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Coronavirus

[Bookmark] COVID-19 and 1300 Years of Pandemic Politics in Japan: What Can We Learn?

With COVID-19, Japan is now headed towards a set of measures most of the West has already embraced. But as history shows, there is the potential for failure and discrimination as well.

JAPAN Forward

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Bookmark is a JAPAN Forward feature that gives you long reads for the weekend. Each edition introduces one overarching thought that branches off to a wide variety of themes. Our hope is for readers to find new depths and perspectives to explore and enjoy.

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A healthcare worker receives a dose of a Pfizer-BioNTech COVID-19 (REUTERS/Lisi Niesner)

Where Is the Conservative Vaccine Policy in Japan?

An editorial in the The Sankei Shimbun on July 26, 2021 (English version July 30, 2021) spoke out in favor of COVID-19 vaccination certification, not only for travel between countries (so-called “vaccine passports”) but also within Japan. The editorial called on the Government of Japan to “work out steps to make effective use of these documents [vaccine passports or vaccine certificates] domestically.”

The Sankei editorial went on to cite the support of such a measure from the Japanese Business Federation (Keidanren). Given that the name Sankei Shimbun means “Industrial and Economic News,” it should not be surprising that the paper approves of the Keidanren’s position. But there seems to be more to the story than just this.

The editorial quotes Chief Cabinet Secretary Kato Katsunobu on such a measure to promote vaccination. According to Kato, “It is not appropriate to coerce the public to get vaccinated by using unfair discrimination…” 

In response to this, the Sankei fired back with, “It is not appropriate for the government to maintain excessive impartiality in the midst of a national health emergency,” adding that it is important to “create an environment” in which people have a “sense of security.”

The Sankei Shimbun is described as a politically “conservative” newspaper. However, the “conservative” Sankei Shimbun apparently supports the notion that the government ought to define who is allowed to freely participate in society based on health status, favoring “security” over, for example, an individual’s control over his or her own body.

Health worker checks subject for symptoms of coronavirus

Liberal Japan News Outlets Rightly Concerned with Government Overreach

The thoughts of the The Sankei Shimbun may not sit well with conservative Americans, who, in fact, are not at all comfortable with the top-down, government-mandated approach in the area of health care (e.g., Obamacare). In response to U.S. Centers for Disease Control and Prevention recommendations on masking and vaccination as anti-coronavirus measures, several conservative U.S. governors have banned both state-mandated masking and vaccination.

In fact, on vaccine politics, The Sankei Shimbun editorial aligns more with American liberals, who are perfectly comfortable with the use of state coercion to impose their health care agenda. American liberals have led the charge for 100% of Americans to be vaccinated against COVID-19, as well as for masking and lockdowns

While many major Japanese newspapers, such as the Mainichi Shimbun, are politically “liberal,” their views on the coronavirus pandemic do not really mesh with that of American liberals. For example, the Mainichi Shimbun (English edition August 16, 2021) suggested that “everyday lives amid the coronavirus pandemic evoke days from wartime,” in that during the war people in Japan were at the “mercy of state power.” 

The Mainichi Shimbun noted earlier this year (May 3, 2021) that “the debate over coronavirus measures has been insufficient from the standpoint of guaranteeing rights protected under the Constitution [of Japan].”

While the Mainichi Shimbun states that government orders for business closures violate several articles of the Constitution, it has yet to weigh in on the potential use of COVID-19 vaccine certification as an internal passport. It is possible that liberal Japanese newspapers will be against such a scheme, perhaps going as far as to, again, evoke imagery of wartime “state power.”

The Spanish Flu epidemic (early 20th century)

Japanese History and Tradition Complicate Ideological Divisions

The apparent inversion of core values of Japanese and American liberalism and conservatism may be confusing to Americans, but it is an interesting reflection of the differences in evolved ethos between Japanese and American people. In any case, looking beyond ideological labels is key.

Some Japanese suggest that adding an “emergency clause into the Constitution to limit the rights of citizens” and lockdowns are all but inevitable to deal with the current pandemic. With such suggestions in play, now would be a good time to reflect on past Japanese efforts on public health management.

Constitutional debates aside, Japan has a long-standing tradition of controlling infectious diseases through mandatory case reporting, quarantine, and immunization.

Traditional medical practice in Japan was based on the Confucian notion of jin or benevolence. Thus, “physicians fulfilled their responsibility toward their patients and the patients’ family members by acting in a paternalistic and authoritative way…” 

The same reference goes on to say, “The Japanese, nurtured in the Confucian ethos to respect law, order, authority, and social status, acquiesced without murmur to the superior knowledge of the physician.”

During the Meiji Era, it relates:

“Japan, seeking models for modernization, was drawn to the German approach because of the success and progress of German science and technology, and the similarity of the German authoritarian political system under the Prussian Kaiser to its own under the emperor. Official acceptance of Western, particularly German, medicine guided the development of Japanese policy on medical administration and education and set the course for the future.”

With the country opened to foreign trade after the arrival of the Americans in 1853, Japan faced epidemics of new infectious diseases. In an effort to control these diseases, “Infectious Disease Prevention Regulations” were enacted in 1880, which required physicians to report patients showing any signs of six specific diseases to the local Municipal Public Health Committee. If needed, patients were isolated and quarantined.

More diseases were added with subsequent changes to the infectious disease prevention law. In 1885, the Department of Police replaced civilian public health officials and was tasked until the end of World War II with public health administration.

Various options for quarantine of asymptomatic coronavirus patients were considered

What the Law Says, Then and Now

Currently, the Japanese government has classified COVID-19 as an infectious disease. Thus, according to the “Law Concerning the Prevention of Infectious Disease and Medical Care for Patients of Infections,” which replaced the “Infectious Disease Prevention Law” in 1999, positive COVID-19 cases, whether signs of illness are present or not, must be reported to the “designated Public Health Center”.

COVID-19 patients can also be isolated and quarantined based on the Quarantine Act of 1951. (Also of note, Acquired Immunodeficiency Syndrome (AIDS) is a reportable infectious disease according to the law.)

But COVID-19 is, of course, not the first disease to wreak havoc in Japan. Leprosy, now known as Hansen’s disease, has been known in Japan since ancient times, having been mentioned in the Nihon Shoki (Chronicles of Japan) which was completed in the year 720. Leprosy is characterized by severe skin disfigurement, thus, patients in Japan and elsewhere around the world were often ostracized from society and forced to live as vagrants.

While initially thought to be a heritable disease due to the leprosy bacteria’s long incubation period, the causative agent was discovered at the end of the 19th century, confirming that leprosy is not hereditary. 

“Following the science,” Japan in 1907 enacted the “Law Concerning the Prevention of Leprosy”, which mandated sequestering vagrants with leprosy in sanatoriums, in line with international recommendations of the time.

Subsequent amendments of the law expanded mandatory committal to all patients with leprosy (and not just vagrants) into state-run sanatoriums, or leprosaria, established specifically for leprosy patients. As there were no cures or effective treatments for leprosy, confinement to leprosaria was for life. Leprosaria patients did sometimes marry, and married male patients were sterilized “on their own consent.” It should be noted that while treatment of pre-World War II leprosy patients sounds horrible, the Japanese system “did not incur international censure at the time.”

With the development of effective treatments against the bacteria that causes leprosy in the 1940s and the discovery that that bacteria that caused leprosy was not highly contagious, there was no further necessity to keep patients isolated. Japan amended its law in 1953 to state that admission to leprosaria would be “recommended” rather than compulsory.

By that time, the rest of the world had already unlocked its leprosaria and allowed former patients to integrate with the rest of society. Japan finally repealed its governing leprosy law in 1996. Former leprosaria patients brought suit against the government in 1998 and the Kumamoto District Court found the government “negligent in continuing the policy of segregation… and at fault for failing to revise the [L]aw…” The government did not appeal and settled with former patients in 2002.

In 2016, family members of leprosy patients filed suit against the government and sought an apology and compensation for their own suffering. The government did not appeal and agreed to compensate family members.

Novel Coronavirus image

The Harsh Realities of Public Health Politics

With respect to vaccination, the “Smallpox Prevention Regulations” which Japan enacted in 1876 made immunization for smallpox compulsory, with penalties for noncompliance. Vaccinations for other diseases were made mandatory with subsequent amendments to the “Immunization Law” (enacted in 1909).

In 1994, the Immunization Law was changed to make immunizations “recommended” and not mandatory. This was due to a discovery over time of a number of serious adverse effects following mandatory measles, mumps and rubella vaccination in children. The previous version of the law stated that the government would be responsible for compensating victims in the event of adverse side effects due to vaccination. The government faced almost 4,000 claims by the time the Immunization Law was changed in 1994.

Beyond preventing illness and death through infectious diseases, Japan has also tried to regulate the health of Japanese citizens through sterilization and abortion. In order to increase its tax base through increasing the number of farmers, the Tokugawa bakufu attempted various (albeit feeble) means of discouraging abortion. In the Meiji Era, abortion was officially outlawed in the Criminal Code of 1880, later revised in 1907, with a similar intent expressed by the Tokugawa bakufu of increasing the population in order to compete with the larger Western imperialist powers (uner the concept, “give birth and multiply”).

Western countries at the time, including the U.S., were adopting laws promoting physical and mental health by eradicating socially unacceptable mental and physical traits that were thought to be heritable. Those found with an unacceptable trait underwent sterilization, oftentimes forced.

Shigeru Omi, chair of the Government’s COVID-19 Subcommittee, answers questions in the Diet.

Abortion, Eugenics, and War

Along these same lines, and with much influence by Western scientists, Japan adopted the “National Eugenic Law” in 1940 as a means to further both population quality and quantity, but more as “population reinforcement” rather than “sterilization of inferiors”. While abortion was still illegal, the National Eugenic Law “authorized legal abortion in narrow circumstances… prior approval from a second doctor and report to a government agency were required.” Sterilizations were performed on “individuals with mental illness or retardation and those thought to be at risk of transmitting genetic diseases or physical deformities to the offspring.”

At the end of World War II, a total of 454 patients were sterilized. Under the American Occupation, the National Eugenic Law was replaced in 1948 by the “Eugenic Protection Law”. It allowed abortions under five “narrow” circumstances, one of which was if the woman’s “physical heath could be seriously affect by continuation of the pregnancy.” The other circumstances included “rape, leprosy, hereditary illness and mental illness.” In 1949, the law was amended to include “economic reasons.”

Today, the “Maternal Health Law”, which replaced the National Eugenic Law in 1996, allows voluntary-only abortion following consultations between the patient and her physician. There have been a number of claims against the government brought by those who were forcibly sterilized under the National Eugenic Law. For now, the government has contended that the procedures performed at the time were entirely within the framework of the law.

Will social distancing help or hurt normal interactions in society?

Learn from the Past while ‘Following the Science’

One should note that the laws listed above were enacted by the Japanese Diet and not through executive order. 

In hindsight, one could also note that these laws were enacted without complete understanding of the biological mechanism of diseases or their genetics. Nonetheless, the Japanese public, their parliamentary representatives, and the government as a whole accepted “the science” at the time and supported these laws.

Japan is now headed towards a set of measures most of the West has already embraced, including vaccine passports, masking mandates, and lockdowns. Those who insist on these measures promise more security, but as history shows there is the potential for more discrimination as well.

One of the authors of Japan’s Experience in Public Health and Medical Systems reflects on Japan’s experience in dealing with leprosy, which current readers could apply to the current pandemic by substituting the word “leprosy” with “COVID-19”. He writes:

“As we have seen, the government’s isolation policy caused unnecessary suffering to leprosy patients. In this instance, Japan’s experience gives us a lesson that an inappropriate government policy can cause irreparable damage, and the government needs to take careful and prompt actions for improvement.”

Author: Aldric Hama, PhD

Find other thoughtful and thought-provoking essays and reports by Dr. Hama on JAPAN Forward at this link.