinations are led by municipal governments, but if there appear to be issues with getting vaccines to elderly people who receive care at home, then we will consider highlighting individual municipalities' efforts as model cases." The official did not, however, present any fundamental solutions.

    Another issue is a lack of understanding of the state of bedridden elderly people who can't receive vaccinations. According to the health ministry's Statistics of Long-term Care Benefit Expenditures, as of April 2020 about 200,000 people were classed as individuals requiring level 5 nursing care who used long-term care insurance services at home. A certain number of them appear to have difficulties leaving home.

    Hiromi Makino is head of care provision at Care Service Hikari, a business offering home care based in the Tokyo suburban city of Hamura. She told the Mainichi Shimbun that of the approximately 50 elderly people receiving care from the service, between 10 and 20% reportedly have difficulty traveling to vaccination venues. "I'd like municipal governments to partner with care firms to consider how they can make progress on vaccinations," she said.

    Professor Yasuhiro Yuki, a specialist in social welfare studies at Shukutoku University and an expert on conditions at care facilities, said, "For people who can't go to vaccination venues, municipal governments must actively intervene and work to understand their needs. I'd like the national government to stop leaving it all up to municipalities, and instead take measures including drawing up guidelines on vaccinations at residences."

    (Japanese original by Natsuko Ishida, Lifestyle and Medical News Department)

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