Japan’s experience with the pandemic shows that harsh restrictions are not necessarily the answer to containing the virus. Historian and faculty member Andrew Gordon sheds light on the political and cultural factors that allow for the country’s unique response.
By Andrew Gordon
My wife and I arrived in Japan on January 24, 2020, excited to be spending my sabbatical semester based in our favorite city, Tokyo. It has been a strange sojourn with unsettling twists and turns, as the comparative situation here and back home in the US has flipped back and forth. In February, I was fearful of a deluge of cases to come. In mid-March, Japan seemed to have dodged the worst, and the situation back home became desperate. But infections here rose in late March, and by early April we braced for an American-level explosion of infections and deaths. Thankfully, that did not materialize. Japan has joined the list of nations, mostly in Asia, where somehow, within a few months, devastation has been mitigated and the outbreak brought under control.
The story of Japan’s response to the pandemic is surely ironic. Containment measures were not particularly draconian; they came earlier than in the US or Europe, but were somewhat delayed compared to other Asian countries. Testing was more limited than any major country. This hardly sounds like a recipe for success. Yet, Japan’s COVID-19 mortality rates are low. Here, I will explore this puzzling and fascinating outcome first by looking briefly at political leadership and social structures. I then examine two more factors at greater length: historically embedded cultural practices, and historically rooted state policies of “moral suasion” and “administrative guidance.”
Outcome Comparisons
Reported cases in Japan did climb for a time, peaking at 500 to 700 daily nationwide in the middle of April, and between 150 to 200 daily in Tokyo. But by the end of April, newly detected or reported infections were declining, and the daily death toll began to fall. These trends continued through May and June. The relevant comparison here is not between Japan and the US, but between East and Southeast Asia and the rest of the world. Data on COVID-19 deaths per million shows that the US and major European nations so far (as of late June) have suffered from 250 to 850 deaths per million people. Among major European nations, the only one that has a significantly lower ratio is Germany (at just over 100 deaths per million). Countries in Asia (from lowest to highest: China, Singapore, South Korea, Japan) show fatalities ranging from 3 to 7.5 deaths per million. Taiwan is at the lowest end of the range, with only seven total deaths and a population of twenty-four million. On a graph of deaths per capita against tests per capita, Japan is also at the lowest end of the range—with by far the fewest tests, yet among the fewest fatalities per capita. We see a roughly hundred-fold difference in death rates between Asia and major Western nations.
Leadership
Living in Japan, it was—and remains—easy to find fault with the response of the administration of Prime Minister Shinzō Abe, and of the government more generally. Handling of the Diamond Princess cruise ship was a fiasco, as the vessel docked at Yokohama with 3,000 passengers kept on board, infecting each other by the hundreds. Major decisions such as closing schools in late February were made suddenly and without much explanation. The Abe administration, along with Tokyo Governor Yuriko Koike, moved slowly toward emergency measures while trying to save the Olympics for 2020, even after it was very clear it would be impossible to hold the games as scheduled. Since the declaration of a “state of emergency” on April 7, economic relief has been slow to reach people. There was some remarkable inconsistency in deciding on proposed steps of economic relief. It has been clear for some time that more testing is needed—especially as the country has moved toward restarting activities—but the increase has been slow. In early April, the experts in the Ministry of Health, Labour and Welfare continued to defend the policy of limited testing focused mainly on cluster tracking, even after it was clear that community spread was rapidly taking place outside of clusters and that wider testing was needed to quickly detect and contain cases in the community.
But compared to the response of Donald Trump and the US federal government, and European leaders such as Boris Johnson, or Brazil’s president Jair Bolsonaro, problems in the responses of top Japanese leaders and state bureaucracy were modest. (In the Olympic contest for “worst leadership,” the US, Britain, and Brazil are my choices for the gold, silver, and bronze medals. Japan and other Asian nations except for the PRC do not even qualify to enter the competition.)
Compared to these three worst-case responses, the Japanese government—including the prime minister, the LDP and opposition parties, key state ministries, and prefectural governors—took the threat of COVID-19 seriously from the start. The decision to close schools at the end of February might have been announced suddenly. But that decision, as well as the call to curtail large group events which began a few days before that, was wise and important. It far preceded any such steps in the US or Europe. The initial focus on testing for and containing clusters made sense, even if the authorities should have moved more quickly to wider testing as the disease spread outside clusters. The government has generally respected the opinions of experts. It has given increasingly clear and consistent messages to the public. This seems to have been the case in other countries in Asia as well.
Structural Factors
Even if leaders around the world had been similarly proactive and consistent in responding to the virus, underlying structural factors would have made the situation worse in the United States and parts of Europe compared to Japan and other Asian countries, such as Taiwan or South Korea. Systems for public health are particularly weak in the US and strong in these Asian countries. This is certainly ironic, since the concept of “public health” entered Asia from the West in the second half of the nineteenth century.
This long-term structural problem worsened under the Trump administration, which disbanded the Global Health Security and Biodefense unit, responsible for pandemic preparedness, set up by the Obama administration in 2015 after the Ebola crisis, as part of the National Security Council (NSC). There is an important contrast here with Taiwan and South Korea, even more than Japan. Taiwan’s experience of dealing with SARS in 2003 and South Korea’s experience with MERS in 2015 led to important improvements in public health systems and response plans.
Today, the Japanese population is famous for being among the oldest in the world, with 28 percent over the age of sixty-five. This structural factor obviously raises the overall risk of death from COVID-19. But the population is also healthy. Rates of obesity, considered a major risk factor, are low. The international standard for obesity is a body mass index (BMI) over 30. By this measure, just 3.6 percent of Japanese are obese, compared to 32 percent of Americans and 24 percent of Europeans.
Other structural factors not directly related to public health are also part of the explanation. Social and economic inequality has been increasing in Japan for some time, but it still lags far behind that of many countries in the West.
Daily Life Practices
It has become increasingly clear that at least one of Japan’s culturally embodied practices is part of the story. A long list of cultural factors is familiar in media accounts: a widespread habit of mask-wearing for health purposes; removing shoes at the door; bowing in greeting, rather than shaking hands, hugging, or kissing on both cheeks as in Europe. At the same time, other cultural practices, such as crowded workspaces where desks are facing each other—without barriers and with few private offices—seemingly make Japanese workplaces extremely vulnerable. And the immense popularity of karaoke and pachinko makes for dangerous leisure activity, though it is difficult to assess the impact of these indoor pastimes beyond noting them.
The one practice on this list that strikes me as undeniably important is wearing masks. There is growing consensus now in medical literature that masks, while certainly not sufficient as the only public health measure, indeed dramatically impede the spread of the airborne droplets that convey the virus from person to person. And it has been a ubiquitous practice in Japan and elsewhere in East Asia for several decades. How this came to be the case is a fascinating story. Elsewhere I have presented a rough version of this history. Mask-wearing is neither a culturally Asian practice in its roots nor a longstanding and widespread practice in East Asia. It emerged from the late nineteenth to the early twentieth century in the West and in Asia through a complex exchange of knowledge and ideas. Americans promoted masks to deal with the Spanish flu even in 1918, and this prompted Europeans and Japanese to follow suit in 1919 and 1920. Japan’s colonial authorities also promoted mask use in Korea and Taiwan, at least to some extent. Over decades the practice gradually sunk roots in Japan, and elsewhere in Asia, while the reliance on masks for public health protection evaporated in the United States and Europe.
Policies
Many commentators both within Japan and around the world have emphasized the uniqueness of Japan’s relatively soft “state of emergency,” which, even though enacted by law, relies on requests and instructions rather than orders, fines, or arrests. This is indeed a notable contrast between Japan and just about every other country, and I believe it is quite important. What is the source of this policy?
The turn to a “soft” state of emergency was not the way the Japanese government dealt with epidemic disease in the past. In the Meiji period, cholera was a major problem, and the government enacted mandatory confinement in response. As historian Barak Kushner explains in a recent article, “Japan's state of emergency has dark history,” in 1877, the Japanese government enacted a series of cholera prevention laws that gave the police powers to test, isolate, and sanitize the living areas of people who came down with the disease. And from the late Meiji era well into the postwar decades, the Japanese government took harsh mandatory measures to isolate those suffering from leprosy. Kushner also notes that in 1907 the Leprosy Prevention Law mandated that doctors report leprosy patients and gave the police power to force them to live in designated and often very isolated facilities. These laws remained in force decades after medical advances made it possible to treat leprosy. The disease remained a horrible social stigma until lepers were removed from quarantined facilities in 1996.
The relatively soft state of emergency put in place to deal with COVID-19 is different not only from harsher restrictions imposed in other countries in Asia (China, South Korea) and in much of Europe and the United States. It is also clearly different from Japan’s historic response to cholera and, more recently, leprosy.
One common explanation for the unusual Japanese response is that postwar democracy has so prevailed that it is now difficult for the state to take harsh steps to restrict individual freedom. I see this as only part of the story. After all, nations such as France, the UK, or the US that have imposed much harsher containment measures backed up by police power have long and deep histories of protecting individual liberties. And Japan’s harsh confinement of leprosy patients continued far into the era of postwar democracy.
Persuasion Instead of Compulsion
I think Japan’s “soft state of emergency” in the case of COVID-19 stems not only from a liberal commitment to resisting state impositions on personal freedom. It also grows out of a modern tradition of the use of persuasion in state-society relations with roots going back to the Meiji era. This practice ran parallel to, and separate from, the harsh policies toward cholera or leprosy. In the pre-WWII and wartime era, persuasion was used not for disease control, but for other social purposes.
My colleague at Princeton University, the historian Sheldon Garon, refers to this practice as “moral suasion.” It goes back to Buddhist or Confucian thinking about educating and cultivating others. This term was used in the Meiji period through the 1920s. In later years, these projects were variously described with the term “mobilization” during wartime especially, or the term "campaign" in the postwar era. Garon describes moral suasion as grounded in a belief that states and various groups in society can first enlighten and then mobilize or persuade the populace to behave in desired ways.
Especially from the 1920s through the 1980s, we find mobilization campaigns by the government—all without compulsory legal force—aimed to promote saving, restrain consumption, buy Japanese products, improve hygiene by wiping out mosquitoes and flies in city neighborhoods and rural villages, or teach women to be "scientific" mothers and wives. Savings campaigns continued up to the 1990s. We also see moral suasion, rather than compulsion, in the calls for voluntary cuts in energy consumption during the oil crises of the 1970s, and the response to the Fukushima nuclear accident in 2011.
Garon shows that these campaigns rested on an elaborate social infrastructure of semi-official organizations that reached from the state to the neighborhood. Examples include women's associations, army reserves and veterans associations, agricultural cooperatives, youth associations, savings associations, and neighborhood associations. When the government wanted to modify mass behavior, it used media such as magazines and posters. But most importantly, state officials joined in partnerships with these civil organizations, working jointly to persuade people to save, to be punctual, to buy Japanese products, or to cut back on consumption.
Of comparable importance to moral suasion as a social policy tactic is the more famous practice of “administrative guidance” in economic policy. The concepts are arguably two sides of a single coin. In the response to COVID-19, both have been present. The coordination between Japanese state agencies and industrial organizations in shaping responses to COVID-19 has been truly impressive. On May 14, pointing toward the gradual reopening of the economy, the government published a list with hyperlinks to the specific reopening guidelines for each of eighty-one economic federations, with the name of the industrial sector, the specific federation, the relevant state ministry, and the hyperlink to detailed documents for each group. That such federations exist is no surprise and hardly unique to Japan. The United States also boasts a national federation of warehouse companies (number seventy-two in the document!). But I am pretty sure there is not a similar level of coordination between the government, these federations, and individual business operations in the United States. Still, more research on the global comparison of state-economy coordination in response to COVID-19 would be valuable. That it was possible to pull together this carefully coordinated and detailed set of guidelines and make them public a week before the state of emergency began to be relaxed suggests that “administrative guidance” is alive and well in Japan.
When the government launched its soft “state of emergency” in early April, I doubted the social infrastructure of moral suasion, or the economic structure of administrative guidance, still existed to an extent that would allow effective action. Convinced that policies lacking compulsion would not suffice in a situation as urgent as a pandemic, I began drafting this essay intending to argue that historically rooted practices were hobbling the Japanese state and society. But the case and mortality data suggest that Japan still possesses an effective structure of persuasion. In just the past two weeks, detected infections in Tokyo have increased notably with the “reopening” of economic and social activity (though still at levels far below those in the US). A second wave might come. The Japanese Wile E. Coyote might charge off the cliff, remain briefly suspended, then look down and crash. To declare victory is premature.
But to date, nations in Asia, including Japan, have taken varied approaches that have been relatively successful in coping with COVID-19. There seem to be diverse models and lessons to be drawn from experience in Asia, not just one best practice.
—Andrew Gordon, Faculty Associate, Weatherhead Center for International Affairs
Faculty Associate Andrew Gordon is the Lee and Juliet Folger Fund Professor of History at Harvard University. His research interests focus on the discourse and political economy of Japan’s “lost decades” of the 1990s and 2000s, and the phenomenon of “dark tourism” in Japan and globally. His most recent book, A Modern History of Japan: From Tokugawa Times to the Present, Fourth Edition, is available at Oxford University Press.
Captions
- Matsudaira Toshogu shrine, Okazaki city, Aichi prefecture. Credit: Bong Grit, Flickr (CC BY-NC-ND 2.0)
- Japan's Prime Minister Shinzo Abe (2nd L), wearing a face mask, attends a meeting of COVID-19 coronavirus task force in Tokyo on April 16, 2020. Abe extended a state of emergency for the entire country to stem the spread of the disease. Credit: STR/JIJI PRESS/AFP via Getty Images
- Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, right, wears a protective mask while listening as U.S. Vice President Mike Pence speaks during a White House Coronavirus Task Force briefing at the Department of Health and Human Services (HHS) in Washington, D.C., U.S., on Friday, June 26, 2020. Pence tried to paint a reassuring picture of the U.S. battle against Covid-19 citing "truly remarkable progress" during the briefing while Fauci pleaded for Americans to take the virus more seriously. Credit: Erin Scott/Bloomberg via Getty Images
- An American family and their cat during the 1918 Spanish flu epidemic. Credit: Wikimedia Commons
- During the 1920 Spanish flu pandemic, Japanese health authorities circulated this poster widely. Translation: “Fearful ‘germs’ of the ‘rampant cold’!” “Your life’s at risk without a mask!” Credit: Public domain, downloaded from Flashbak