In light of Japan’s decision last week to waive pre-departure COVID-19 tests for vaccinated inbound travelers, it is worthwhile to consider that its strong performance over the first two years of the pandemic may have had less to do with policy than with culture.
In a study published this summer in the Canadian Medical Association Journal, Dr. Fahad Razak and colleagues at the University of Toronto examined COVID-19 outcomes in Canada, Belgium, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, the U.K. and the U.S.
Japan tallied by far the lowest cumulative per capita rate of COVID-19 cases. The next best performer was Canada. The other eight nations in the study showed cumulative per capita case rates 5 to 11 times higher than Japan.
Japan managed its relatively low COVID-19 case rate and death tally, the authors noted, despite having a vaccination rate comparable to the other nations studied, the least strict public health measures of any country reviewed and the oldest population cohort.
What explains Japan’s outperformance? The study’s authors looked at diverse hypotheses, including the country’s isolation as an island chain, relatively high baseline population immunity due to previous coronavirus infections, comparatively homogeneous population whose genetic makeup proved resilient to this virus, cultural predisposition to compliance with mask-wearing and the early recognition by Japanese public health officials of COVID-19’s spread in aerosolized form.
Even more remarkable about Japan’s performance is the fact that the study’s authors did not account for the age breakdown of the various countries in terms of mortality. Had they done so, Japan would have emerged as an even greater outlier since the percentage of its population over age 65 is more than 28%, compared with 17% in the U.S. and 18% in Canada.
Experts in cultural differences and in global public health offer a variety of explanations too. Noriko Kishida, a Tokyo-based research consultant to the Japan Marketing Research Association, noted that resistance to wearing masks has been low in Japan compared with other countries, while the public has instinctively done what they have been asked to do by authorities. There is a Japanese custom of respect for other people’s public health needs, she said, which defaults to precaution. [Continue reading…]