RESOLVED: Japan's Response to Covid-19 is Prudent
May 20, 2020
On January 16, 2020, Japan announced its first case of Covid-19 and continues to coordinate a response to the pandemic. On April 7, Prime Minister Shinzo Abe declared a partial state of emergency and expanded it nationwide on April 16. He lifted the state of emergency last week in all but eight of the country’s prefectures and could soon cancel the remaining restrictions as the government tries to address public health concerns and promote economic growth.
From the Editor
In the fifteenth issue of the Debating Japan newsletter series, the CSIS Japan Chair invited Dr. Kazuto Suzuki of Hokkaido University and Dr. Hiromi Murakami of the National Graduate Institute for Policy Studies to share their perspectives on Japan’s response to the coronavirus.
Dr. Kazuto Suzuki
Vice Dean and Professor, Public Policy School, Hokkaido University
Although it is still too early to say, Japan’s response to Covid-19 has been prudent so far. If we take the number of deaths due to Covid-19 as a measure of success, Japan has been successful with 5.38 deaths per million (67th in 140 states), compared to 256.76 deaths per million in the United States (9th) or 499.12 deaths per million in the United Kingdom (4th). If we take the excess mortality rate (the number of deaths exceeding a country’s previous five-year average) as a measure of success, according to the National Institute of Infectious Disease of Japan, it is in the negative, compared to 30,800 excess deaths in the United States and 50,000 excess deaths in the United Kingdom, according to the Financial Times. While there are different explanations for why these numbers are so low compared to other countries, it is at least possible to say that Japan has not made too many mistakes.
One reason Japan has been successful up to this point is because of its strategy at the early stage of the spread of the disease. The experts tasked with developing Japan’s strategy, Dr. Shigeru Omi and Professor Jin Oshitani, are experienced epidemiologists who fought against polio and SARS during their tenures at the World Health Organization (WHO). They are also joined by Professor Hiroshi Nishiura, a leading expert in infection modeling. These experts had to consider Japan’s lack of testing capabilities (1,500 per day at the end of January) and the limited number of Intensive Care Unit (ICU) beds (5.6 per 100,000). In addition, Covid-19 was designated as an infectious disease under the Infectious Disease Law, which requires the mandatory hospitalization of any positive patients. Given this requirement, the most important objective for these experts was to protect these limited medical resources with very small testing capabilities.
Although such a task was daunting, they found a silver lining from the data collected in China and on the Diamond Princess, the cruise ship harbored in Yokohama during early February. Their finding was that the transmission of the disease happens through only 20 percent of patients, but these patients will then infect many others at once and create a cluster. So, they found that it is possible to mitigate the spread of disease by focusing on the cluster with aggressive contact tracing. They applied this hypothesis in trying to mitigate the spread of Covid-19 in Hokkaido in late February. They advised the governor of Hokkaido, Naomichi Suzuki, to declare a state of emergency despite there being no legal basis to do so. Governor Suzuki made an announcement based on this advice, requesting that people stay home and that bars and restaurants close for three weeks. Meanwhile, the experts dispatched a contact tracing team with experience from the novel influenza outbreak of 2009. This strategy paid off, and Hokkaido was able to contain the spread. Governor Suzuki declared an end to the state of emergency on March 19.
However, this announcement sent the wrong message to the rest of the country. There was a three-day weekend from March 20 to 22, and it was Hanami season, when many have parties and go view the cherry blossoms. In addition to that, there were a number of people coming back from trips to Europe who had contracted the virus. This nationwide relaxation created a second wave of the coronavirus that made it extremely difficult to trace all patients given the limited number of tracing experts. Thus, Omi, Oshitani, and Nishiura recommended that the government declare a national state of emergency.
In their research, the experts found that most transmission takes place through droplets. They promoted the idea of avoiding the “three Cs”: (1) closed spaces, (2) crowded places, and (3) close-contact settings. In addition to avoiding the three Cs, Japanese citizens continued their long-held practice of wearing masks and other cleanliness practices. There is little resistance to this behavior since hay fever is very common, and washing hands and taking off shoes are built into Japanese culture. The high consciousness of proper sanitation surely contributed to the mitigation strategy.
The national and local governments took up this idea and requested businesses that feature the three Cs to close during the state of emergency. These businesses include bars, restaurants, cafés, Karaoke venues, Izakaya pubs, live music houses, etc. Because of strong criticism from opposition parties, the law does not grant the government the power to enforce the lockdown, so the government can only request these sectors to close. However, many shops, bars, and restaurants have closed since they do not want to be blamed for spreading the disease. The risk to a business’ reputation has more significant commercial and financial implications than closing for a short period. Such normative pressure has contributed to the successful implementation of a “soft” lockdown.
Dr. Hiromi Murakami
Visiting Scholar, National Graduate Institute for Policy Studies
The Abe administration’s over-confidence and indecisiveness in response to the coronavirus pandemic have probably made it difficult for Japan to learn from its Covid-19 experience in preparing for the next waves of Covid-19.
On May 14, Abe lifted the national emergency order with an exception for major prefectures, as the number of new Covid-19 cases has decreased. However, insufficient testing capabilities have continued to remain, making it difficult for Japan to grasp a complete picture of the pandemic. Some may believe that Japan is wisely and steadily combatting the disease, given the relatively low number of reported cases and deaths thus far, but the truth is that the Abe administration has fumbled the ball. Japan’s leadership has been mostly reactive, invisible, and indecisive. As a result, criticism of the Abe government is rising, and Prime Minister Abe’s approval rating has declined while the approval ratings of a majority of democratic leaders around the world have soared.
This is partly because Abe’s economy-first policies have not been sufficient, and concerns about an economic downturn have complicated efforts to bring the Covid-19 situation under control. Stung by a consumption tax hike in 2019 that introduced economic fragility, Abe initially resisted coronavirus response measures that would in any way restrict economic growth. Thus, instead of an immediate and dramatic regiment of testing, contact tracing, and lockdowns, the Abe government adopted an incremental approach relying mainly on voluntary restraint, providing minimal support even while it requests businesses to suspend operations. The ruling parties finally prepared a bill to mitigate the rent burden for already failing small and mid-sized firms. However, such delayed action is only increasing anxiety among the public and the business community that the government may be helpless in the face of rising unemployment and bankruptcies.
At first, the relatively low death toll in Japan lulled the Abe administration into a false sense of confidence that its three-pillar plan—identification of early clusters, selective Polymerase chain reaction (PCR) testing, and voluntary stay-home orders—was working. However, while Abe was trying to move forward with hosting the Tokyo Olympic Games, which he views as an important part of his legacy, no one was in charge of the coronavirus response. It wasn’t until March 6 that Yasutoshi Nishimura, the minister in charge of economic revitalization, was appointed to lead the government’s coronavirus response. On March 13, the Diet passed a law that would enable Abe to declare Covid-19 a national emergency, two months after the first patient was discovered. Abe officially postponed the Tokyo Olympic Games on March 24, but by then, Japan was already in the next phase of its health crisis, in which it was no longer possible to track when and where people had contracted the disease. Tracing clusters had become virtually impossible, and health facilities were filling up and coming to the verge of collapse, given that Japan’s intensive care unit (ICU) bed capacity is only half of Italy’s.
Even the passage of the new emergency law did not adequately address the problem. It did not state where various decisionmaking responsibilities rested, nor did it provide superseding emergency power over ministries and agencies to overcome bureaucratic stove-piping by ordering inter-agency collaboration on Covid-19 response measures. Everyone was frustrated with the health ministry’s slow movement to address the chronic shortage of PCR testing kits. Because limiting people-to-people contact was critical, the ministry reluctantly made telemedicine available for a patient’s first visit, but only for a limited time during the crisis. It didn’t allow drive-thru testing until April 15, two months after South Korea had launched its very successful testing program.
Compounding this problem is the fact that the Abe administration is also hesitant to empower governors. While most governors were hesitant to take bold positions on their own and tended to wait for orders from above, Governor Yuriko Koike of Tokyo introduced her own initiative to contain the virus. This generated friction with the Abe administration over which types of businesses should be designated for voluntary closure under an emergency order. Koike desired stricter measures to allow for only a small number of stores to remain open, but Abe pushed back and included a range of businesses such as barbershops and bar-restaurants with limited hours. With no real power to enforce closures and a requirement to consult with the central government, Koike initially struggled to minimize the impact of the virus.
Abe’s declaration to end the national emergency order last week raised questions as neither concrete conditions nor an exit strategy have been presented to the public. Frustrated with the administration’s laidback stance and the rising number of bankruptcies within his prefecture, Osaka governor Hirofumi Yoshimura fearlessly announced Osaka’s detailed criteria to remove part of its business suspension requests on May 16, even though it remains under the emergency order by the central government. Public opinion polls reveal a contrast between the soaring popularity of Governor Yoshimura and the widespread frustration with the Abe administration. Low death tolls are not due to prudent measures, but rather pure luck. There should be no more hesitation, disorganization, and wishful thinking. It is time for the Abe administration to think through what needs to be done to prepare for the coming waves of this pandemic.
About the AuthorsKAZUTO SUZUKI is vice dean and professor of international politics at Public Policy School of Hokkaido University, Japan. He graduated from the Department of International Relations at Ritsumeikan University and received his Ph.D. from the Sussex European Institute at the University of Sussex, England. He has worked in the Fondation pour la recherche stratégique in Paris, France, as the assistant researcher and at the University of Tsukuba from 2000 to 2008 as an associate professor before moving to Hokkaido University. He also spent one year at the Woodrow Wilson School of Public and International Affairs at Princeton University from 2012 to 2013 as a visiting researcher. He served as an expert in the Panel of Experts for Iranian Sanctions Committee under the United Nations Security Council from 2013 to July 2015. He has also been the president of Japan Association of International Security and Trade. His research focuses on the conjunction of science/technology and international relations and subjects, including space policy, nonproliferation, export control, and sanctions. His recent work includes Space and International Politics (2011, in Japanese, awarded Suntory Prize for Social Sciences and Humanities), Policy Logics and Institutions of European Space Collaboration (2003), and many others.
HIROMI MURAKAMI is an adjunct fellow with the CSIS Global Health Policy Center and is a visiting scholar at Global Health Innovation Policy Center of National Graduate Institute for Policy Studies (GRIPS) in Tokyo, Japan. Previously, she was a board member of Health and Global Policy Institute, and led Asia research as a vice president at the Economic Strategy Institute in Washington, D.C., and taught courses at GRIPS and the Johns Hopkins School of Advanced International Studies (SAIS) in Washington. She holds an M.B.A. from St. Mary's College and a Ph.D. in international relations from Johns Hopkins SAIS. Her expertise includes global health policies, public policy analysis, and state-industrial relations. Her recent article regarding Covid-19 is “A Japan divided over Covid-19 control.”
“Japan’s Response to Covid-19: A Work in Progress,” Nicholas Szechenyi and Joseph S. Bermudez Jr. (2020)
“Geopolitical Scenarios for Asia after Covid-19,” Michael J. Green (2020)
“Breaking down the G20 Covid-19 Fiscal Response,” Stephanie Segal and Dylan Gerstel (2020)
Coronavirus Crisis Update, Sara M. Allinder, J. Stephen Morrison, Janet Fleishman, and Nellie Bristol
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About the Editor
Hannah Fodale is a research assistant with the Japan Chair at the Center for Strategic and International Studies, where she focuses on projects involving U.S.-Japan relations and security in the Indo-Pacific region.