Japan’s response to COVID-19 has certain characteristics in addition to basic measures against infectious diseases including “taking social distance”, “wearing mask” and “hand hygiene such as hand washing”. One of them is the adoption of a strategy of early detection of and early response to clusters, writes Valdai Club expert Taisuke Abiru.
On May 25, 2020 Japanese government lifted COVID-19 State of Emergency in the last remaining areas of the country including Hokkaido and Greater Tokyo area. It lasted for about one and half month since April 7.
Japan’s Ministry of Health, Labor and Welfare, as of May 24, reported the country had 16,581 people of “PCR tested positive”, 2121 of “need inpatient treatment” including 165 of “critically ill”, 13,612 of “discharged or end of medical treatment” and 830 of “death”.
Needless to say, this must be nothing more than the end of the first round of the expected long-term fight against COVID-19 for which effective treatments and vaccines are under development. Still, a review of how Japanese government has responded to COVID-19 so far could be helpful in preparing for the expected next round of COVID-19 in the fall.
The first case of COVID-19 infection was confirmed on January 15, 2020. According to the National Institute of Infectious Diseases, there have been two waves of COVID-19 virus spread in Japan. The first one including the cases of Diamond Princess was likely connected to Wuhan in China’s Hubei province which was largely contained by the end of February. The second one which has started since March is more likely to have spread widely in the country through travelers and returnees from Europe and the United States.
Meanwhile, Japan’s response to COVID-19 has certain characteristics in addition to basic measures against infectious diseases including “taking social distance”, “wearing mask” and “hand hygiene such as hand washing”. One of them is the adoption of a strategy of early detection of and early response to clusters.
In many of cases, COVID-19 virus does not transmit from infected persons to those around them. However, there exist several cases in which it is suspected that a single person spread the infection to many others. Furthermore, there have been reported small clusters of patients outbreaks in some areas. It is critical that a cluster does not create another cluster in order to contain the outbreak as early as possible and to minimize the number of infections, critically ills and deaths.
As mentioned above, Japan successfully contained the first wave of COVID-19 by the end of February through the implementation of a strategy of early detection of and early response to clusters. In this regard Japanese government emphasized the importance of avoiding the “Three Cs”, referring to closed spaces with poor ventilation, crowded places with many people nearby and close-contact settings such as close-range conversations.
However, from the second half of March the number of infection cases in which it was difficult to identify the routes of transmission started increasing. And on April 7 Japanese government declared the state of emergency over COVID-19. This declaration was made on the assumption that without taking state of emergency measures COVID-19 infection situation could exceed the capacity of Japan’s medical system and cause a serious damage to the lives and health of the people and have a great impact of the daily lives of the people and the national economy. In the press conference on April 8 PM Abe called for making efforts and reducing opportunities for person-to-person contact by minimum of 70 percent, or ideally 80 percent.
The Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response provided the legal basis for the declaration. This law was made in 2012 in response to the global pandemic of HINI influenza from 2009 to 2010. On March 13, 2020 an amendment to the Act related to COVID-19 was enacted. Now, base on this law, the prime minister can declare the state of emergency if necessary and take various measure to prevent the wide spread of infection and maintain societal functions.
The declaration allows prefectural governors in the affected areas to request residents to stay home except for leaving to perform essential tasks, including going to the hospital, buying food and commuting to work. Governors are also permitted to ask businesses deemed non-essential to close temporarily. However, the Japanese government doesn’t have the legal authority to impose a lockdown or penalty residents who ignore the request, as seen in other countries. These non-compulsory measures under the state of emergency are another characteristic of Japan’s response to COVID-19.
Article 15 of the Cabinet Act stipulates the definition of crisis management as “addressing emergency situations that may cause serious damage to the lives, bodies or property of the people, and preventing the occurrence of such situations”. The current Japanese Constitution does not have the emergency clause that other countries’ constitution usually has. In addition to the Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response, there are only 3 laws with the emergency clause ; the Basic Act on Disaster Management, the Act on Special Measures Concerning Nuclear Emergency Preparedness and the Act on the Peace and Independence of Japan and Maintenance of the Nation and the People’s Security in Armed Attack Situations etc. and Existential Crisis”.
Moreover, except that there are penalties for entering “warning areas” where safety of human life is directly affected or for refusing to comply with the evacuation order, there is no provision in any of these laws that significantly restricts the behavior of people through penalties such as city lockdown and restrictions on going out, as seen in other countries.
Behind this, there has been still deep rooted distrust among Japanese people of human rights violations by the government in the state of emergency before the end of World War Ⅱ. The Liberal Democratic Party, led by Abe, complied in March 2018 a plan to amend four elements of the Constitution. The introduction of the emergency clause was one of the four. But public opposition to the introduction of the emergency clause to the constitution remains strong.
How should we evaluate the results of measures against COVID-19 taken by the Japanese government, which has such a legal handicap for crisis management? When compared to that of other countries, the most reliable indicator would be deaths per 100,000 population. The number of key G7 countries and countries of Asia-Oceania region are as follows; The US (29.87), UK (55.46), France (42.35), Germany (9.99), Italy (54.25), China (0.33), South Korea (0.52), Taiwan (0.03), Indonesia (0.51), Malaysia (0.36), Australia ( 0.41), Thailand (0.08), Singapore (0.41), New Zealand (0.43), Philippine (0.81), Japan (0.65).
Compared with other Western G7 countries, the number of deaths in Japan is clearly small. It can be said that the main purpose of the emergency declaration to manage the collapse of medical care due to the explosive spread of infections experienced in other countries and to minimize the death toll has been reached.
On the other hand, Asian and Oceanian countries generally have fewer deaths than the United States and Western European countries. In preparation for the second wave, which is expected in autumn, we should identify the points for improvement and take immediate action.
Finally, in order to overcome the crisis of a global pandemic of infectious diseases such as COVID-19, it is not enough for a single country to do so, and close international cooperation is essentially required. On May 25, 2020, Prime Minister Abe said in a press conference on the full lifting of the declaration of emergency, "Making developing medicines and vaccines against this virus available to developing countries under a transparent international framework. I would like to propose the creation of a future patent pool at the G7 Summit scheduled next month". The world's first and second largest economies, the United States and China, are increasing the degree of conflict, rather than working together to combat corona after the COVID-19 pandemic. Japan, which has the third largest economy, should play a major role in creating necessary environment for international cooperation on this issue.