My 89-year-old Japanese mother-in-law, who lives with us, received a Covid-19 vaccination ticket number in the mail from Tokyo’s Setagaya Ward Office last week, with a notice saying that online reservations would open at 8:30 am on April 28. Reservations would be available at multiple venues throughout the ward from May 3.
Setagaya Ward has a population of 950,000, of whom some 100,000 are over-75s. The Government of Japan has committed to immunize all over-75s by the end of July.
A few milliseconds before 8:30, I clicked the link to the reservation website. It was already totally frozen. Over the next seven hours, I put myself through a year’s worth of carpal tunnel syndrome risk as I hammered away repeatedly at the reservation system using multiple tabs of multiple windows of both Safari and Google Chrome on my laptop.
I closed windows, cleared caches and restarted browsers frequently, imagining that I might receive mercy by appearing more like a fresh applicant, rather than one who had already been rejected hundreds of times.
There are four steps before you can get anywhere useful:
- Go to reservation page;
- Commence reservation;
- Click box to accept personal data policy; and
- Login screen.
The system froze, timed out and displayed various other error messages throughout the entire day. In seven hours I managed to get to the login screen maybe 20 or 30 times. Were I to add up all my clicks they would be in the thousands.
Multitasking
Meanwhile, simultaneously, I used a free finger to dial the reservation phone line. I managed to phone 113 times while I was attempting to get in via the internet, and my wife also called over 100 times that day.
Twice I reached the second login screen, where one creates a unique password – but each time there was another “system error” message. I went back to the website after dinner and tried for another two hours until I was nodding off on the keyboard.
The next morning I awoke before five and went straight to the laptop. In the sparse early morning traffic, the system let me through all four steps almost immediately. I got to the password create screen, and – although the system froze and timed out several times – I did eventually hit the reservation screen.
By this time, all the early May dates were gone and May 13 was the first one available. I grabbed it and clicked “reserve” but it timed out, telling me that there was a system error and I should log in again.
This happened a second time, and although it had been at most 20 seconds since my last attempt, the first available date was now May 18. Timed out again, system error, log out and log in. Under 30 seconds later, I was in again and barely managed to grab May 25.
As I was going through this process I noticed that the number of available slots was displayed at each time slot: 3, 4, 2, or 6 slots. I finally managed to book both shots for my mother-in-law, although her second shot won’t be until June 15.
Now he tells us
The Setagaya vaccine website carried a message from the mayor of Setagaya, Nobuto Hosaka, saying, “There are 100,000 seniors over 75 in Setagaya and we have secured more than enough doses for all of them, so please relax and reserve calmly.”
The site also displays occasional updates on the progress of the reservations. As of 5pm on the first day, 10,500 reservations had been completed. By the end of the second day, the number was up to 33,000.
The reservation system looked vaguely familiar. Indeed, I thought I had seen similar screens when booking a hot spring getaway in the old days, before Covid-19. My impression turned out to be accurate when I received the confirmation e-mails for the shots: The reservation system is run by Japan Travel Bureau.
So far, all the Covid-19 inoculations are being carried out at large local facilities like public halls – in our case, a nearby municipal gymnasium.
Family docs need not apply
General practitioners who function as family physicians running small neighborhood clinics are not allowed to administer the vaccines.
The doctors at our local clinic said they themselves had not been included in the millions of medical personnel who have been inoculated. Their impression was that only staff at the large comprehensive hospitals received that privilege.
With that huge cohort eliminated from the eligible population of doctors, Japan’s slow vaccination rate must be attributed in significant part to the requirement that a physician must be present at the inoculation.
There are some 1.2 million nurses in the country, but only 320,000 doctors. The low per-capita number of doctors in Japan and the resulting shortage of doctors here has been well known since the 1990s. While the numbers have inched up, Japan’s numbers remain quite low compared with other developed nations.
The Ministry of Health, Labor and Welfare has been working on a solution: there is now a plan to allow the training of temp nurses as “vaccination specialists.”
Historically, the use of temps in nursing and clinics was prohibited on the grounds that strong working relationships among staff members are essential in the medical environment. However, in 2003 the use of long-term temps was allowed, and just last month regulations were further relaxed to allow the use of daily temps.
There are still naysayers who fear the presence of temps at vaccination sites could cause confusion and liability issues, and some object to the use of temps altogether on the grounds that the fees charged by the temp agencies should rightfully be in the nurses’ pockets instead of being paid to a broker.
Syringes
Finally, there is an issue with Japanese syringes. The vaccine bottles are designed for use with modern “low dead space” syringes, which can extract six doses from each bottle. The typical Japanese syringe, however, is not at this standard and only five doses can be extracted.
Last month the ministry permitted the use of insulin syringes, which may even allow seven doses to be extracted from each vial, but insulin syringes have short needles and may not be suitable for patients with more subcutaneous fat.
As a result, uptake has been minimal and most vaccinating is being carried out with the less efficient domestically manufactured syringes, meaning that one dose of precious vaccine is being wasted for every vial.
Meanwhile, in a classic example of public health mismanagement, Japanese pharma manufacturer Terumo was authorized by the MHLW only in March to produce low dead space syringes, as if the issue had been completely unknown until then.
My mother-in-law is frail and cannot travel alone. While she is alert and basically healthy, she grew exhausted just watching me try to book her jab. She does not use a computer and, while she is active on the telephone, she would not be capable of making a hundred calls a day.
Her comment was, “If it’s that hard to get the vaccination, anyone my age will just do without.”