Japan passes Germany on Covid Vaccines

On September 24, 2021 Japan’s first vaccine dose rate passed Germany’s rate (67.8 % vs 67.7 %) but with a steeper trajectory still: While Germany only has a gap of 3.8 percentage points between first and second doses, in Japan it’s still 12.0 percentage points, indicating much faster recent growth. The 1st/2nd dose gap is the equivalent of the number of additional first doses over the past 3+ weeks, since 2nd doses are given 3 weeks after first doses with Pfizer/BioNTech, 4 weeks in case of Moderna and 4-12 weeks in case of AstraZeneca. Both in Germany and in Japan the vast majority of doses used (~80%) have been Pfizer/BioNTech.

This means Japan has not only matched Germany, it is still vaccinating at three times the rate of Germany and will therefore be left with far fewer unvaccinated people. Reluctance to get vaccinated is a much bigger problem in Germany than it is in Japan. Especially in eastern states vaccination rates are much lower than average. Saxony, Saxony-Anhalt, Thuringia, Brandenburg have the lowest vaccination rates, followed by the southern states of Bavaria and Baden-Württemberg and the northernmost of eastern states, Mecklenburg-Vorpommern. Not coincidentally, the states with the lowest vaccination rates also have the highest support for the far right AfD. According to opinion polls, about 60% of AfD-supporters had no intention of getting vaccinated.

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Setagaya Vaccination Update (II)

My wife and I have received both of our shots, three weeks after the first shot. In not quite two weeks we will be fully vaccinated.

The first shot triggers an immune system reaction that produces antibodies against the spike protein of the virus. After about two weeks, the immune system also produces Memory T cells, which are its way of remembering how to make more antibodies should they be needed again in the future. After three or more weeks, when the second dose is given, it puts those newly formed T cells through their paces, boosting the antibody levels.

According to the latest published numbers for Tokyo, the more infectious Delta variant already causes more new cases than all other strains of SARS-CoV-2 combined and is most likely to completely displace them soon. This is part of the reason why the reproduction rate of the virus has been increasing for several weeks, with weekly averages of new cases growth accelerating from under 20 percent a week to over 50 percent recently.

Now it is crucially important that more people get shots as soon as possible. Not all prefectures and municipalities in Japan have made the same use of the vaccine they have received from the central government.

Tokyo has the questionable distinction as the prefecture with the largest portion of unused vaccine doses, even though people are desperate for vaccine appointments. By Sunday, July 25 Tokyo had received 15,227,660 doses. According to the Vaccination Recording System (VRS), 4,081,931 of these doses had been used as first doses and another 2,380,397 as second doses, for a total of 6,462,328 – just over 42 percent of the total. That means about 8.8 million doses either have not yet been reported after use or they’re still sitting in freezers, earmarked for shots that are weeks away.

The basic supply of future vaccines are going to be about 1.3 million doses every two weeks distributed to the municipalities in Tokyo by population by the central government and another 320,000 or so allocated to the prefecture to give to the cities that need extra supplies the most because they have the smallest stocks.

In the past week (July 19 through July 26), 8,620,790 doses have been distributed for general vaccinations in all of Japan. During the same period, 3,521,414 doses were used as first shots and 3,921,705 doses as second shots, for a total of 7,443,119 shots. The same picture shows in Tokyo, with delivered stocks growing by 2,100,180 million (13,127,480 on 7/19 to 15,227,660 on 7/26) while only 895,327 doses were used (502,489 first doses and 392,838 second doses).

This would actually mean that unused stocks in freezers grew, rather than being shrunk to vaccinate as many people as early as possible to protect them against the Delta variant. Vials in freezers do not protect against illness, only shots in arms do.

However, it is also possible that the recent 4-day long weekend (Thursday, 7/22 through Sunday, 7/25) caused bigger than usual delays in the VRS reports, in which case the actual results of vaccine use could be a little better than these numbers appear to show.

Data from the “Vaccination Recording System” (VRS) in Japan

Daily vaccination statistics published by the Cabinet Office of the Japanese prime Minister suffer from lag problem: They are not reported back to a central database the day the vaccinations take place. This has the curious effect of making the published chart of daily first and second shots always trend downwards for the most recent 7-120 days or so.

There is a relatively simple way to compensate for the under-count: Its ratio is consistent between first and second doses. In Japan first and second doses for Pfizer are almost religiously spaced 21 days apart. Thus by looking at the first dose count 21 days earlier one can get a close approximation of the real second dose count for a given date. The ratio between the published incomplete second dose number and the approximation derived from the more accurate first dose count can then be applied to the 1st dose Pfizer count for the date you’re looking at. Those two numbers plus the Moderna numbers (which are not subject to the same delays because of the way the SDF sites — the main consumers of Moderna doses — are operating) then give you the real up-to-date General Vaccination count 🙂

From the current numbers we can see that first doses peaked on June 8 at around 650,000 doses day. However, second doses were still steeply climbing then and the total of first second doses exceeded 1,000,000 doses a day on June 15. On June 29, exactly 21 days after the first dose peak, second doses peaked at about 625,000 doses. For about 5 days, second doses clearly outnumbered first doses (June 28-July 2).

After July 3, first doses pulled ahead again, as many municipalities had sent vaccination tickets to people with medical conditions or younger then 65 years. The overall total seems to have largely stabilised at 1.1-1.2 million doses a day.

During July, August and September, the government will distribute a basic allocation of 8,000 boxes (9.36 million doses) every two weeks plus an “adjustment” of 2,000 boxes (2.34 million doses) that will go to municipalities with the best progress in using their allocated doses. This is pushing municipalities to update data on VRS more quickly, as this will be the metric used by the government to allocate the “adjustment” doses. The basic allocation is based on the number of residents age 12-64 in each municipality (the amounts for age 65 and above have already been fully distributed).

One potential problem with this is the fact that some local clinics have been vaccinating people who did not have a vaccination ticket with bar code yet, making this portion of the vaccination total hard to track. The doses have been allocated to the municipalities but may appear unused in VRS.

Handling Vaccine Stocks like Toilet Paper

The sky is not falling and Japan is not about to run out of vaccine any time soon. There is enough vaccine already in the country (either in national government freezers or in municipal/local clinic freezers) or scheduled to be delivered at regular intervals over the next 3-4 months that Japan will be able to vaccinate all of its residents age 12 and above by the end of November. Pfizer/BioNTech shipments run until October, Moderna shipments until September. Japan can maintain a rate of about 1.4 million doses a day (i.e. higher than now) until the final month, when mostly only second doses will be needed and the pace could drop by half from the peak. All this while not even tapping into its supplies of 120m doses of AstraZeneca, of which it is giving away millions to Taiwan (2x), Malaysia, Indonesia (both July 1), the Philippines (July 8) and Thailand (July 9) so far and undoubtedly will give away a lot more.

Nevertheless the media report about local governments cancelling or postponing reservations due to vaccine shortages, while the government blames some municipalities for hoarding vaccine instead of using it. What’s behind all this?

The Japanese government wants municipalities to use all Pfizer doses as soon as possible. They allocate doses for every city and prefecture for every two week period. Pfizer vaccination takes two doses at least three weeks apart. According to Minister Kono, second doses should be taken from later shipments than first doses, as he made clear in a June 1 interview. Instead, municipalities treat first and second doses like Siamese twins, allocating them from the same source and keeping the second in a freezer for 3 extra weeks. That causes artificial shortages down the road, just like back when everybody tried to keep three months worth of toilet paper in stock at home.

By the end of June the government had distributed 78 million doses, more than enough doses for all people aged 65 and above to be completely vaccinated, priming the pipeline. After the allocations in May and June, extra doses were to continue being shipped in allocations every two weeks.

In many places the 65+ group won’t finish vaccinations until the end of July, so first doses will have finished for them around July 10 after which second doses will continue for another three weeks. Once the number of first doses for 65+ has reached a peak and then decreases, first doses for the next groups (people with medical conditions, 60-64, 50-59 etc.) can take over the next vaccination slots using the supplies in stock at that time. This phase would start no later than July 10.

Where the problem arises is that municipalities have this fixed idea that second shots for 65+ in July should still come from the original May/June shipments, kept waiting in a freezer until then, instead of from July shipments.

For example, 65 year old person A gets his first shot in the 4th week of June. The second shot will be due in the 3rd week of July. 60 year old person B wants to get her first shot in the first week of July, after the city has finished first shots for the 65+ group, and her second shot in the 4th week of July. The smart thing would be to let person B go ahead since enough vaccine is still in stock from June. More will arrive in allocations in the first and second half of July and both A and B will get their second doses in the 3rd and 4th week from that fresh supply. Instead what the cities are doing is to reserve the June stocks exclusively for the 65+ group, letting it sit in a freezer for a month while keeping person B waiting to make her reservation only after sufficient July shipments have come in to cover both of her first and second shots. That’s what the 40 million unused doses cited by the government and the cancellation of vaccinations due to “insufficient supplies” as per the mayors is about.

It doesn’t really make sense to let vaccines sit idle while keeping unvaccinated people waiting for their shots. Vaccine should go into arms as soon as possible to protect people against sickness and death.

Setagaya Vaccination Update

We’ll be getting our first shots on Monday, about two weeks after we received the tickets to be able to make a reservation. I am excited! Vaccinations are our best chance to push the reproduction rate of the virus below 1, despite the spread of the more transmissible Delta and Kappa variants (B.1.617.2 and B.1.617.1) that were first sequenced in India late last year. Right now it looks like these variants are rapidly replacing the Alpha variant that arrived from the UK earlier this year and will have largely done so by the opening of the Olympics three weeks from now.

Setagaya, the ward of Tokyo where we live, suspended its reservation system for a couple of days to perform an upgrade. Now that it has come back online, they have also extended the time period until when you can make reservations from the end of August to September 21. They will revisit it again after watching how many individuals will get vaccinations through their universities or workplaces starting from this month.

Looking at the September overview of open slots (which we can assume to be close to the pre-booking state) it seems the mass inoculation sites run by the city are designed to handle about 33,500 shots per week. All sites have some days off (presumably for the staff), but all are open Saturdays and Sundays to make it easy for people to get vaccinated without taking off time from work or schools.

Besides the mass vaccination sites people can also go to local clinics. Appointments there are mostly not done through the municipal reservation system. I have not seen any data yet on how many people are choosing their regular clinics vs mass vaccination sites, which makes it hard to get an accurate view for progress in Setagaya.

The earliest available mass vaccination slots listed right now are about 3 weeks from now. By July 20 vaccination tickets will have been mailed out to the rmaining population aged 16-59, with children age 12-15 added at the end of the month. Assuming the vaccination capacity for July 1-21 is comparable to the empty slots in September (1-21) then about 100,000 shots can be given over these three weeks, while about another half a million people will get tickets allowing them to make appointments to get two shots each. This will presumable push the available dates months into the future. The big unknown for me is how many shots the local clinics will handle.

Vaccine Supply Situation in Japan

Currently about a million Pfizer/BioNTech and Moderna vaccine doses are being used per day for general vaccinations in Japan. On top of that about 100,000 doses are used for vaccinating healthcare workers and other essential workers, such as police officers and firefighters.

The government has offered companies to vaccinate their employees using Moderna. Initially that offer was only extended to large companies with at least 1,000 employees, but after complaints smaller companies were allowed to band together or extend the service to some of their customers and business partners. Some real estate companies are offering it to all tenant companies in their office blocks. The uptake of this offer has been so overwhelming that the government is now talking about slowing down or pausing new signups for companies, as they were getting concerned the demand would outstrip the Moderna vaccine supply.

On June 4 the Japanese government updated municipalities with the vaccine distribution schedule for July and it includes lower numbers for vaccine shipments. Apparently, Pfizer has been shipping 36,000,000 doses per month in both June and July but will ship only about 2/3 of that in each of the next four months (July-October). Does that mean Japan will be unable to maintain the current pace of vaccinations? Some local governments are concerned that they were pushed to set up mass vaccination facilities, only now to be told there will be fewer vaccine doses.

However, the National government is still sitting on large stockpiles as it was due to receive 100 million doses of Pfizer and 40 million doses of Moderna by the end of June, most of which is still sitting in freezers. According to the published supply schedule, Japan should be able to sustain more than 1 million Pfizer shots a day until the end of November and 400,000 Moderna shots a day until the end of October by gradually drawing down these stockpiles.

Both dates are one month after the last contracted shipment month, by which time a total of 122 million residents would be vaccinated. The projected Pfizer usage rate is similar to what they’re doing now while in the case of Moderna the rate is more than 10 times larger (i.e. for use in future company vaccinations programs).

Assumptions:

  • 100 million Pfizer doses received by end of June
  • 41 million doses used by end of June.
  • 94 million additional doses received in roughly equal installments in July, August, September, October.
  • 40 million Moderna doses received by end of June
  • 800,000 doses used by end of June
  • 10 million additional doses received by end of September.

See this spreadsheet for an overview.

Will Japan be Vaccinated by November?

“I want vaccines to have been given to all residents who want to receive them by the October-November period,” Japanese prime minister Suga Yoshihide said in a parliamentary debate on Wednesday, June 9, 2021. He also estimated, the grand total of doses could “exceed at least 40 million by the end of this month.”

As of June 8 the count on the Prime Minister’s Office (Kantei) website stood at 19.4 million doses, so to hit 40 million doses by the end of June requires a little more than 900,000 a day (20.6 m doses in 22 days). From the published numbers it looks like we may already be in that vicinity for the daily rate.

Even though the number of doses per day for residents age 65 and above (“koreisha”) for the most recent date added is still coming in at under 500,000 the day it’s released, but many of the local counts arrive delayed. The daily counts will later increase through daily retroactive updates. By the time all numbers for a given date have trickled in over the course of several weeks, the total often doubles. For example, the May 30 “koreisha” total was originally released as 200,187 but within 10 days it had grown to 405,165.

Let’s do a quick back of the envelope calculation to see if the projection for vaccinating all adult residents of Japan who want to get vaccinated by the end of November is realistic.

If they hit 40 million doses by end of June (which as I mentioned above requires an average of 900,000 doses a day until then) and we take a figure of 110 million adults of a a population of 126 million: assuming 80 percent of them would opt to get vaccinated, we end up with 88 million people times two doses per person, i.e. 176 million doses. Subtracting 40 million done by the end of June leaves 136 million doses to be injected between July and November (5 months). Divide the total by the roughly 150 days and it becomes clear that if they maintain about 900,000 a day for the next half a year they will indeed be done by the end of November.

However this ignores that the vaccinations are proceeding at vastly different speeds in different cities and prefectures. All things staying the way they are, once the most efficient places are done (which would happen before November) and only the laggards remain in the race, the 900,000 a day average would no longer be sustained. So the key will be to speed up the places that are lagging behind others right now.

How realistic is the 900,000 a day goal if daily vaccine counts still pop up on the Kantei website at less than 500,000? What’s the real number right now?

We can make a rough guess of what percentage of the actual daily vaccinations are represented in the initial count that gets published for a given date by looking at past data.

For example, the count for June 9 published today (June 10) for 65+ is 474,484. The actual number is likely to be over a million, as I’ll explain below. The published number is a partial count, as only about 50 percent of the vaccinations are reported via VRS (Vaccine Recording System) within one day. The rest arrives later. Another 10 percent or so arrive the next day, then another 5 percent, etc, etc until we get to over 99 percent of the total after a month or so.

I looked at the 28 days ending on June 8 and how they had changed on June 10 vs. June 9 in the Excel spreadsheets. They increased by factors of 1.0015 to 1.1845. Multiplying all these increases by each other to get the cumulative 28 day growth yields a factor of 2.27.

I repeated the same exercise for one day earlier, i.e. 28 days ending on June 7 and their change between June 9 vs. June 8. The daily increases range from 1.0058 to 1.1885. Multiplying 4 weeks’ worth of increases gives a factor of 2.47.

If we apply the lower of these factor values to today’s addition, on the assumption that the spread of what percentage of reports comes in after how many days is consistent, that would suggest an actual figure of 1.08 million vaccinations of residents 65+ done yesterday whose total count will be known by July 7 (after 28 days of reports still arriving). That’s on top of another 160,000 or so vaccinations of healthcare workers, by the way.

While it’s disgraceful that we have to figure out the state of the campaign so indirectly (because of a broken IT system built using 385 million yen of our taxes), this exercise at least gives us a good guess of how things are really going.

On that basis I’d say the government’s outline is plausible: Japan is likely to reach a goal of 40 million doses deployed by the end of June and full vaccination of willing adults by the end of November.

Setagaya Vaccination Update

I live in Setagaya, the most populous of the 23 Special Wards (ku) of Tokyo. Out of about 195,000 residents aged 65 and over, about 141,000 have made reservations for vaccinations. Of those 73,000 have received at least one vaccine dose and 8,000 of these have received both doses. There are vacant reservation slots for another 54,000 people.

Starting from next Tuesday (June 15), tickets will be sent to the next group, including people with medical conditions and people aged 60-64. That includes my wife and myself. Note that it’s not your age today that counts but age on March 31, 2022. So anyone born before April 1, 1962 counts as age 60 and up! This is consistent with the system used for elementary school enrollment in Japan.

The next groups after that will be:

  • Age 50-59 (born before April 1, 1972): from June 30, 2021
  • Age 40-49 (born before April 1, 1982): from July 5, 2021
  • Age 30-39 (born before April 1, 1992): from July 12, 2021
  • Age 16-29: from July 20, 2021

Currently there is a published list of vaccination sites with available slots per day for each date until the end of August. At the moment free slots are available starting from early July (i.e. with a 3 week wait list). The wait list most likely will grow significantly, seeing the rate at which age groups will be added vs. the rate at which people are currently getting vaccinated.

Online reservations can be made 24 hours a day, except for website maintenance periods. Reservations can also be made by phone during daytime, but the number used is a 0570 number not covered by flat rate mobile phone plans and unreachable by IP telephony services such as Skype or Google Voice. For people who only have a mobile phone and who don’t have internet access this is not very convenient.

For the senior citizens the city has been offering a service where they can visit city run facilities who will help them make an online reservation using a smartphone. This service was further publicised via the jichikai (neighbourhood associations) in Setagaya.

Meanwhile the number of shots given to senior citizens has surpassed the number of shots to healthcare workers (10.7 vs 8.7 million doses) and first doses given to healthcare workers are exceeding 5 million, more than the 4.8 million previously quoted as the total number of healthcare workers eligible for them. Compliance seems exceptionally high.

In total, about 14.5 million out of 126 million residents have received at least one doses. The Olympic Games will begin in 44 days.

Vaccination Progress in Japan

The City of Setagaya (東京都世田谷区) has announced the dates when vaccination will be expanded beyond the current group 2 (residents aged 65 and above). Between June 15-19, coupons will be mailed to group 3 which includes:

  • people with existing medical conditions
  • people aged 60-64 (anyone born no later than March 31, 1962)
  • people working in elderly care

Group 1 were the health care workers, if you are wondering!

Currently about half a million vaccinations are happening in Japan per day, about 2/3 of them aged 65 and above, 1/3 health care workers. As of Friday, 2021-05-28, over 92 percent of healthcare workers had received at least one shot and over 60 percent had received both. That leaves them only about 350,000 shots short of full coverage for first shots. About 1.55 million healthcare workers have only received one shot, so fully vaccinating them with a second shot in the next three weeks will be the bulk of the remaining vaccinations for this group.
Of the people aged 65 and above, 12.46 percent have received at least one shot and 0.86 percent have received both. Meanwhile the Olympics start in 52 days…

Setagaya also announced that more reservation slots would be opened at mass vaccination sites for people aged 65 and above, recommending people in that group who currently have dates in August to move them to July (i.e. cancel in August, make new reservation in July). This will then free up those slots for the next group.
This means there’s a good chance that both my wife and I (who were born before the March 1962 deadline for age 60-64) will get vaccinated in August.

In my last post I had pointed out that daily vaccination totals for healthcare workers and people above 65 was being handled differently. One set was being updated retroactively, the other set only once per listed date.

Basically, for healthcare workers the government publishes daily numbers (on weekdays, excluding public holidays) of the number of total shots given since the previous published total. That’s why numbers only get added for the final date, once a day. It is also why no vaccinations are listed on Saturday, Sundays and holidays — not because no healthcare workers were vaccinated on those days, but because no results are published on those days. Consequently, healthcare worker stats do not show how many healthcare workers were actually vaccinated on a particular day.

For people aged 65 and over, they precisely track the totals by the date the doses are used. So there are entries for Saturdays and Sundays, even though it may take until Tuesday for them to be listed on the website. Furthermore, unpublished counts of shots already given weeks ago are still finding their way to the Prime Minister’s Office and are then added. Here’s the total given for April 14, as listed on the day the numbers for a given recent date were also added:

May 18: 2,533
May 20: 2,666
May 27: 2,793
May 30: 3,078

A near 20 percent increase for vaccinations that already took place over a month ago is quite surprising, considering that vaccinations are tracked with Android tablets with software specifically developed for the purpose. How can a computer-based system be so slow? It actually makes fax machines look good by comparison (yes, they are still widely used here in Japan)!


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.