Prime Minister Abe today announced that he was placing seven regions of Japan, Tokyo and its neighboring prefectures of Saitama, Kanagawa, and Chiba, as well as Osaka, Hyogo, and Fukuoka under a state of emergency to cope with the accelerating spread of COVID-19 cases. For the early months of the epidemic, Japan’s numbers remained remarkably low, aligning more with Singapore, South Korea and Taiwan than with Europe and the United States. But recent rising numbers of confirmed coronavirus cases prompted Abe to take a different tack.
Three months have passed since news from Wuhan alerted Japanese policymakers to the possibility of a new infectious disease. Early on, Japanese officials had to rely on their public health expertise for a policy response, and like elsewhere in Asia much of the initial discussion built upon experience with SARS and the H1N1 influenza response. But the arrival of the corona virus to Japan was shaped by two factors. The first was the docking of the cruise ship, Diamond Princess, in Yokohama. With 3,711 passengers and crew aboard the ship, its first passenger identified as having the corona virus tested positive in Hong Kong on February 1. Japanese authorities quarantined the ship, and over those two weeks, over seven hundred passengers were identified as having the virus. By February 17, the United States and other governments had reached agreements with Japan to bring their citizens on the ship home. Those who were not sick were allowed to disembark and go home, while some chose to be treated in Japanese medical facilities. The bulk of Japan’s February COVID-19 cases thus overwhelmingly reflected those aboard the Diamond Princess.
A second factor that shaped Japan’s response was its complex relationship with China, the site of the original outbreak. Early Japanese cases of corona virus detected in January had all traveled to Wuhan, China. China’s lockdown of Hubei province had an immediate effect on Japanese manufacturers who rely heavily on China for their supply chain. Equally problematic was the disruption to Chinese tourism to Japan. In 2019, Chinese tourists made up 30 percent of the monthly foreign visitors to Japan, a considerable contribution to the Japanese economy. On January 31, the Abe Cabinet announced that it would bar entry to Japan for travelers from Hubei province. And there were diplomatic sensitivities at play as well. In April, President Xi was due to arrive in Japan for his first state visit, the culmination of years of diplomatic effort by Tokyo and Beijing to recover from their territorial dispute of 2012.
Finally, like China, Europe and the United States, Japan had much at stake economically in getting its public health response right. By the end of 2019, Japan’s economy was sluggish as a result of the new consumption tax hike, with an annual real growth rate of 0.7 percent and a 1.8 percent contraction in the fourth quarter. The initial impact of the pandemic was largely felt in the tourism sector. In January, visitors were down only by 1.1 percent year over year, but in February that dropped to 58.3 percent. On March 9, the Japanese government restricted travel from all of China and from South Korea, and on March 21 added multiple countries from Europe. By the end of March, Tokyo announced restrictions on travel from thirteen more countries, including the United States.
But the real economic worry was the possibility that the 2020 Tokyo Olympics, scheduled to begin in July, would be canceled. As concern grew about the idea of holding a massive international sports event in the midst of a global COVID-19 outbreak, the Abe Cabinet wanted to avoid the loss of significant investment made by the government and the private sector in preparation for the Olympic and Paralympic games. Moreover, the economic boost to Japan’s economy of hosting the games could not be ignored. Tickets had been booked, hotels had been reserved, and a whole host of accompanying activities, including lucrative broadcasting rights, had been contracted. 240 billion yen was estimated in income from tourism alone. After weeks of difficult negotiation, the IOC and the Japanese government announced that they would be postponing the games until July of 2021.
Ultimately, the efficacy of Japan’s public health strategy—as with the strategies of other governments around the world—will be judged in terms of the lives saved. Abe surprised many on February 27 when he shut down Japan's schools, and urged that large gatherings be cancelled. The Emperor set the tone by canceling his birthday celebration on February 17. The Japanese government has put in place a new law that raises the level of national urgency for managing the public health crisis.
Three factors prompted this shift. First, medical experts began to see evidence that their initial cluster strategy, identifying those infected early on and finding out who had contact with them, would be insufficient for the rising community transmission numbers in densely populated urban centers. Very early cases could be seen as falling into two groupings: early cases of COVID-19 infection discovered in January among those who had traveled to Wuhan and in February, the passengers aboard the Diamond Princess cruise ship quarantined in Yokohama. But then cases of community transmission began to shape the Ministry of Health, Labor and Welfare’s assessment. In Hokkaido, after an initial case on January 28, small clusters began to develop on February 14, many of which could not be traced back to previous cases. In Tokyo, a taxi driver with no travel to China or contact with cruise ship passengers was the origin of another cluster. By mid-March, the numbers began to climb.
Second, Japan’s initial public health response was predicated on the Special Measures Law for Pandemic Influenza and New Infectious Diseases and the Abe Cabinet determined it needed new authorities designed for the COVID-19 epidemic. In March, an amendment to that Special Measures Law regarding COVID-19 was passed to increase the options available to the prime minister. What may have seemed like a smart initial strategy in Japan to contain the virus has like elsewhere proven insufficient in a global pandemic. Mitigation of its impact is now the Abe Cabinet’s goal. The prime minister’s decision to put Japan on a national emergency footing will allow the national government to mobilize its resources, including the Self Defense Force, to help tend to the sick.
There is no expanded authority for local government, however. The division of labor between national and local authorities on the coronavirus has been much debated, especially in recent weeks as Tokyo Governor Yuriko Koike has grappled with a rapidly growing number of cases. Here the contrast between Hokkaido and Tokyo is noteworthy. Hokkaido Governor Naomichi Suzuki imposed a state of emergency from February 28-March 19 for his prefecture after a daily rise of 17 new patients in mid-February marked a significant cluster of corona spread. The governor’s declaration carried no legal weight, and caused considerable consternation for downtown Sapporo businesses. Nonetheless, in a region popular with domestic and foreign tourists in the winter ski season, the governor acted independent of the national government to stem the spread of COVID-19. On March 18, Suzuki lifted the emergency status while cautioning residents to remain vigilant.
Tokyo Governor Yuriko Koike’s recent effort to persuade Tokyoites to stay home was far more difficult. By mid-March, Japan’s daily numbers had increased at an alarming pace, mostly in the nation’s capital: from 90 on March 15, to 138 on March 22, and to 521 on March 31. In a press conference on March 26, Governor Koike implored the city’s 13 million residents to stay at home over the weekend, and then again the following Monday, to stay home during the work week also. The Tokyo Metropolitan Government also began to take steps to ensure that an adequate number of hospital beds, especially in intensive care units, would be available. Like New York, new facilities for corona virus patients are being set up in hotels, in sports arenas and other public space. By the end of April 6, the Ministry of Health, Labor and Welfare reported 3,906 cases of COVID-19 in Japan with 80 deaths attributed to the virus. Thirty-one percent of those cases were in Tokyo.
Criticism within Japan of the government’s response has come from various quarters. Early disapproval of the handling of the Diamond Princess came from medical professionals outside the government. Iwata Kentaro, a medical doctor with expertise on infectious diseases who had worked on the Ebola epidemic, took to YouTube on February 18 to report on the mistakes being made onboard the ship. Others were unhappy with the way in which foreign citizens were treated as they were evacuated, and the U.S. government for example took some heat for the way in which it merged infected and non-infected cruise passengers on return flights to the U.S.
In the Diet, opposition lawmakers were also concerned about the Abe Cabinet’s response, demanding more information about the data and analysis that underpinned government decision-making. Prime Minister Abe met with leaders of Japan’s political parties, starting first with Yamaguchi Natsuo of the Komeito, the LDP’s coalition partner, and asked for their cooperation in drafting a new law for COVID-19. For the most part, opposition party members supported a stronger national response but differed on whether a new law was needed to move forward with declaring a national emergency.
Finally, even after the new law passed the Diet, the ambiguity of whether and when the prime minister would announce a national emergency began to chafe, as did repeated press conferences by Koike that stopped short of imposing curfews or other measures to compel Tokyoites to stay home. Former Minister of Health, Labor and Welfare and former governor of Tokyo, Masuzoe Yōichi became an outspoken critic of both the Abe Cabinet and Governor Koike, attracting a wide following to his daily Twitter brief on global responses to COVID-19 and his urging for more stringent controls on Japanese behavior.
For all of these criticisms, however, Japan’s numbers still lag far behind those of Europe and the U.S. Yet the fear is that in the weeks and months to come, Japan too could see its urban population centers broadly infected and its hospitals overwhelmed. Abe and Japan’s governors must balance the expertise and capacity of their medical experts with the real challenge of controlling the behavior of their citizens, the tens of millions in Tokyo—and the 120 million who live across the country. COVID-19 will be particularly harsh given Japan’s demographics; twenty-five percent of its population are over the age of sixty-five.
The longer-term impact of the corona virus could be especially difficult for a deeply globalized Japan. The sluggishness of Japan’s economic growth makes it difficult to imagine an easy or quick recovery should the global economic recovery be weak. The stimulus package under consideration will deepen Japan’s national debt, already at least twice the size of the national economy. Complex geopolitical currents were already challenging Japan’s strategic interests. Tokyo will become deeply enmeshed should there be further deterioration in the relationship between the U.S. and PRC. And coping at home with the social and economic consequences of Japan’s aging population will become much harder in the face of the corona virus. While universal health care provides a sound foundation for managing the disease, insufficient health care facilities and personnel have already been targeted for an overhaul, especially in an around Tokyo.
Undoubtedly, there will be heroes and there will be demons in Japan’s coronavirus story, but it is too early to tell how Abe will be cast, or how the reputation of Japan’s bureaucrats will fare. Last week, the prime minister was chastened for what seemed to be ineffectual and token responses to the crisis: his decision to send two masks to each Japanese household, a policy dubbed as “Abenomask,” and to offer discount coupons for the purchase of beef and fish. Today, however, Abe marshaled far more government muscle to the effort.
At a minimum, the coronavirus has rewritten the widely accepted political script for Abe’s 2020. No Olympics, no jumpstart to Japan’s economic growth, and no triumphant electoral wave for Abe’s party, the LDP. Now it will be the success or failure of the management of COVID-19 that will be Abe's legacy. He must do all that he can to avoid having Tokyo and other cities in Japan share the fate of northern Italy and New York. Like every other national leader, Abe must live with the numbers that make this crisis beyond the scale of any other.