Omicron and Japan’s sixth COVID-19 wave

Three members of a family hospitalized with Covid-19 symptoms in Osaka have tested positive for the Omicron variant. They are the first cases reported in Japan without a travel history or linked to someone with travel history. All other cases were either detected at immigration inspections or in quarantine or linked to someone who had recently arrived from abroad.

It must be assumed however that there are many other cases that remained undetected and spreading under the radar screen. As the Washington Post reported on December 15, the Philippines had quarantined a man on December 1 who had tested positive on arrival from Japan and who was later confirmed to have been infected with Omicron. It therefore sounds likely that there was already some community spreading in Japan three weeks ago, soon after the variant was isolated by scientists in South Africa.

During the Delta-driven fifth wave in July/August, the 7-day average of cases peaked on August 24, with the health care system in crisis. At that point the reproduction rate fell below 1. For several weeks the fall was so steep, cases almost halved every week. The most likely explanation for that was increasing immunity in the population from a successful vaccination campaign in combination with continued wearing of masks and reduced mobility (e.g. working from home, less eating out in restaurants). After two months the reproduction rate slowly increased again but as long as it stayed below 1, it still resulted in a further reduction of cases. Weekly cases reached a temporary minimum on November 9. For about a week, cases slightly increased before sliding again at a somewhat slower rate than before. Since then the reproduction rate has been gradually drifting up. Since the minimum in late November/early, December Tokyo cases have been rising from a very small basis of about 100 cases per 7 days, 99.7 percent below the 33,000+ cases per 7 days in late August. They are now around 200 cases per 7 days, a doubling in three weeks.

For the last 4 days the 7-day average increase from a week earlier has been over 40 percent, which is equivalent to a doubling every two weeks. This is not really surprising. Once cases had dropped to less than one percent of the peak, people felt safe to resume activities that they had not been able to do for a very long time, such as enjoying year end parties or having wedding receptions with guests. They felt the risk was low enough.

However, Delta has not gone away. It is still around and as people’s level of antibodies from vaccines gradually wanes, they become more susceptible to infection again, even if they remain largely protected against hospitalization or death. This is compounded by greater risk-taking when cases are perceived to be “rare enough.”

We knew that Omicron would eventually spread in the community. When it does, it will not immediately replace Delta. For a while, both will be increasing but at different rates. A level of immunity and non-medical interventions (such as mask-wearing) that is only just about adequate to control Delta will be unable to halt the spread of much more infectious Omicron. Under the current conditions where even Delta cases are increasing, we would continue seeing Delta grow relatively slowly while Omicron cases would explode. Eventually, especially as hospitals start to fill, people will modify their behaviour to reduce exposure, for example by avoiding restaurants or by using KN95/KF94 masks instead of surgical masks or cloth masks. This would then push the reproduction rate of less infectious Delta below 1 and its cases would fall while cases of more infectious Omicron would still increase but at a slightly reduced rate. That is the point from which Omicron will start to replace Delta rather than spread in addition to it.

Third doses can reduce the exposure to Omicron, especially for the older generations who were first to get vaccinated this spring and summer but Japan has not taken any measures yet to speed up the additional shots. From the beginning of December to December 21, third shots averaged a mere 10,000 per day which is less than one percent of the rate achieved and maintained for several months in the Summer.

Japan is still running its booster campaign as if its only purpose was to prevent a resurgence of Delta (like in Israel last summer) rather than to protect the population as well as possible against the immunity escape that comes with the new Omicron variant. This has to change.

I can only hope that the first official case of community transmission of Omicron will galvanize the government into action for dramatically speeding up the distribution of third shots, especially to senior citizens and people with medical conditions that make them more vulnerable.

Waiting for Vaccine Boosters in Japan

In the spring of 2021 Japan was running about 4 months behind the US and much of Europe vaccinating its population against Covid-19. Vaccinations for senior citizens did not start ramping up significantly until May when other countries had started in December 2020 or January 2021.

After Israel and then the US decided to go for 3rd shots to boost immunity after antibody levels dropped months after 2nd shots of Pfizer and Moderna, Japan also negotiated for booster shots from Pfizer and Moderna. The government went for an 8-month interval and planned for 3rd shots for healthcare workers from December 2021 and the general population from January 2022, with eligibility starting 8 months after the second shot.

Then came Omicron which significantly escapes immune system responses from antibodies. Without boosters protection against symptomatic infection drops significantly with this new variant, as it takes a much higher concentration of antibodies in the blood serum to achieve sterilizing immunity. Long term T-cell immunity, which still protects against hospitalization and death, is much less affected.

In the city of Setagaya, Tokyo where I live, those who have received their second dose at the end of June will receive tickets by the end of January that will allow them to make vaccination appointments some time in February. So far no date has been announced for the group I’m in but having received my shots in July, I probably won’t be getting those tickets before late February and no booster appointment before March. It’s going to be a very long three months when some European countries are expecting to be Omicron-dominated by Christmas, within 4 weeks of the WHO having awarded B.1.1.529 its new name!

Japan is talking to Pfizer about moving part of the 78 million booster doses due for delivery in Q1 2022 forwarded so they can be dispenses sooner. However, former vaccine czar Kono Taro recently pointed out on his personal blog that Japan has enough leftover vaccines still in stock to give 56 million booster shots without waiting for any supplies from Pfizer or Moderna.

In order to protect the public from the new coronavirus, efficiency and speed are more important than equality and fairness.

Some people say that if the vaccine is brought forward, the supply of the vaccine will not be sufficient in time.

At present, Pfizer and Moderna have about 10 million doses of vaccine in stock in the market.

There may be a few doses that have been discarded, but there is no way that 1 million doses were discarded.

In addition, 4 million doses of Pfizer have already been distributed to local governments.

Another 12 million doses of Pfizer will be distributed next week and the week after.

In addition, we have 15 million doses of Moderna in stock for this year, and since the third dose of Moderna is only half the amount of the first and second doses, we will need 30 million doses for the third dose. This will be 30 million doses.

This means that 56 million doses of vaccine could be distributed by the end of the year.

In the first quarter of next year, Pfizer will distribute 30 million doses and Moderna will distribute 24 million doses. In the first quarter of next year, Pfizer will receive 30 million doses, Moderna will receive 24 million doses, and the third dose will be 48 million doses, for a total of 7.8 million doses. In the first quarter of next year, Pfizer will receive 30 million doses, Moderna 24 million doses, and 48 million doses for the third dose, for a total of 78 million doses.
(3回目のワクチン接種, 2021-12-09 [translation by DeepL])

The Japanese government can not blame a slow booster vaccination campaign on a lack of supplies. It needs to act as quickly as possible. The day before yesterday, Germany gave about 1.3 million booster shots in one day.

While officially no community spread of Omicron has been detected in Japan yet, that may simply being because they are not looking for it hard enough.

On Wednesday, 2021-12-15 the Philippine government reported its first Omicron case, a Philippine resident of Japan who had arrived from there on December 1 and tested positive. He had symptoms of a cold at the time. After the positive test the sample was sequenced and determined to be Omicron. This suggests that most likely Omicron was already circulating within Japan two weeks ago. Regardless, it will officially be here very soon.

Once it hits the hospitals, many nurses and doctors are likely to get infected and may have to quarantine. As of today, only about 149,884 of about 5 million healthcare workers (about 3 percent) who had been fully vaccinated have received a third shot. That’s after two weeks of booster campaign. 97 percent are yet to receive their booster. Only 0.11 percent of the Japanese population have received a 3rd shot. In many European countries it’s 20 percent and more.

The vaccination of the elderly is not even due to start until another two weeks from now. There are 52 million people in Japan who have received two doses and are age 50 or above. We should use the doses that we have now as soon as we can.

We really have no time to lose.

Toyota Hydrogen Combustion Engine Cars

Since 2014 Toyota has sold a little over 10,000 Toyota Mirai, a hydrogen fuel cell vehicle (FCV). The starting price of this 4 seat sedan model in Japan is about 7.1 million yen (currently about US$63,000) which is more than 50% more expensive than a battery electric Tesla Model 3 which seats 5 adults. And it seems unlikely that Toyota can make a profit on a car being made in such small numbers as the Mirai, unlike Tesla does with the cars it makes in large numbers in its plants on three continents.

Tesla sold about half a million battery electric vehicles (BEVs) last year and looks set to sell somewhere between 900,000 and 1 million cars in 2021. This means Tesla will have sold twice as many BEVs every week in 2021 than the total number of FCVs Toyota has sold since 2014. The sales gap between BEVs and FCVs is getting bigger and bigger.

Recognizing that the high cost of fuel cells makes it difficult to compete, Toyota has announced that it sees a market for cars with internal combustion engines (ICE) that burn hydrogen instead of gasoline. They should be cheaper to make than fuel cell cars and will not produce any CO2 if hydrogen is made from non-fossil energy sources.

It’s not a novel idea though. BMW tried it in its BMW Hydrogen 7 technology carrier based on its 7-series back in 2005-2007. It never went anywhere. Besides the absence of a fuel supply network, there were also issues with emissions. Hydrogen flames burn extremely hot, which means you end up with a lot of smog-forming NOX emissions — worse than diesels.

In terms of efficiency, hydrogen ICEs are worse than FCVs which are much worse than BEVs. While BMW used cryogenic tanks with liquefied hydrogen at -253 °C, Toyota most likely will use high pressure tanks like in its Mirai for its hydrogen ICEs. They hold hydrogen gas at pressures of up to 700 bar. Both liquefaction and compression require huge amounts of electricity that can not be used for propulsion but is effectively wasted. An FCV consumes three times more electricity for electrolysis to make the hydrogen fuel it consumes than a BEV uses to charge a battery to drive the same distance. A hydrogen combustion engine is even less efficient. Where will this hydrogen come from? We don’t currently have a surplus of solar panels or wind turbines to produce this electricity. That means a hydrogen economy will need significantly larger investments in renewable energy than with battery vehicles. Hydrogen for cars makes no economic sense whatsoever.

It makes even less sense for hydrogen ICEs than for hydrogen FCVs. Fundamentally, it’s no more than an excuse for not giving up on building internal combustion engines, pretending that nothing has changed even in a world that is facing climate change that we need to address as soon as possible.

I am afraid Toyota will not make a turn-around and face the reality that the industry is switching to BEVs within the shortest time possible until it replaces Toyoda Akio, its current company president. Mr Toyoda is the grandson of the founder of the company and a keen race car driver. He lacks the vision that Toyota will need in the transition to a carbon free future. Mr Toyoda needs to retire, along with the dead-end technologies he is committed to.

Subaru announces the Solterra, it’s first battery electric car

Perhaps not by coincidence Subaru chose the week of the COP26 climate summit in Glasgow to launch its first battery electric car, the Solterra (the name is a portmanteau of the Latin worlds for sun and earth). To say that it’s based on the same “e-TNGA” electric vehicle platform as the Toyota bZ4X understates how much the two cars have in common: They are basically one and the same car fitted with different badges. Even the wheels are the same. You have to look very carefully at this pair of genetically identical twins until you find a minor detail that distinguishes them: Yes, the rear lights are a bit different.

Toyota owns 20% of Subaru and they have shared models before (Toyota 86 / Subaru BRZ), but I did not expect to see so little recognizable Subaru DNA in their first battery electric vehicle. Yes, there is a four wheel drive model of both the Solterra and the bZ4X and one assumes that Subaru had a hand in design choices for this, but 4WD is by no means unique for BEVs, as models ranging from the Tesla Model 3 to the Volkswagen’s ID.4 are also offered in dual motor 4 wheel drive configurations. Even the hybrid Prius is available in an electric 4WD version.

What seems a little odd is that the non-4WD model is front wheel drive (FWD). In internal combustion engine (ICE) cars, FWD offers some advantages as it saves having to have a long drive shaft between the front engine and the rear differential. The engine and the gearbox can be bolted together and directly drive the nearby front wheels. At the same time the weight of the engine and gearbox provides good traction for the driving wheels, especially in wintry conditions.

With a BEV however, the bulk of the weight is not in the engine but in the battery under the passenger compartment. Thus there is no real advantage in driving the front wheels as opposed to the rear wheels.

An electric motor driving the rear wheels can be very compact, not much bigger than the rear differential and exhaust system in rear wheel drive (RWD) ICE car. Without the traction advantage of the engine over the wheels, it would be better to go for RWD to get more weight on the driving wheels when going uphill or when accelerating. The turning circle would benefit too if the driving wheels don’t have to steer. It is no coincidence that both Tesla and Volkswagen use RWD for their BEVs, in the case of Volkswagen despite the fact that its best selling models such as the Golf and Passat are FWD. So why not Toyota and Subaru? It’s a mystery to me.

Another detail that surprised me was that even though DC charging on this car can reach a respectable 150 kW, AC charging at home is limited to mere 6.6 kW, which is less than for a compact Chevy Bolt. A Golf-sized ID.3 actually handles up to 11 kW. Some of this may be due to the Japanese Chademo charging standard and domestic grid considerations, as Japanese households only have access to 100 V and 200 V single phase current while the US and Europe use the CCS standard and 120 V / 230 V respectively, with 400 V 3-phase AC available anywhere in Europe. So even if there were technical reasons for limited AC charging speeds in Japan, export models should be able to do much better. Toyota may have specified its home charging module to the smallest common denominator, which if true is a bit disappointing.

As for the looks of the Toyota bZ4X / Subaru Solterra, to me they look like a close cousin to the existing Toyota RAV4 that I personally do not find very appealing. However, it is a big seller in the US market and this similarity may help move existing RAV4 owners over to BEV models once they become available some time in 2022.

Toyota has never been enthusiastic about battery electric vehicles. Its official line has been that hybrids are good enough for today and tomorrow we’ll get hydrogen fuel cell cars like its own Toyota Mirai, with all the benefits of battery electric but none of the drawbacks. There was no real space for battery electric in this vision. Toyota clearly over-promised and under-delivered on this strategy: Hybrid cars still spew CO2 into the atmosphere while almost all hydrogen today is made from fossil fuels. Battery electric does much better than that.

In Japan Toyota could rely on the government to help promote its “hybrids today, hydrogen tomorrow” story but in international markets that won’t fly. There the war for the future of the car is over and battery electric won hands down. No other country has a comparable push for hydrogen refuelling infrastructure as Japan has. Even if there were a domestic market for hydrogen cars in Japan, there won’t be any export markets.

Most experts agree that hydrogen vehicles are at least three times less energy efficient than battery electric vehicles, a flaw that would kill them even if the cars and the necessary fueling infrastructure could be built for the same cost, which isn’t the case. Batteries are far cheaper than hydrogen fuel cells and DC chargers are cheaper than electrolysers and hydrogen fuel stations. With battery prices falling further and further, within a few years BEVs will become cheaper to build than hybrid cars. Then the speed of conversion will only be limited by battery production capacity. It’s not clear Toyota will have the right investments in place by then, since it says its future BEVs will eventually be using solid-state batteries, an as yet unproven technology that only exists in the lab.

Until now Toyota had been avoiding BEVs except for the Chinese market, as it hoped buyers would keep buying its existing more profitable hybrid models. That is becoming a risky bet. Drastic changes needed to avoid the worst of a climate disaster no longer seem so radical compared to worldwide measures taken to deal with SARS-CoV-2. Huge numbers of consumers are ready for change. New BEVs by competitors are picking up market share in the US and in Europe. Toyota can no longer afford to wait on the sidelines or it will be seen as becoming irrelevant due to obsolete products.

This new BEV model is a very cautious move by Toyota and Subaru. Instead of competing head on with Tesla or Volkswagen, Toyota and Subaru are entering the BEV market only about as far as they absolutely have to, to still be a credible global player in 2022. The two companies will have to up their stakes to keep up with market developments.

Covid-19 numbers in Japan and Germany this autumn

My home state of Bavaria (population: 13.1 million) in Germany has had 30,117 new Covid-19 cases in the past 7 days, a 7-day incidence rate of 229 per 100,000. Meanwhile, Tokyo (population: 14.0 million) has had 142, a 7-day incidence rate of 1 per 100,000. The difference in numbers is simply staggering. Given that Germany started vaccinating its citizens months before Japan, it had a headstart on the road to immunity but it has since given up this advantage. A larger share of Japanese residents is fully vaccinated in every age group than in Germany. The growth in the vaccination rate slowed to a crawl in Germany months ago, while it’s still continuing at a healthy clip in Japan.

About two months ago, Tokyo’s Covid incidence (147 per 100,000 in 7 days on 2021-09-03) was quite similar to Bavaria’s current rate. But while the Covid incidence rate has been falling week after week in Japan since early September, it has almost doubled in Germany. The Japanese drop in cases has been amazingly consistent. When cases fall by half every 8 days and this continues for 8 weeks then cases will fall over 100-fold overall. That’s what an exponential decrease looks like. It happens when the reproduction rate of the virus drops below 1.

According to a numerical model created by Kris Popendorf, the two main contributors to the swings in the reproduction rate of the virus are mobility and immunity (you can read more details about his model here). One pushes the number up, the other pushes it down. The combined changes of the two either push the number above 1 (case numbers grow) or below 1 (cases drop). There are other factors, such as adherence to mask-wearing in indoor situations but in Japan’s case this has barely budged even when cases have been falling. Even when the risk of encountering infected individuals has decreased, few Japanese have stopped wearing masks as they still strive to comply with social norms.

With the end of the state of emergency, mobility has increased. People have started to go out and travel again and companies are reducing remote work. On the other hand, while rates of immunity will increase further, this increase is slowing down as the vaccination campaign will be nearing the saturation point over the next month or so. This will shift the balance of the two factors driving the reproduction rate of the virus towards the factor that drives an increase. We can therefore expect the rate of drop to slow and eventually rebound when mobility reaches a level that outweighs the level of immunity in the population. To achieve herd immunity regardless of mobility, the vaccination rate would have to reach a level estimated to be as high as 85-90 percent, which even Japan is unlikely to reach.

Case numbers in Tokyo are now at a level about 1/200 of the peak in August. Therefore even when the numbers start rebounding and grow again, there remains some time for public messaging to prevent a return to a caseload that would overwhelm the healthcare system.

I am much more concerned about the situation in Germany, which has a significant population of people reluctant to protect themselves and others by getting vaccinated. While not as large as in Russia, Romania, Bulgaria or the USA, it makes it very difficult to get numbers under control. In Bavaria, the Covid-19 incidence amongst unvaccinated people is 9 times higher than amongst fully vaccinated people (451.5 vs. 50.9). This means that even though about 65 percent of the population are fully vaccinated, the vast majority of cases are of unvaccinated people. Only 39 percent of teenagers are fully vaccinated there while more than two thirds of teenagers in Tokyo will soon have both shots. Even for age 65+ the rate is 80 percent in Bavaria vs. 91 percent in Tokyo, which means there are proportionally more than twice as many unvaccinated seniors in Bavaria as in Japan.

Unfortunately it will be very difficult to change the attitudes behind the vaccine resistance in Germany and other countries, as it is an issue of trust. Many of the people reluctant to get the shots trust neither politicians nor mass media nor medical professionals nor science in general. They will therefore be difficult to reach.

Restrictions on public activities, such as eating out or travel that are becoming more convenient again for low-risk vaccinated people will gradually erode the non-vaccinated population share but that will take time.

METI and Japan’s exit from the Carbon Economy

On the eve of COP26, the UN Climate Conference in Glasgow, Scotland, the Japanese government took out a full page ad in the Japan times to talk about “beyond zero”, a series of events and initiatives related to Climate Change. It struck me that none of them were specifically about renewable energy, the essential ingredient for a carbon-free economy.

The title of “Tokyo Beyond Zero Week” already had me confused: It reminded me of the Toyota bZ4x, a battery electric SUV that is the first mainstream battery electric vehicle for the Japanese market that Toyota has announced. Toyota has become notorious for bucking the Battery electric trend by plugging hybrids and hydrogen fuel cells, despite hydrogen fuel from renewable sources being 3 times less energy-efficient than battery electric vehicles. The bZ4x is too little, too late when Toyota is telling potential customers that they should really be buying hybrids like the Prius or hydrogen fuel cell vehicles like the Mirai.

METI, the Japanese Ministry of Economy, Trade and Industry has been sponsoring vehicles based on hydrogen fuel cells using hydrogen made from Australian brown coal (lignite), with the resulting CO2 emissions sequestered using “carbon capture and storage” (CCS) and the hydrogen shipped to Japan in cryogenic tank ships developed by Japanese shipyards with METI funding. Essentially it’s a massive pork barrel project, designed to pay industry players to go along with a Rube Goldberg project that will not be economically viable. It’s a way of keeping ecological laggards such as Toyota and the huge Japanese shipbuilders and trading companies relevant. Some of the initiatives sponsored by METI are:

  • LNG (Liquified Natural Gas) Producer-Consumer conference
  • International Conference on Carbon Recycling
  • International Conference on Fuel Ammonia

There is no place for LNG in a zero carbon economy. “Carbon Recycling” aka CCS is a fig leaf to keep burning fossil fuels. Ammonia may be a necessary fuels for ships and airplanes, but if it’s made from coal it won’t be green energy.

Why is the METI ad not talking about offshore wind and geothermal power, two of the most important energy sources for green baseload electricity? It’s because they are primarily concerned about creating and maintaining business opportunities for Toyota, trading companies making profits from fossil fuel imports and other companies wedded to the fossil fuel industry and not about how to get Japan ready for the zero carbon age.

I find this very sad. As a country with limited fossil fuel resources, Japan could become a prime player in the post-carbon era, developing new technologies to help other countries move beyond fossil energy sources. Japan has huge opportunities in offshore wind, onshore wind, solar and geothermal but its government has been largely turning a blind eye to them because those energy sources can not be controlled by its big trading companies. Likewise, its biggest automobile manufacturer is a laggard in battery electric vehicles which is determined to sabotage the switch to BEVs.

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.

Links:

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.