Tracking Vaccination Numbers in Japan

The website of the Prime Minister’s Office in Japan (Kantei) is providing a daily update of vaccination progress in two categories: medical staff (doctors and nurses) and senior residents (age 65 and above).

To track these vaccinations, the government has issued tablet computers running software known as the Vaccine Recording System (ワクチン接種記録システム, VRS). It was developed by Milabo, a small privately held company founded in 2013. It describes itself as:

A start-up that provides child-rearing support services such as DX, immunization, health checkup, checkup scheduler, electronic maternal and child notebook, health center reservation system, mainly for local governments.

It had previously worked with the cabinet secretariat on the “MyNumber” personal ID system that assigns a personal identification number to every resident of the country. The budget for developing VRS was 385 million yen (about US$3.5 million).

The software in the tablets is used to scan bar codes and forms when people receive their vaccine doses. Theoretically this should allow the government to accurately track the progress being made.

However, the numbers published on the website keep changing even after they are published. For example, on Monday, May 17 the Kantei website listed a total of 69,526 doses (first and second doses) given to seniors on Monday, May 10 and 57,172 on Saturday, May 15. Two days later, on Wednesday, May 19 the numbers for those two days had been revised to 71,543 and 83,311 doses, respectively. That is an increase of 2.9 percent and 45.7 percent several days after publication.

What this suggests is that the software does not track the numbers and automatically uploads them to a government server at the end of the day (say, via a mobile data connection with a SIM card). Instead, there must be manual steps involved. Comparing the results published two days apart and looking back across 4 weeks worth of data, it turns out that daily totals still change after a whole month, for example by 46 doses from 2,533 to 2,579 for Wednesday, April 14 between May 17 and 19. I mean, really?

In rare cases the numbers have also decreased by 2 or 3 doses from the previously reported totals, which would be hard to explain by late reporting: the numbers should go up but not down! This could be cases were mistakes were made that made vaccination unreliable and so the cases were purged from the total.

The good news is that currently about 77 percent of healthcare workers have received at least one dose while 42 percent have received both doses. At the current pace of second doses it should take less than two weeks for all remaining healthcare workers to have received their first shots and three weeks after that anyone willing to get the first shot will have had their second shot too. For some strange reason, the healthcare worker counts seem unaffected by the late count updates and I don’t understand why.

One thing to look forward to is for the Moderna vaccine (mRNA-1273) to receive approval in Japan at the end end of this week. It is very similar to the Pfizer/BioNTech vaccine in terms of safety and efficacy. It has already been imported into Japan since the end of last month.

There are about 7 times more senior citizens than there are health care workers, so the number will have to increase much more. There should be enough vaccine by the end of June/early July to vaccinate about 36 million of them, but will the local governments be able to keep up with setting up vaccination sites? Each prefecture and city has been left to figure it out on its own. There is no national vaccination reservation system, each local government was left to build its own system. If the bottleneck is not vaccine supplies but organisation then the Moderna vaccine will not help all that much.

If Japan manages to vaccinate all its doctors and nurses by early June and most of its people aged 65 and above by the end of July, that still leaves about 70 million people to be vaccinated after that, with no date yet when this is expected to start and how long it is expected to take. It looks like a long road ahead to herd immunity and for life to return to normal.

Covid Vaccinations in Japan

Japan has been lagging other rich countries on the number of vaccine shots delivered per 100 people. It reportedly comes 37th out of 37 OECD countries. Other countries already started vaccinating in December or early January while Japan didn’t approve of the its first vaccine until February. Vaccinations of doctors and nurses started in initially small numbers in March. The elderly were added starting from April 12, but again numbers were initially very small.

My 81-year old mother in Germany got her second shot before the end of March. My 86-year old mother-in-law in Japan was not even able to make an application before yesterday (May 14) and is now waiting for the vaccination date to come. Tokyo is currently in its third state of emergency, struggling with its fourth wave of infections.

For the last 7 days with published numbers for vaccinations of healthcare workers and elderly residents (2021-05-05 to 2021-05-13) the daily average is about 193,000 doses per day. At that rate it would take 3 1/2 years to finish vaccinating the entire population.

Even other rich countries in the Pacific region that (unlike Japan) currently have few new Covid cases have vaccinated far more of their population. For example, with only 5 Covid-19 deaths in the past 12 months New Zealand has been virtually Covid-free, yet it has vaccinated proportionally twice as much of its population than has Japan. The same is true for Australia and South Korea, which both have proportionally fewer cases but more vaccinations.

Like other countries, Japan has struggled to secure sufficient vaccine supplies, but that is not the whole picture. Starting from April, far more vaccine doses have been arriving than were being used, leaving 24 of 28 million doses imported by the end of April still unused in early May.

According to the Ministry of Health, Labour and Welfare (MHLW) the expected vaccine supply in May and June should allow for bringing in enough Pfizer/BioNTech vaccine for the entire 36 million residents aged 65 and above by the week starting 2021-06-28, which should allow giving everyone the first shot in early July, knowing there will be enough vaccine for the second shot three weeks later, thereby finishing to vaccinate the 65+ population by the end of July.

As an aside, Japan rigidly adheres to the 3 week interval set by the manufacturer, unlike the UK and Germany which had lengthened the interval between shots to maximize early partial immunity by giving as many people as possible a first shot: The protection given by the first shot is considerably stronger than half the final protection from both shots, so fewer people will become ill or die in a population of 10 million if 1 million are half-vaccinated than if 500,000 are fully vaccinated but the rest non-vaccinated.

Shipments arrive in boxes of 195 vials. Starting from the week of 2021-05-10, all boxes will be paired with low dead space syringes needed for 6 doses per vial = 1,170 shots per box. Previously only 5 doses could be extracted with the available syringes (975 shots per box).

2021-05-10 + 2021-05-17: 16,000 boxes = 18,720,000 doses total
2021-05-24 + 2021-05-31: 13,000 boxes or more = 15,210,000 doses or more
2021-06-07 + 2021-06-14: 13,435 boxes or more = 15,718,950 doses or more
2021-06-21 + 2021-06-28: 13,434 boxes or more = 15,717,780 doses or more

The “or more” in the numbers above refers to extra supplies that may be released from the central government’s stockpile whose size they don’t normally talk about.

Combined with the much smaller numbers in April that’s a total of 62,710 boxes, enough for two doses each for 35,490,000 residents aged 65 or above.

With supplies secured, the big question will be how fast the vaccine can actually be distributed. With the national government only taking care of import and distribution of vaccines, the actual vaccinations are left to local governments and are happening in a patchwork of different approaches. For example, in Setagaya where I live, the city website lists quite a few public vaccination sites to be set up at event halls, gymnasims, etc. in the next couple of weeks and months. There’s a website to make online reservations, once your mailed coupon arrives. This is similar to the approach in Germany. In my mother-in-law’s city in Saitama prefecture however, the city lists hospitals and small clinics, none of which can be reserved online yet (reservations are by telephone only) and many of them will currently only accept people already on their patient register. That approach is not very encouraging for cranking up the volume.

The central government-run vaccination sites to be set up in Tokyo and Osaka that are supposed to handle 10,000 and 5,000 vaccinations per day respectively will not be a game changer unless there will be many more such sites operating everywhere for the rest of the year. 10,000 shots a day for 3 months (the planned operating time of the Tokyo/Kanto site) will cover 2 shots for 450,000 people, a mere 5% of the 65+ population of Tokyo+3 (Kanagawa, Saitama and Chiba) of 9 million and then there will be the much larger under-65 population still to take care of.

The next group in line will be the under-65 with pre-existing conditions, then everybody else (probably in decreasing age order). Japan will need many more mass vaccination sites, it will need to recruit and train staff (both people with a medical background and volunteers) and maybe also change some regulations to widen the circle of people qualified to give injections. Otherwise the vaccination process could drag on far into next year. Another winter with another wave of infections and an unpredictable cost in lives and economic pain would be disastrous.

See also:

Replacement Chainrings for Sugino Compact Plus Cranks (OX601D, OX801D)

Since 2016 I have been using a Sugino OX601D “compact-plus” crank on my Elephant Bikes National Forest Explorer. A compact-plus crank offers lower gearing than conventional 50/34 “compact” or 52/36 “mid-compact” cranks. I use 42/26 rings. Another popular combination is 46/30.

These smaller tooth counts allow for lower gears, making hilly courses more accessible to many cyclists of different abilities. This used to be the purpose of triple cranks until they were largely abandoned by Shimano, Campagnolo and SRAM a couple of years ago. In 2013 Shimano dropped triples on Ultegra when it moved from 6700 to 6800. The following year it did the same to 105 with the switch from 5700 to 5800. So-called compact and mid-compact double cranks were supposed to be a replacement for triples, but in truth their gearing never went low enough for many cyclists on all kinds of terrain.

Most road triple cranks used a bolt circle of 130/74 mm or 110/74. That meant the middle could be no smaller than 38T (130 BCD) or 33T (110 BCD), though in practice 39T and 34T were more common. The 74 BCD allows rings of 32T and smaller, down to 24T. Shimano compacts give you only 110 BCD, excluding any inner rings smaller than 34T.

Into this void stepped Sugino with its compact-plus cranks that combined the more flexible gearing of triples with compatibility with double front derailleurs and shifters. They do that with a 110/74 BCD combination with 5 bolts, just like an old touring triple (typical configuration: 48/36/26).

Effectively, a compact plus crank is a triple in which the middle and large rings are replaced by one in-between ring that can do both jobs. So for example, instead of a 50/39/30 you would have a 46/30. You just give up some very tall gears, but those typically see very little actual use outside of road racing.

Eventually Shimano also jumped on the compact-plus bandwagon: It is now offering 48/31 and 46/30 cranks in its GRX group set for gravel bikes, using a proprietary 110/80 BCD setup with 4 bolts.

I’ve been very happy with my Sugino OX601D. The 42T large ring and the 26T small ring in combination with a 11-32 cassette (11 speed) provide just the right gear range for my kind of riding. I ride a lot of mountain routes with grades of 10 percent and more and 160 km or more in a day where I really appreciate being able to spin up a mountain in a low gear. If I push heavy gears, I end up paying for it with knee pain.

Recently I replaced my bicycle chain as it had worn and stretched and noticed in the process that the teeth of the large ring were quite worn too. I had put over 30,000 km on that crank already and should have replaced the most recent chain a long time ago. In any case, I realized that I now needed a new chain ring and it turned out that Sugino no longer makes it. That’s because the OX601D and OX801D cranks have been discontinued, along with the PE110S rings that were used on them.

Sugino only ever sold these cranks with ring combinations of 44T to 50T for the large ring and 30T or more for the small ring. The 40T and 42T versions of the PE110S were made specifically for use with the ZX801D, a Mountain Bike equivalent of the OX801D but Soma/Merry Sales in the US sold them as a combination with the OX601D. That’s where I had bought mine.

Sugino’s current compact-plus offering is the OX2-901D, the successor to the OX901D which in turn was the 10/11-speed version of the 9/10-speed OX801D. My OX601D is a cheaper but functionally identical version of the OX801D – basically just not as shiny. I had no problems running the OX601D in an 11-speed configuration, with an 11-speed chain, cassette and rear derailleur, but I guess there are some subtle differences with the latest versions, such as maybe the spacing between the two rings to optimize it for the narrower 11-speed chain.

The OX2-901D uses CP110S chain rings with the same 110 BCD bolt circle as the PE110S, but they’re for 11 speed. The large rings are offered in even steps from 44T to 52T and small rings (CP74S, CP110s) in even numbers from 30T to 36T. There is no 40T or 42T for the large ring or 24, 26 or 28 for the small ring as there was for the PE110S for the ZX801D because there’s no MTB equivalent of the OX2-901D. Sugono’s only concession to people needing lower gearing is the “Super Hill Climb” CY5-SHC, a 27T 74 BCD inner ring.

One option would have been to buy a CP110S 44T chain ring. Given the close family relationship between the OX2-901D, OX901D and OX801D/OX601D, I am pretty sure it would have worked worked just fine on my older crank. It would have raised the gearing on the large ring by about 5 percent though (44/42). On top of that, the difference in tooth count between the two rings would have increased from 16T (42-26) to 18T (44-28). The specification for my FD-CX70 says its maximum capacity is 16T, but it would probably would have still worked. However, 44/26 at the front with 11-32 at the rear would on paper have required a total rear derailleur capacity of 39, one more than the specification of my RD-6800-GS. That can get tricky.

Exceeding the total rear derailleur capacity theoretically creates problems during cross chaining, as the rear derailleur arm can not take up all the chain slack from switching between the two extreme positions. If the installed chain is kept short enough to not go slack when running on the the small ring at the front with the smallest sprocket at the rear, it risks the derailleur pulley making contact with the spinning cassette when running on the big ring at the front and the largest sprocket at the rear. That could be disastrous. The safer way is to keep the chain long enough for the big/big combination, which I quite often use. At worst your chain will slip in the small/small combination which should be avoided anyway (and which is easy to avoid, you just switch back to the big ring after the first couple of upshifts when you have reached the top of a steep climb).

Sugino rings are not the only choice for compact-plus cranks. French bicycle parts maker Spécialités T.A. also offers a wide variety of high quality chain rings that can be used on many different cranks. Specifically, the TA Zephyr rings are also ramped and pinned for Shimano STI and will work with 10 and 11 speed groups. When you are looking for a large ring for a Sugino OX crank, it is best to use a 110 BCD ring meant for a use as a middle in a triple. That’s because these rings are mounted on the inside of the OX crank spider, not the outside. This matters because some rings have bolt holes that are countersunk for mounting on a particular side, to match bolts with conical heads. So it makes a difference if the bolt enters the bolt hole from the left or the right. In any case, there’s a TA Zephyr 110 BCD middle in either 40T or 42T, making them suitable replacements for the PE110S 40T and 42T formerly made for the ZX801D that are no longer available.

It’s a pity that Sugino no longer offers chain ring combinations below 44/30, such as 44/28, 42/26, 40/26 or 40/24 which would all be possible with the dual bolt circle of 110/74 mm on OX and OX2 cranks. As long as TA offers the rings we can still create and maintain such combinations though.

Another great option are Rene Herse cranks, which are available in a wide range of chain ring sizes, supporting speeds from 9 to 12 speed. That may be my fall-back position a couple of years down the road.