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Japan: Backward vaccination policy

29 Jun, 2018
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The number of people infected by measles in Japan has already exceeded 100 this year and the total appears to be rising. Those born between 1977 and 1990 have been vaccinated against measles just once. Experts in infectious diseases say that at least two vaccinations are needed to attain immunity. That generation has been hit the hardest by measles this time.

Unless the Health, Labor and Welfare Ministry overhauls its vaccination policy, measles is likely to become an epidemic at certain intervals. What the ministry must immediately do is to vaccinate those people who had only one vaccination.

In the event that diseases like measles and rubella become epidemics, the government has the power to give vaccination shots to people of all ages by importing vaccines from abroad, outside the framework of regular vaccinations for particular age groups. But the ministry has shown no signs of doing so.

Since measles began spreading in various parts of the country this year, many people have rushed to clinics to receive shots even outside the scope of public health insurance coverage, and a medical practitioner in Tokyo has complained that the supply of vaccine ran out. Ministry officials with medical backgrounds are in charge of inoculation programs. But the ministry has taken no action to import vaccines from abroad as an emergency measure. The reason, according to a ministry insider, is that those officials lack expert knowledge in medicine and legal matters, and do not have the ability to effectively use all legal means to push public health policy forward. Thus the current rampage of measles is nothing but the result of negligence on the part of the ministry.

A university professor of medicine says that Japan is more than 10 years behind European and North American countries in its inoculation policy and his view is widely shared.

Japan has two types of vaccination programs: vaccinations regularly carried out by municipalities and voluntary vaccinations. Although the fees for the regular vaccinations are covered by public funds, the types of vaccinations under this program are limited.

In the United States, publicly funded health care programs cover vaccination against mumps, hepatitis A and childhood influenza. In Japan, individuals must pay for the same inoculations. Hepatitis A and influenza could become serious and mumps could result in aftereffects such as hearing impairment and infertility. The National Institute of Infectious Diseases (NIID) estimates that every year, some 650 people suffer from hearing impairment due to mumps.

Some progress has been made in Japan. After being bitterly criticized for failing to prevent the 2009 flu pandemic, the health ministry has expanded the scope of vaccinations whose costs are covered by public funds including haemophilus influenza type b or Hib, which is different from the virus-caused influenza, in 2013, pneumococcal pneumonia in 2014 and hepatitis B in 2016.

But the ministry did nothing to help those who had not been vaccinated prior to the vaccination expansion. Therein lies the root cause of the latest measles outbreak. Although the ministry started a policy of inoculating people twice with a combination vaccine against measles and rubella (the MR vaccine) in 2006, prior generations were left out and measles is now playing havoc with them. The situation is the same for rubella. If a pregnant woman is infected with the disease, it could directly lead to a miscarriage or an inborn deformity.

Vaccination situations can differ from one region to another. In Hokkaido, vaccination against Japanese encephalitis was not legally required until 2016 on the grounds that Culex tritaeniorhynchus, a type of mosquito that transmits the encephalitis virus from pigs to humans, did not exist on the island. But this policy made no sense given temperature rises and the fact that people in Hokkaido don’t necessarily stay there their entire lives. People who didn’t receive the vaccination have an imminent risk of being infected with Japanese encephalitis, but the health ministry is closing its eyes to this.

Japanese encephalitis is prevalent among pigs mainly in western Japan. The NIID tested 40 pigs in the four prefectures of Shikoku and found that 17 of them had the antibody against the disease, including nine that had been infected recently. In 2015, a 10-month-old boy in Chiba Prefecture caught Japanese encephalitis. Although he survived, his legs and arms have been severely paralyzed. The boy was not vaccinated and there was a pork-processing factory near his home.

That only a small number of diseases are covered by the regular vaccination programs is not the only problem. Another issue is that a relatively small percentage of people receive such vaccinations. The NIID’s 2016 survey showed that only 83 percent of 7-year-old children were inoculated twice with the MR vaccine. Of the 2-year-old children born in the year when the Immunization Law-based vaccination against chickenpox was introduced, a mere 52 percent had received two shots — far below the 95 percent rate required for ensuring mass immunity.

The health ministry is to blame also for these low inoculation rates. Newborn babies are required by law to be inoculated with seven types of vaccines before turning 1. This puts a heavy burden on parents, who have to take their babies to clinics at least seven times for a total of 19 shots. Moreover, if they miss the tight inoculation schedule, they will have to bear the vaccination costs.

To relieve parents of the burden, combination vaccines have been developed in other countries. The U.S. in 2002 certified a combination vaccine against tetanus, diphtheria, whooping cough, hepatitis B and polio and in 2005, another combination vaccine against measles, rubella, mumps and chickenpox. Such vaccines can reduce the number of required shots and greatly lighten the burden of both parents and children.

Japan lags far behind. Companies including Mitsubishi Tanabe Pharma Corp. are now conducting clinical tests for a combination vaccine against five diseases. The health ministry is reluctant to import combination vaccines from abroad because it wants to protect domestic vaccine makers, according to an ex-official of the ministry. Former health ministry officials are now in the top two positions of the Federation of Pharmaceutical Manufacturers’ Associations of Japan (FARMA) after having “parachuted” there after retirement.

To increase the inoculation rates, it would be effective to make the vaccinations a condition for children’s enrollment at kindergartens and elementary schools. But Japanese schools merely recommend the vaccinations if they find that new students have not received them.

The U.S. has a strict “No Shot, No School” rule. Many European countries also have the same system. Japan moved in the opposite direction in 1994 when it turned regular vaccinations from an obligation into something one must make efforts to receive.

The health ministry must increase the stock of vaccines and improve inoculation rates, including those for people who missed inoculations in the past. But Japan’s vaccination policy is determined by what medical officials at the ministry feel and think, and their decisions are blindly followed by the government’s advisory panels.

Reforming this kind of system, which treats citizens’ health as something of secondary importance, would be a quick remedy for Japan’s status as a backward country when it comes to vaccination policy.

This is an abridged translation of an article from the June issue of Sentaku, a monthly magazine covering political, social and economic scenes. More English articles can be read at www.sentaku-en.com.

This entry was posted on Friday, June 29th, 2018 at 9:36 am and is filed under Latest News.

Literature Literature archive

Baalen, S. van. 2018 Research Ethics 14(4), 1–17. https://doi.org/10.1177/1747016117750312

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