Waiting for third doses in Japan

In December, 470,000 medical workers, 280,000 seniors (65 and above) and 90,000 others in Tokyo were qualified to receive the 3rd dose because of the time interval since their second dose and their status. Only 63,292 (7.6%) of them actually received their dose. 1,829,880 booster doses were supplied by the central government. As for January, out of 620,000 qualified individuals, 29,645 (4.8%) have received their dose so far. The scheduled supply for this month is a further 1,702,800 doses for Tokyo, for an accumulated total of 3,532,680. The number of people eligible for boosters in Tokyo by the end of February is only 2,100,000.

Also, according to the Cabinet Office (kenbetsu-vaccination_data2.xlsx file), Tokyo had received 16,586,310 million doses of Pfizer for 1st/2nd shots in 2021, of which they have used 15,358,949 doses (92.60%). Therefore, about 1,227,361 Pfizer doses should still be have been available before any of the above mentioned supplies were delivered.

Nationwide, about 10 million doses of Pfizer have been supplied but not used (165,148,620 vs. 155,989,956). Of the 50,000,000 doses of Moderna that the central government had contracted for, 34,251,400 had been distributed and 31,938,353 actually used. That leaves about 18 million doses unused, which translates to 36 million booster shots, if you add 18 million sets of syringes (Moderna boosters are half doses of regular 1st/2nd doses).

It’s not a supply problem. Based on these numbers, it’s going to be something like a mere 120,000 people with a booster in Tokyo by the beginning of February, when literally millions could have received them. Meanwhile, new cases numbers (most of them Omicron) have been increasing 4 to 5-fold week on week. We will soon hit unprecedented numbers of cases.

Without a 3rd dose, two doses of Pfizer received 5 months ago offer little protection against symptomatic infection with Omicron, though they still reduce the risk of hospitalizations and other severe outcomes. This is because of the immunity escape from Omicron. Even two weeks after the second shot, efficacy is only a little over 60% with Omicron, significantly lower than with Delta. A third shot boosts efficacy to a slightly higher level than after the 2nd shot, winding the clock back by 6 months or more. Accelerating the booster campaign by using left-over vaccine doses as soon as possible should be a high priority.

Another important point is to improve the messaging on masks: Many people are still using simple masks that cover the face but do not fit particularly well. Mask policy in Japan is still not based on the recognition that Covid-19 is airborne disease that spreads via aerosols. One person can infect another without them being in the room at the same time. High grade masks like N95, KN95, KF94, FFP2 offer much better filtration because they reduce the unfiltered side stream. They offer the best first line of defense against the explosive spread of Omicron. A rapid roll-out of boosters should be the second line.

Numbers listed for all 47 prefectures in this MHLW document:
追加接種対象者数、接種回数及びワクチンの供給量 (“Number of subjects to be additionally vaccinated, number of times vaccinated, and quantity of vaccine supplied”, mhlw.go.jp)

Vaccination data by prefecture from Cabinet Office:
kenbetsu-vaccination_data2.xlsx (kantei.go.jp)

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