【by Takayuki Onai, June 2021】
The Current Situation in Japan
Japan is in the midst of its third state of emergency, as this essay is written. Tokyo has remained under a state of emergency since the beginning of 2021, with the exception of a short period of about four weeks early this spring. Put simply, the Japanese government has been unable to curb community transmission.
In terms of infection numbers and fatalities, the situation in Japan may be less severe than other countries. This is true in comparison with the statistics of the United Kingdom or the United States. However, compared with the other island nations of Taiwan, Australia, and New Zealand, where new infections have been reduced almost to zero, Japan’s failure is distinctly visible.[1] In Osaka Prefecture, a number of those infected with Covid-19 have died at home without ever having been admitted to hospitals due to a shortage of Covid beds. The lengthy delay in Japan’s vaccine rollout has also shocked the world.
Faced with this reality, anxious Japanese citizens are doing all they can to protect themselves from the virus, holding infections in check by controlling their behaviour. Public surveys show that approval-ratings for the cabinet and people’s trust in the government remain consistently low. Why, then, has Japan failed? This essay focuses on the relationship between politics and science to explore the reasons for Japan’s failure.
The Politics-Science Relationship
Governments are responsible for deciding policy on Covid-19, and the role of experts is to provide scientific advice for governments. Scientific knowledge is essential to policy-making, but governments must also consider a range of factors when making decisions, including policy costs, economic impacts, allocation of medical resources and so on. It is clear that policy on Covid-19 cannot be formulated on the basis of scientific knowledge alone.
Therefore, it is not uncommon for disagreements to arise between governments and experts. In the early stages of Britain’s pandemic, Prof. Neil Ferguson, arguing in favour of lockdown, clashed with Boris Johnson’s administration, which wished to avoid a lockdown. In the United States, Dr. Anthony Fauci’s correction of unscientific remarks made by former President Trump made the headlines. Trump was reported to have distanced himself from Dr. Fauci while often exerting forceful pressure with regards to federal Covid-19 policy. The government of the United Kingdom quickly shifted its policy to introduce a lockdown, following a debate in which public opinion played a part. The case of the United States demonstrates how experts employed as government advisors can operate independently of the government.
Covid-19 presents a host of unknowns, demanding close cooperation between governments and experts. However, their responsibilities must be separated. Experts should offer advice along with a number of alternatives for governments to choose among. Governments must then account for the basis for their choice. In this way, experts aim to make proper scientific judgements, without being swayed by the interests or expectations of government; at the same time the government can shows their responsibility for any decisions they makes. This is the ideal model of the relationship between governments and experts.
This corresponds to the current standard codes of practice on how to deal with risk. For example, a report by the FAO/WHO CODEX Alimentarius Commission (see it’s Appendix Ⅳ[2]) advises, ‘There should be a functional separation of risk assessment and risk management, in order to ensure the scientific integrity of the risk assessment, to avoid confusion over the functions to be performed by risk assessors and risk managers and to reduce any conflict of interest.’ If risk assessment and risk management are confused, the scientific character of risk assessment will be lost and assessment will instead be conducted in a way that conforms to the preferred policies of the risk managers.
Regrettably, Japan’s Covid-19 policy appears to be afflicted by such a distortion, whereby the government makes unilateral political decisions and its experts offer scientific grounds to back up the decisions.
Anti-scientism among Politicians
Japanese politicians (Cabinet members) do not understand how they should employ scientific knowledge. They prioritise their political interests, often ‘cherry picking’ scientific advice to suit their agendas. Moreover, politicians have sometimes disregarded the roles that their expert advisory panels and committees ought to play.
Former Prime Minister Abe did not even attempt to seek advice from experts before deciding to close all schools in February 2020. Later he acknowledged that in the Diet session. In hindsight, this school closure may have helped to prevent the virus from spreading. Yet the people of Japan were left with the sense that Covid policy was decided without any scientific evidences, and trust in the government was undermined. The Abe administration also pushed through a plan to distribute two cloth face masks to all Japanese households despite many people’s doubts over cost-effectiveness.
From autumn 2020 on, the subsequent Suga administration promoted a travel subsidy campaign intended as a political eye-catcher. Many specialists, including both inside and outside the government, argued at the time that the virus would spread by human mobility increase. When the number of cases surged across Japan last December, experts repeatedly advised the government to put a temporary halt to the travel campaign. Yet Prime Minister Suga denied to end the programme, citing an assessment by the government’s expert panel conducted when the programme was under consideration six months earlier, which approved that ‘travel would not spread the virus’. This is the clearest example of the political leaders’ attitude to ignore the latest scientific assessments and logical thinking, to utilise only the knowledge that fits its agenda.
Though Prime Minister Suga has reiterated his claim to be ‘following the judgements of experts’, this is likely an attempt to shift his responsibility onto them.
Adhering to the Status Quo
Since the early days of the pandemic, the Ministry of Health, Labour and Welfare’s Department of Public Health has remained underestimate about the situation. Then, the border measures to protect people have been left in place. After community transmission expanded, MHLW chose not to disclose its predictive simulations of Covid-19 spread. Moreover, as MHLW continues to avoid any significant expansion of the testing and contact tracing systems, the country is deprived of its key means of containing the virus.
According to a report published by a private-sector independent investigation group, MHLW staff lobbied Diet members to oppose the budget for PCR testing expansion. They were also spreading scientifically inaccurate views at that time, intent on emphasising the drawbacks of PCR tests. As the Japanese public grew increasingly indignant about the difficulty in accessing tests, former Prime Minister Abe urged MHLW to expand PCR tests; however, the systems of testing and quarantine are still inadequate for dealing with the increase in cases.
Thus, during the second state of emergency begun at the beginning of this year, the Tokyo Metropolitan Government was obliged to significantly cut back its contact tracing of infected persons. There are strong indications that MHLW and its subordinate research institutes have certain particular interests.
In addition to reducing costs, one reason why the government as a whole has neglected the basic approach to controlling communicable diseases is its intention to maintain ’business as usual’, even during emergencies. A similar pattern can be seen in the way the Ministry of Education, Culture, Sports, Science and Technology has requested universities and schools to continue providing face-to-face lessons regardless of the status of the epidemic. The continuous flow of data and scientific knowledge may be great hindrance to a government that has little intention to respond to emergencies flexibly.
The Government’s Expert Panel and Distorted Science
The situation suggests that government officials are unwilling to listen to the recommendations from experts, and that the public health authorities, which are positioned to cooperate with experts, are instead preventing them from being heard. Despite the critical role of scientific advice, experts are by no means in a position of strength. Although experts’ efforts under these circumstances are praiseworthy, it is also difficult to ignore some of the problematic aspects of their conduct.
During the first state of emergency in April 2020, an extraordinary situation arose in which experts made direct appeals to the public, urging individuals to voluntarily restrict their behaviour, their living styles, and even the corporate activities affecting their incomes. The reason for this is in the government’s stance. In March 2020, during the early days of the pandemic, the government was keener to establish post-pandemic economic policies than to put resources into curbing infections. Emblematic of this posture was the appointment of the Minister of State for Economic and Fiscal Policy to an additional post in charge of Covid-19 policy. Experts sensed crisis in this situation. While their frustration and feelings of responsibility is understandable, their actions went beyond the limits of their role, muddying the waters of responsibility. This then enabled the government to shift to them the blame for criticisms by the Japanese people.
Another problem with the government’s expert panel relates to its scientific advice itself, which constitutes the panel’s most important role. A case in point is how the panel continued to argue against expanding the scale of PCR testing.
Countries that have succeeded in containing coronavirus have implemented mass PCR testing, including asymptomatic cases. Although Japanese experts have also been emphasising the importance of PCR testing since last year, they have at the same time argued that the scope of official government tests should be narrowed down. In their arguments, they citied the cost-effectiveness of mass testing and the problem that testing of people with a low prior probability of infection can generate false positives.
Now the data shows that there is a large number of asymptomatic cases, and in many cases the infection routes are unknown. Under these circumstances, the first-line choice to prevent the spread of infections should be to quarantine infected persons quickly through mass testing. Even if mass PCR testing cannot be proven to suppress infections, logically speaking, infections are unlikely to spread due to ‘false positives’. This means that the basis for the experts’ arguments is not a scientific judgement, but a political intention to reduce testing costs, along with consideration for public health centre which would become much more exhausted if the system were expanded.
A similar problem can be seen in the way experts claimed that travel-related movements would not cause infections to spread, back when the government launched its travel subsidy campaign. In terms of scientific evidence, infection clusters inside airplanes had already been reported by US Centers for Disease Control and Prevention in the early days of the pandemic. Above all, ‘travel’ is more than simply ‘moving’ to another place.
This is not to say that experts can simply disregard factors such as policy costs. But providing a basis just for the policies that the government wishes to implement is inappropriate as the role of a scientific advisory panel. If the government’s expert panel continues to avoid providing critical views to the government, Japan is likely to repeat these same mistakes in the future.
Losing Sight of the Way to ‘Exit’
Some experts seek to justify the governments’ lack of action by referring that the United Kingdom has been unable to curb infections despite its lockdown. On the contrary, both the government and its experts seldom mention the success stories of Taiwan or New Zealand. However, the United Kingdom has also turned its fortunes around thanks to a tenacious lockdown, widespread rapid testing and an expeditious vaccine rollout. In short, the efforts of the United Kingdom were likely to be the textbook case of infectious disease control. But Japan has not followed the textbook, has not learned from the successes of other countries, and has failed to respond to the pandemic in a scientific and rational way.
To change this situation, first of all, the government’s expert panel must perform its role with scientific integrity. That said, unless the government changes its behaviour of rejecting expert advice that does not fit its policies, the expert panel is likely to remain powerless. Then, only a critical response from the citizens would have the power to change the government’s attitude: Our recovery from Covid-19 should be seen as a proving ground for democratic politics in Japan.
AUTHOR
Takayuki Onai, Ryutsu-Keizai University, Japan
NOTES
[1] The situations of the countries this essay refers are at the time before the Delta variant epidemic. Many countries, even including Taiwan and Australia which once got a zero Covid status, are struggling with the resurge of the Delta variant community transmission. However, for example, the number of daily new cases in Taiwan was sharply declining during few weeks last June. Although the future of the Covid pandemic effected by some upcoming variants is surely unclear, the key notions of this essay will continue to be reasonable.
[2] http://www.fao.org/3/y4800e/y4800e0o.htm