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In Japan, the first COVID-19 case was confirmed on January 15, 2020. 1 Japanese media often use the term “a surge” to describe a rapid increase in the number of new positive cases, and five such surges have been observed since last year. The ‘first surge’ was at its peak on April 11, 2020, where the number of confirmed cases reached 701 per day.2 The peaks of each surge have continued to increase, with the most recently observed ‘fifth surge’ from July to August this year reaching the highest daily number of 25,892 cases on August 20, as the result of the spread of the delta variant.3
One of the representative actions of the Japanese government to COVID-19 is a declaration of “State of Emergency.” Since the Japanese government does not have the legal authority to enforce a mandatory lockdown like other countries, this declaration is just a way for the government to ask the public for their cooperation and provide preventative guidelines to curb the outbreak. The first state of emergency was declared for seven prefectures on April 7, around the first surge, and the target area was later expanded nationwide until it was lifted on May 25. The duration was extended once from the original schedule, and it lasted 49 days in total. The expert meeting, which was established as a part of Novel Coronavirus Response Headquarters of the Japanese Cabinet, reported that this first state of emergency declaration had a certain effect of suppressing people’s flow and a further outbreak. They assessed the components that contributed to these results: the Japanese quality health care system, Japanese high hygiene awareness and lifestyle, and the cluster control measure Japan adopted. 4 The cluster control measure in Japan differed from those of other countries in that they traced all the contacts retrospectively from the cases and identified the source of infection, a cluster.5 This method was effective for a limited number of cases and only when the health department could conduct the investigation. The government’s message to the public was always focused on avoiding the" Three C’s (Closed spaces, Crowded spaces, and Close-contact settings)" known to be the source of clusters.
The state of emergency has been declared four times so far. As mentioned above, most of the public followed the order and stayed home during the first declaration despite its lack of enforcement. However, as the situation gets worse and has not been easily controlled, the state of emergency has been repeatedly declared and extended, causing the public fatigue of refraining from their activities and many complaints from restaurants and bars, primarily targeted by its restrictions. In areas where the state of emergency has been declared, restaurants and bars are required to close or shorten their business hours and are also ordered not to serve alcoholic beverages. If they do not comply with the order, the restaurant’s name will be made public, and a fine will be imposed. Although the restaurants in these areas that adhere to the request can receive compensation, some decided not to follow the orders with this never-ending declaration. In fact, restaurants and bars account for the largest number of coronavirus-related bankruptcies in Japan. 6
The public’s frustration and fatigue resulted in distrust in governments, and the Suga Cabinet’s approval rating has fallen as the cases increase. Especially when the fourth state of emergency was applied in July for Tokyo and other areas during the Tokyo Olympics, the public’s disappointment against the government was at its peak. 7 Although most games were held without spectators, all the government’s efforts to facilitate the Olympics were frequently criticized as it contradicts their message to the public to refrain from their activities such as dining and traveling. The fourth declaration, which was the longest, lasted for 80 days maximum and targeted 19 prefectures with three announcements to extend its duration. The declaration, which highly depends on the public’s voluntary actions, seems to be losing its effectiveness as it is frequently repeated and extended.
What about Japanese quality medical and public health systems? The number of deaths per 100,000 people in Japan due to COVID-19 is 14.04 today, which is lower than other G7 countries.8 But other East Asian countries show much lower deaths, and it might be difficult to say that the Japanese health care system has functioned well to control the pandemic. According to OECD data, Japan has the highest number of hospital beds per population, 12.8 per 1,000 inhabitants.9 Nevertheless, it has been pointed out from the beginning that the number of hospital beds for treating covid patients soon becomes full. Unfortunately, this problem still has not been solved, and many prefectures lack enough hospital beds to accept and treat covid patients. One of the main reasons behind this problem is the high proportion of private hospitals. Unlike European countries, the government has no authority to order them to provide enough beds even under emergency conditions. Japan also had a hard time securing the testing capacity as well as the beds. Neighbouring countries, South Korea, or Taiwan, which show fewer deaths than Japan, built excellent testing and surveillance systems with their serious SERS and MERS experience. Covid revealed the Japanese health care system’s vulnerability and lack of strong government leadership in infectious disease control.
Under these circumstances, vaccines seem to be the only hope for both the government and the public to end this fight. As of today (October 3, 2021), the share of fully vaccinated people in Japan is 60.06%.10 The vaccination started with healthcare workers in February and then primarily targeted the elderly over 65 years in April. The vaccination rate among the elderly group, which initially accounted for the most severe cases and deaths, has now reached 90%.11 Although Japan has been behind Europe and the United States initially, the vaccination rates have increased with the municipal governments’ efforts. Prime Minister Suga has announced that all those who wish to get the vaccine will complete it by November.
The effectiveness and efficacy of the government’s responses, such as the declaration of the state of emergency, will be further evaluated from an economic perspective or in comparison with other countries’ regulations. Prime Minister Suga, who served for one year during the covid pandemic, decided to step down, and Mr. Kishida will succeed him. Further reform of the healthcare system and economic measures are expected under the new prime minister’s strong leadership.
Ministry of Health Labour and Welfare, January 16th, 2020. https://www.mhlw.go.jp/stf/newpage_08906.html↩︎
Our World in Data, Accessed October 3rd, 2021. https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&hideControls=true&Metric=Confirmed+cases&Interval=New+per+day&Relative+to+Population=false&Align+outbreaks=false&country=~JPN↩︎
Our World in Data, Accessed October 3rd, 2021. https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=none&hideControls=true&Metric=Confirmed+cases&Interval=New+per+day&Relative+to+Population=false&Align+outbreaks=false&country=~JPN↩︎
Novel Coronavirus Expert Meeting, May29th, 2020. Ministry of Health Labour and Welfare https://www.mhlw.go.jp/content/10900000/000635411.pdf↩︎
Novel Coronavirus Expert Meeting, May29th, 2020. Ministry of Health Labour and Welfare https://www.mhlw.go.jp/content/10900000/000635411.pdf↩︎
Teikoku Databank, October 1st, 2021. https://www.tdb.co.jp/tosan/covid19/pdf/tosan.pdf↩︎
Osawa Kaoru, July 26th, 2021. Nikkei Asisa, https://asia.nikkei.com/Politics/Suga-cabinet-s-approval-rating-sinks-to-34-as-Olympics-start↩︎
Johns Hopkins University & Medicine, Accessed October 3rd, 2021. https://coronavirus.jhu.edu/data/mortality↩︎
Johns Hopkins University & Medicine, Accessed October 3rd, 2021. https://coronavirus.jhu.edu/data/mortality↩︎
Our World in Data, Accessed October 3rd, 2021. https://ourworldindata.org/explorers/coronavirus-data-explorer↩︎
Prime Minister’s Office of Japan, Accessed October 3rd, 2021. https://www.kantei.go.jp/jp/headline/kansensho/vaccine.html↩︎