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Japan starts 4th COVID vaccine shots for certain demographics

A man receives his fourth COVID-19 vaccine dose at a vaccination center in Tokyo's Minato Ward on May 25, 2022. (Mainichi/Ayako Yamagata)

TOKYO -- Japan began offering fourth doses of the coronavirus vaccines nationwide on May 25, restricting shots to those aged 60 and over, and people aged 18 and over who are at high risk of severe COVID-19, such as those with preexisting medical conditions.

    In Tokyo's Minato Ward, elderly people made their way to a vaccination venue to be inoculated.

    The fourth doses, using either the Pfizer or Moderna vaccines, can be given to people five months after they receive their third shot. On May 20, Japan's Cabinet decided to partially revise the Immunization Act enforcement order to include people aged 60 and older among those required to try to get their fourth jabs. Over 90% of coronavirus deaths in Japan have been among those aged 60 and older. Those with chronic respiratory illnesses and diseases that weaken the immune system are also prone to developing serious COVID-19 symptoms.

    Research conducted in Israel and elsewhere has also shown that fourth COVID-19 vaccine shots are effective for those aged 60 and up, but less so for young people. Up until the third dose, vaccine shots have been administered mainly to prevent infection, but based on the latest data, the Japanese government decided to pivot to a fourth-shot policy aimed at preventing serious COVID-19 symptoms, and restricting eligibility for the boosters.

    Atsuo Hamada, a specially appointed professor and vaccine expert at Tokyo Medical University, commented, "When looking at the data on fourth shots in Israel, we can see that the shots have helped prevent serious symptoms. In other developed countries, too, fourth shots have been given to groups at risk of developing serious COVID-19.

    The government and local bodies, however, are not fully aware of who among people under the age of 60 have underlying medical conditions. As a result, the way vaccination vouchers have been sent out differs from municipality to municipality.

    The two mainstream methods are sending out vouchers to those who apply for them, and sending vouchers to everyone aged 18 and over for them to use once five months has passed after their third shot. But there are also examples of local bodies allowing people to come directly to vaccination venues without a voucher, and having a doctor check whether they are eligible. The government says that it wants local bodies to consider a flexible response corresponding to the situation in each area. However, if a person does not fall within an eligible group, they cannot get a fourth jab.

    "The system is difficult to understand," Hamada said. "People with underlying ailments have their own doctors. There is a need to cooperate with local medical associations and provide an easy-to-understand explanation to residents while specifically naming illnesses, saying, 'We want people with these conditions to get vaccinated.'"

    The Japan Association of City Mayors and other bodies are calling for medical workers and staff at nursing homes to be added to those eligible for a fourth shot.

    "I think there may be a need for reconsideration," Hamada said. "It's possible that from this fall onward in particular, we may see another increase in infections. If that happens, then we need to consider once more whether the scope of those eligible for the fourth shots should be expanded."

    (Japanese original by Ayako Yamagata, Lifestyle and Medical News Department)

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