Japan’s Fragmented COVID Response: A Systemic Failure of National Leadership

Politics Health

One of the curious features of the Japanese response to the COVID-19 crisis has been the inability of the central government to impose its pandemic policies on prefectures and cities, even during a state of emergency. Political scientist Takenaka Harukata scrutinizes the phenomenon.

Ever since the COVID-19 pandemic hit Japan, the Japanese government has attempted to orchestrate a coherent nationwide response to the public health crisis, but with mixed results. In the following, I examine the government’s COVID-19 response from January 2020, when the first cases were reported, to March 3 of this year, when Prime Minister Suga Yoshihide announced another extension of the state of emergency for the Tokyo region. After a brief description of the legal framework for government action in such a crisis, I offer a chronological account of steps taken by two successive administrations, the Abe administration and the Suga administration, and the obstacles they encountered at the local level owing to systemic constraints on the prime minister’s powers in responding to the pandemic crisis.

Local Government in the Driver’s Seat

First, let us take a look at the political actors involved in the pandemic policy process. At the national level, they consist of the prime minister and the cabinet; the chief cabinet secretary; the state minister in charge of the coronavirus response; the minister of health, labor, and welfare; and various senior administrative officials attached to the Ministry of Health, Labor, and Welfare and the Prime Minister’s Office. They are assisted, in an advisory capacity, by a panel of experts—currently, the Subcommittee on Novel Coronavirus Disease Control under the prime minister’s Advisory Council on Countermeasures against Novel Influenza and Other Diseases (which replaced the Novel Coronavirus Expert Meeting established initially under the government’s Novel Coronavirus Response Headquarters). At the local level, the key actors are the governors of the 47 prefectures (understood here to include metropolitan Tokyo) and the local public health centers (hokensho) that operate under their direction as well as majors of major cities and wards.

Japan adopts a defacto “federal” system to respond to a pandemic crisis.

The powers of the political actors at the national level are limited. Under the Infectious Disease Act, the cabinet has the power to designate infectious diseases which have not been categorized under the law, and on January 28, 2020, COVID-19 was declared a “designated infectious disease.” (It was later incorporated as a category II disease in the amended Infectious Disease Act, passed in February 2021.) In addition, the 2012 Act on Special Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response (hereafter, Pandemic Special Measures Act) assigns the cabinet and the Ministry of Health responsibility for drawing up basic policies for responding to a pandemic with the input of a panel of experts. The Pandemic Special Measures Act also allows the prime minister to declare a state of emergency to respond to a pandemic. However, as I explain below, the prime minister’s powers are quite limited even under a state of emergency.

In terms of concrete measures, the legal framework puts the bulk of the pandemic response in the hands of the prefectural governors and the public health centers under their jurisdiction. Under the Infectious Disease Act, each governor must ensure that the regional health system is equipped to provide adequate in-patient and out-patient medical care. The prefectural government is also responsible for a wide range of measures to contain the infection, such as cluster surveillance, testing, contact tracing, and notification of individuals recommended for examination, treatment, hospitalization, and so forth. The prefectural government is also in charge of issuing any requests to limit the movements of the people to curtail the expansion of a pandemic. It can issue requests on the people to refrain from going out and on businesses to curtail or suspend operations.

It is important to note that the public health centers under the direction of either the governor, in the case of the prefectures (including Tokyo) or the mayor, in the case of cities and wards with their own public health centers, carry out most of the aforementioned missions except the provision of health system as well as issuing of orders aimed at restricting the movement of the people.

To understand Japan’s somewhat muddled pandemic response it is important to note that the central government, preferecutural governments and city and ward governments are mutually independent with regard to public-health matters. To be sure, the Pandemic Special Measures Act gives the prime minister the power to declare a state of emergency in any or all prefectures, draw up a basic national policy, and issue instructions (shiji) to the affected prefectures as needed to coordinate implementation of that policy. Similarly, the Infectious Disease Act permits the Minister of Health to issue instructions to governors and mayors. But in the end, enforcing such instructions has proven extremely difficult.

The Pandemic Special Measures Act is anything but clear as to the extent of the prime minister’s powers in various situations, leaving plenty of room for disagreement between the central government and the prefectures. And neither the prime minister nor the minister of health is invested with any coercive powers vis-à-vis the local authorities that bear actual responsibility for implementation. Ultimately, it is up to the governors to decide whether to follow the central government’s instructions regarding the functions for which they bear responsibility. By the same token, governors have little power to impose their decisions on the cities or special wards in their jurisdictions.

Legal Authority of Central and Prefectural Governments in Responding to COVID-19

Measures to contain infection

Allowed Not allowed
Central government
  • Designate COVID-19 an infectious disease
  • Craft national policy
  • Declare state of emergency
  • Allocate public funds
  • Direct governors and public health centers
  • Directly oversee testing
  • Prohibit suspected patients from attending work
  • Request businesses to suspend or curtail operations; impose fines for noncompliance (granted under Infectious Disease Act, February 2021)
  • Disclose names of noncompliant businesses
  • Directly oversee public health centers
  • Directly oversee testing
  • Order businesses to suspend operations
Governors and mayors who oversee regional public health centers
  • Request public compliance with measures to contain infection
  • Conduct testing
  • Compel suspected patients to be hospitalized
  • Conduct epidemiologic surveys
  • Compel suspected patients to be tested or impose fines for refusal
  • Compel suspected patients or those with mild symptoms to stay at accommodation facilities

Medical System

Allowed Not allowed
National government
  • Set targets for securing hospital beds
  • Allocate funds
  • Establish payment system for medical services
  • Direct governors
  • Directly procure hospital beds (excluding some facilities like Self-Defense Force hospitals)
  • Oversee procurement of hospital beds
  • Establish emergency medical facilities
  • Secure use of accommodation facilities for suspected patients or those with mild symptoms
  • Directly procure hospital beds (excepts at municipal and prefectural hospitals)

Early COVID-19 Response

The first confirmed case of COVID-19 in Japan was reported on January 15, 2020, in a man believed to have contracted the case in Wuhan, China, the epicenter of the pandemic. On January 23, with the coronavirus spreading rapidly in Wuhan, the Chinese government placed the city in lockdown. On January 28, regional authorities in Japan confirmed the first cases of COVID-19 among residents who had not been to Wuhan.

During the second half of January, the Japanese government, headed by Prime Minister Abe Shinzō, focused its efforts on the repatriation of Japanese citizens in Wuhan. In early February, Abe invoked the Quarantine Act to place the cruise ship Diamond Princess under quarantine in Yokohama to contain an outbreak of COVID-19 among the passengers and crew.

In the second half of February, with community transmission of the virus on the rise, the cabinet issued its Basic Policies for Novel Coronavirus Disease Control, and the government took a series of rigorous measures aimed at containing the infection, including the suspension of all large-scale gatherings and temporary closure of elementary, junior high, and high schools.

On March 9, the government placed new restrictions on travelers entering Japan from China and South Korea. On March 13, the Diet passed legislation amending the Pandemic Special Measures Act. On the 24th, the International Olympic Committee and the Tokyo 2020 Organizing Committee announced a one-year postponement of the 2020 Summer Olympics.

State of Emergency

In the wake of the restrictions imposed in February and early March, the epidemic seemed more or less under control within Japan. As the earlier sense of crisis dissipated, the movement of people picked up. However, by the end of February, the virus was spreading rapidly across Europe, and Japanese citizens returning home from overseas brought the virus back with them. A lack of appropriate and prompt border restrictions by the Japanese government, combined with the rebound in movement within Japan, led to wide dispersion of the virus. By late March, the number of new daily infections was surging, and Prime Minister Abe was under mounting pressure to declare a state of emergency.

Abe was forced to take action in early April, as outbreaks began to overwhelm local healthcare systems. On April 7, he declared a state of emergency for the most hard-hit prefectures, and on April 16 he extended the declaration to the rest of the country. By mid-May, the curve had flattened again. The state of emergency was lifted for the majority of prefectures on May 14 and for the rest of the nation on May 25.

Another surge began in June 2020, but this time, instead of declaring a state of emergency, the central government left it to the governors to contain the spread, and this time, too, case numbers subsided. On July 22, the government launched Go To Travel, a program offering subsidized discounts to promote domestic tourism and consumption. (Tokyo, with its relatively high caseload, was initially excluded from the promotion.) On August 28, Abe announced his resignation, citing chronic health problems. Suga Yoshihide took over as prime minister on September 16.

Mixed Signals

Prime Minister Suga, a key promoter of the Go To Travel campaign launched under the previous administration, was keen to use that program to resuscitate the moribund economy. On October 1, his cabinet expanded the program’s scope to include Tokyo.

Criticism of Go To Travel escalated in the second half of October, as daily case numbers began to rise again. By mid-November, hospitals in a number of prefectures were struggling to cope with the latest wave. On several occasions, beginning November 20, the Subcommittee on Novel Coronavirus Disease Control urged the government to rethink the travel program. But Suga was still unwilling to suspend the policy, though he went as far as excluding the cities of Sapporo and Osaka.

An opinion poll conducted on December 12 by the daily Mainichi Shimbun indicated that public support for the Suga cabinet had sunk to 40%, while disapproval had risen to 49%. A full 67% of respondents were of the view that Go To Travel should be shut down. The prime minister finally succumbed to public pressure and terminated the program entirely on December 28.

On December 31, Tokyo reported more than 1,300 new cases, and the surge showed no signs of subsiding. On January 2, Tokyo Governor Koike Yuriko, backed by the governors of neighboring Kanagawa, Saitama, and Chiba Prefectures, appealed to the central government to declare a state of emergency. On January 7, Suga responded by declaring a second state of emergency for the four jurisdictions, and on January 13, he extended the emergency to seven other prefectures, including Osaka, Kyoto, and Hyōgo.

Before long, the number of new cases outside the Tokyo area subsided, easing pressure on regional healthcare systems. Suga lifted the state of emergency for Osaka, Aichi, and four other prefectures on February 28, a week before it was set to expire. In the capital area, however, hospital capacity was still badly strained. On March 2, the news media reported that the governors of Tokyo and the three neighboring prefectures were considering submitting a joint request for another extension. The following day, March 3, Suga indicated that he would extend the state of emergency.

Meanwhile, on February 3, the Diet passed a revised Pandemic Special Measures Act and other legislation making it possible for governors to order businesses to curtail their hours or close temporarily and to impose penalties for noncompliance.

Ungovernable Governors

One of the distinguishing features of Japan’s policy response to the COVID-19 crisis has been the frequent inability of the central government—first under Abe and then under Suga—to implement its policies as it envisioned owing to constraints on the prime minister’s authority because of the “federal” system. One major constraining factor, mentioned above, is the tense and ambiguous power relationship between central and local government.

When Prime Minister Abe imposed the first state of emergency in April 2020, it was for the purpose of implementing stricter social-distancing and other measures to contain the virus. The revised edition of the Basic Policies adopted on April 7 called for steps to “reduce the contact among people by 70% at minimum or 80% ideally.” The government’s original plan was to have the governors call on residents to stay at home whenever possible for a period of two weeks, at the end of which period the experts would reassess the situation and decide whether it was necessary to ask businesses to suspend or curtail their operations. In the event, the governors set their own agenda.

From the start, Tokyo Governor Koike had wanted to move quickly to request business closures and shorten the business hours of dining and drinking establishments, but the prime minister preferred a more modest approach. Koike wrangled with the government and then, on April 10, announced a long list of closures and shortened hours that differed only minimally from her original plan. The other prefectures quickly followed Tokyo’s lead.

Such an outcome should not be surprising. After all, it is the governors who are legally empowered to adopt and implement measures to prevent and contain the spread of infectious disease.

Abe again found his leadership thwarted during the surge that began in June 2020.

Since March, experts had been warning about clusters of cases originating at nightclubs and bars where customers are entertained by hosts or hostesses. In early June, the Shinjuku ward in Tokyo had begun a program of targeted testing of employees and customers in the Kabukichō nightlife district with the cooperation of the local business association, and the Toshima ward had followed suit. In early July, Nishimura Yasutoshi, state minister in charge of the pandemic response, announced a plan to deploy the same sort of targeted large scale testing nationwide. But in most locales, the initiative fizzled and we can only find some instances of large scale testing carried out by health stations in large cities under the supervision of city and ward mayors. Under the law, in major urban areas, only city and ward mayors have authorities to conduct such testing, relying on local public health centers. Without cooperation from city and ward mayors, there is little the central government can accomplish testing on a nationwide scale including large cities.

The Prime Minister’s Feeble Pandemic Powers

Prime Minister Suga encountered similar resistance from the Tokyo Metropolitan Government in November 2020. With case numbers mounting in the capital area, Suga called on Governor Koike to reinstate the metropolitan government’s earlier request to curtail the business hours to restaurants and bars. At first, Koike demurred. Eventually she compromised by asking such businesses to close by 10 pm, beginning November 28. In December, as new cases continued to rise in Tokyo, Suga urged the metropolitan government to move the requested closing time up to 8 pm, but to no avail.

It can certainly be argued that Suga’s demands were inconsistent with his own unflagging support for the Go To Travel program, which was not halted until December 28. But these episodes symbolizes the fact that the central government currently has no way of directly implementing nationwide policies to control a pandemic, a quandary illustrated by the foregoing examples.

Since the 1990s, Japan has implemented numerous political and administrative reforms aimed at strengthening the executive powers of the prime minister. It has revamped the electoral system, streamlined the administrative apparatus, reformed the civil service system, and beefed up the policy-making functions of the Cabinet Secretariat and the Prime Minister’s Office. However, an examination of the political processes surrounding the government response to the COVID-19 pandemic reveal that the prime minister’s ability to lead the nation through such a crisis is crippled by the flawed distribution of authority among different levels of government, including municipalities. This should be the next target of government reform.

(Originally published in Japanese. Banner photo: Digital signage at JR Shinagawa Station in Tokyo displays the change in the number of people passing through the station compared with January 2020. © Jiji.)

LDP Suga Yoshihide coronavirus COVID-19 pandemic