The Nomura Research Institute (NRI) compiled information on the state of vaccination in six countries, namely, Israel, the UK, the US, Canada, Germany, and France, as of the end of March 2021^*. The results of this survey showed that these six countries are starkly divided into countries that are leaders in promoting vaccination and those that are struggling. We interviewed Shinichiro Umeya of the Center for Strategic Management & Innovation, who carried out the survey, on what are key points for smoothly advancing vaccination and what Japan can learn.

• The results from Israel are as of the end of February 2021.

Israel, the UK, and the US are leaders in promoting vaccination

In Israel, which is a leader in promoting vaccination, the number of vaccinations per 100 in the population was more than 100 as of the end of March 2021, indicating that one vaccine was given for each person. Meanwhile, in France, Germany, and Canada, at most 20 people per 100 were vaccinated.
Under the strong leadership of Prime Minister Netanyahu, Israel secured vaccines and developed a vaccination system early on; the country also implemented a vaccination encouragement campaign, and Israel became one of the most advanced countries in vaccination efforts.
In the UK, the slogan “Keep Calm and Carry On”, which was used in World War II, was also applied to the pandemic, and the country implemented a state-led vaccination campaign and established vaccination sites such that even family doctors and the like could give vaccines.
Meanwhile, as of the end of March, the government of Germany faced harsh criticism for its delayed securing of vaccines and slow pace of vaccination. Similarly, France was delayed in securing vaccines via the EU, and with many there skeptical of the vaccine, vaccination did not progress as expected. (Addition as of May: Nonetheless, the securing of vaccines finally began to progress satisfactorily in these countries, and from April onward vaccination has progressed gradually.)

Israel: early securing of vaccines and leveraging of medical IT infrastructure to advance vaccination

Israeli Prime Minister Netanyahu took a top-down approach to procuring vaccines. Announcing that he would provide vaccination data to the WHO and pharmaceutical companies, he executed an advance contract for purchase of more than the anticipated required quantity of vaccines and imported the first shipments before FDA approval was given in the US. Then, he achieved his stated goal of “vaccinating 5 million citizens, or 55% of the entire population, by the end of March 2021”.
Israel has been developing its digital health infrastructure for about 20 years and has achieved uniform data management using single IDs. This medical IT infrastructure was effectively leveraged in vaccination; an order of priority was automatically set according to sex, age, location of residence, and history of illness, and the country has continually gathered data regarding the number of vaccinations and number of people vaccinated.
With its vaccination encouragement campaign, Israel eased fears about vaccination through disseminating information on the safety and verified efficacy of the vaccine. Prime Minister Netanyahu was the first one to get vaccinated, and then sent out a strong message that “If all citizens cooperate, follow the rules, and get vaccinated, we can become the first country in the world to escape this situation”.

The UK: early securing of vaccines and leveraging of medical IT infrastructure to advance vaccination

In the UK, in April 2020, the government, academia, and business all came together to establish a vaccine task force (VTF). The VTF focused its efforts on procuring vaccines in a way that would enable domestic mass production and swift delivery and succeeded in procuring a large number of vaccines at an early stage.
The UK has its National Health Service (NHS) funded mainly by taxes, and with a top-down system in which NHS oversees execution of the vaccine plan, the scale of vaccination has rapidly increased. NHS England, which manages operations and is the primary administrative organization for carrying out Covid-19 vaccination, was ready with its experience of success and specialized knowledge from the vaccination programs it had implemented against HPV in 2008 and against shingles in 2013. In addition to creating this vaccination system that made maximum use of existing medical infrastructure, the UK achieved centralized management of vaccination information through its integrated IT systems.
After being one of the countries that was worst hit by the Covid-19 pandemic in the world, the UK is carrying out a government-led vaccination promotion campaign under a strong sense of crisis, with even the royal family being actively involved.

Germany: rigid vaccination system administration and confused communication by the government caused struggles

Chancellor Merkel’s early response to the pandemic received high marks on the international stage. However, Germany’s subsequent vaccine distribution and vaccination campaign got bogged down. One reason for this was the problem of securing vaccines. In the EU, a common procurement mechanism is being used so that vaccines are procured in a concentrated manner by the various countries’ governments and then distributed proportionally according to the population of each member state. Therefore, countries are not able to freely procure vaccines at their own discretion.
Further, as Germany is a federal republic, the federal government decides only regulations and rules at the federal level, and states are in charge of public hygiene and disease prevention. Since the vaccine supply is limited, the federal government was forced to set stringent regulations and rules on the order of priority for vaccination, and this is said to have caused confusion at the state level. Further, vaccination sites are concentrated in the metropolitan areas, which is having a major impact on vaccination, particularly the elderly. In addition, reports relating to the efficacy of the AstraZeneca vaccine and the government’s confused response to the reports invited mistrust.
Currently, the German government is revising its vaccination system, and while there is room for dramatic improvement going forward, various challenges have surfaced. (Addition as of May: Subsequently, as securing of vaccines progressed, vaccination in Germany as well has progressed gradually since April.)

A need for flexible, adaptive measures based on the factors that contributed to the success of vaccination leaders

In the responses by countries leading the way in Covid-19 vaccination, we see characteristics such as the securing of vaccines, seamless logistics, the maximal securing of vaccination systems leveraging existing medical infrastructure, and strong, unified messaging and leadership from the country’s leaders. Meanwhile, countries that have struggled with vaccination have seen issues in these four areas, as well as confusion in communication by the government, a lack of flexibility with regard to the creation of vaccination systems, and other such problems.
As Japan enters a stage of vaccination in earnest, construction of a smooth vaccination system (V-SYS) and Vaccine Record System (VRS) has progressed, and development of a delivery mechanism compatible with both group vaccination and individual vaccination is underway; however, it is critical that we aim to promote vaccination based on the factors that contributed to success for the countries leading in vaccination. Thus, the government, including its top leaders, need to convey a strong message that “vaccination is the best means for escaping the Covid-19 pandemic”. Further, an adaptive response meeting the needs of the situation at hand will also likely be required.