How Japan Got the Pandemic Right – and Wrong

On October 11, Japan finally allowed international visitors to enter the country without special restrictions. Japan’s move came after many other countries re-opened borders to international travelers – a full year after the United States. While the headline public health outcomes of Japan’s pandemic have been largely positive (e.g., a relatively low death rate despite elderly and densely populated demographics), the exact contributing factors remain unclear. So far, Japan’s successes and failures appear to be a result of the centralization of political power by the dominant incumbent party, as well as idiosyncratic factors such as human capital in public health leaders, prior behavioral norms, and underlying medical conditions of the population. 

While the reduction of negative health impacts is of primary importance in assessing Japan’s pandemic response, the trajectory of the last two years and 10 months has left observers with uncertainty about the nation’s institutional ability to nimbly and effectively respond to future challenges.

By virtually all headline metrics, Japan’s COVID-19 policy has been a success when compared to its G-7 peer nations. Despite an aging population and densely populated urban areas, Japan suffered a fraction of the case and death rates typically observed abroad (although it should be noted that neighboring South Korea and Taiwan fared similarly).

Japan was thrust into the COVID-19 pandemic before many Western countries, with its first confirmed patient in Tokyo on January 15, 2020, and confirmed infections on the Diamond Princess cruise ship anchored at the Yokohama Port on February 3. Unlike in the following years, the government was not immediately eager to close its borders in the beginning of 2020. While many countries restricted entry from China in February, Japan’s didn’t take that step until March 9. The government announced a state of emergency in seven prefectures on April 7, a month after New York City.

On the public communications side, Japan’s initial messaging surrounding the pandemic was clear and led by scientific advisers. At the onset of the pandemic, the government delegated COVID-19 response and responsibility to an expert panel. The crux of early messaging was to avoid the “three Cs”: closed spaces, crowded places, and close-contact settings. Masking was encouraged almost immediately (including through the Abenomask program, which sent masks to all households during a shortage), while the CDC in the United States waffled on its public messaging on masks. These messages were widely broadcast, and at the outset people largely followed the advice.

Japan’s strict entry and testing requirements, cluster-based contact tracing program, and universal masking kept per capita COVID-19 case and death rates to a mere fraction of those seen in the United States and European Union. It was not until an initial Omicron wave in early 2022 and a second Omicron wave beginning July 2022 that Japan would see the kinds of case rates experienced abroad. Importantly, once Japan did see these comparable spikes in cases, 80 percent of its population was fully vaccinated.

By the end of Japan’s first state of emergency in May 2020, the government’s focus on finding and identifying clusters of infections (e.g., at bars, gyms, karaoke parlors, nightclubs) drove cases down to nearly 0.5 per 100,000. Clusters were identified and individuals were isolated and, if necessary, treated. This initial cluster-based approach, combined with universal masking (strongly enforced by social norms) in other crowded spaces such as trains, helped Japan keep serious home-grown spread of the virus at bay until upticks in summer 2021.

Low rates of vaccine hesitancy also meant that by the time Japan’s vaccine rollout had finished, it had one of the highest vaccination rates among its advanced democratic peers. While Japan has seen vaccine hesitancy in the past, it avoided the political polarization and even much of the disinformation that drove vaccination rates down abroad.

While these successes would not be discounted, Japan also deserves criticism for some of its pandemic policies. As Japan reopens, it should be noted its border policy was highly controversial. While citizens were allowed to freely enter and exit Japan (subject to testing and quarantine requirements), foreign residents were barred from entering the country. This policy split families, kept students from universities, and kept workers planning to start new careers in Japan in limbo. Surely the government could have applied the same entry requirements to its permanent residents and its citizens, as the epidemiological risks were identical.

Another widely criticized policy was Japan’s “Go To Travel” campaign, which launched in July 2020 and encouraged domestic tourism to aid the tourism industry, and almost certainly increased early spread of the virus. On a related note, Japan’s pandemic mitigation policies at home paled in stringency compared to international efforts. For example, throughout the “state of emergency,” indoor restaurants, gyms, and theaters remained open, and most universities (including social clubs) and high schools remained in-person. Outdoor dining did not catch on in Japan, and was never encouraged on a policy level.

Japan’s vaccine rollout was also one of the slowest among advanced economies. Japan was one of the first countries to procure hundreds of millions of vaccine doses for its population. However, it required domestic trials for vaccines, despite sample sizes (160 individuals for the Pfizer vaccine) too small to establish a valid efficacy rate. This delayed rollout for months, and even once vaccines arrived, Japan was ill-prepared to administer them. Only doctors or nurses under doctor supervision could inject vaccines, and mass vaccination sites did not open for three months after the vaccines were approved. In the end, by the time the United States had finished vaccinating everyone who wished to be vaccinated, Japan had just begun rolling out vaccines to the most vulnerable individuals, and cases were rising.

Japan’s testing also lagged behind that of other nations. Then-Prime Minister Suga Yoshihide promised to ramp up testing to 200,000 tests per day in October 2020. However, Japan’s daily testing rarely surpassed 100,000 in the run up to the Olympics, and Tokyo’s daily tests rarely cracked 10,000. For comparison, New York City was testing over 40,000 people per day at the time, despite a smaller population and fewer overall cases. Tokyo’s test positivity rate was over 20 percent at certain points in 2021, and over 40 percent during its first 2022 Omicron wave, well over the WHO recommended 3-12 percent range that suggests testing is done “fairly extensively.”

In response to spiking cases of COVID-19 and decreases in hospital bed vacancies, Japan introduced successive “states of emergency” throughout the pandemic. While well-intentioned in practice, these unclear “states of emergency” and “quasi-states of emergency” largely failed to contain an increase in cases or secure needed resources, with constantly shifting rules and guidance. Japan failed to anticipate the increase in cases in 2021 that led to these “emergencies” by preemptively securing more hospital beds. While estimates vary, a number of COVID-19 patients died at home while waiting for beds.

Japan’s inability to adapt structurally and culturally also made some of the more successful pandemic policies from abroad difficult to implement. The same workplace norms that have hurt Japan’s economy made social distancing an impossibility during the pandemic. Japan has the lowest rate of pandemic telecommuting among advanced economies, and the highest rate of individuals who say that their job cannot be conducted from home. Trains remained packed at rush hour throughout the pandemic (good luck avoiding the three Cs), and a plan to reduce the number of trains per day made them more crowded as commuters were forced to go to work by their employers. Clear government guidance and credible commitments to subsidize adjustment costs could have prompted businesses to shift to a new normal.

In other cases, Japan has had difficulty ending certain practices put in place during the pandemic. For example, despite repeated notices from Japan’s health ministry that masking is unnecessary outdoors, the majority of the public continues to mask up outside.

The Tokyo Olympics – Japan’s first experiment in resuming international travel – also deserves special mention. The Tokyo Olympics was deeply unpopular in Japan. The general public, opposition parties, the vice chair of Japan’s COVID-19 advisory panel, and even the Emperor called for the cancellation of the Olympics or increases in safety measures until opening day. The majority of citizens preferred cancellation or postponement. However, public opinion largely fell on deaf ears as Japan’s ruling Liberal Democratic Party insisted on holding the Olympics.

This is a story familiar to observers of contemporary Japanese politics. The political system can be unresponsive to the people, as no viable opposition party currently exists. Scholars have shown how the ruling Liberal Democratic Party has not represented the median voter, using government resources to maintain its dominating coalition. The opposition offers alternative policy platforms but remains fragmented, eroding democratic accountability.

To be sure, Japan was in a tough spot when it came to the Olympics. It is unlucky that the pandemic hit during the host’s designated year. And the International Olympic Committee (IOC) added numerous burdens, including an unforgiving contract. The IOC and its partners were unreasonable from the onset of the pandemic, only accepting a one-year postponement in response to swelling global resistance.

However, the public health issue could have been mitigated in the year leading up to the rescheduled Olympics. The problem was not the lack of good advice, but the ruling party’s tendency to only lend a politically convenient ear. This was not unique to Japan’s pandemic response. The business community has voiced their concerns on a host of issues like immigration and capital controls, but the ruling coalition is only selectively responsive.

The same goes for pandemic containment. At the onset of the pandemic, the government delegated COVID-19 response and responsibility to an expert panel. Politicians let advisers such as Shigeru Omi, the vice chair with a venerable career at the WHO, come to the fore. All policy was explained as following the scientific advisers. But when Omi’s protests against hosting the Games grew louder, culminating in him telling a June parliamentary committee that “it is not normal to hold the Olympics in the pandemic,” LDP officials waved away the comments, claiming offense at the “strong words” from, in their eyes, the now-inconvenient outsider who had overstepped.

As we enter fall 2022, Japan is finally reopening its doors to international travelers once again.

A bundle of factors in Japan – public health implementation, cultural norms, and the political landscape – were successful in preventing many of the devastating public health outcomes relative to many advanced industrialized societies, and deserve both praise and study. However, there were also blunders and inconsistencies, especially toward the later period, when Japan’s government needed to respond to public opinion and new information. This highlighted an economic and political system that has difficulty adapting to quickly-changing circumstances. Increased transparency about the policymaking process and a thorough review of all factors are paramount for the people of Japan, and the world, to learn from the case of COVID-19 in Japan.

One of the essential roles of governments is to solve problems that are difficult to tackle by individuals. Economic policy addressing structural problems and a public health response to a global pandemic are prime examples of tough problems of this sort.

Just like promises to increase innovation in its corporations and economy, Japan’s COVID-19 responses have contained unfulfilled promises and shown an inability to respond and adapt. In the face of structural macroeconomic shifts from the 1980s, Japanese politicians failed to restructure the economy for the public good. In the face of a global pandemic and world sporting event, the ruling party bungled its response.

It is certainly unfair to blame the Japanese government for pandemic-related complications. But there were better paths, and the government did not take them.