Written By: Shigenori Matsui

Posted On: May 12, 2021

COVID-19 vaccination drive is ramping up everywhere. It is proven that the vaccination is the most effective measure to prevent the spread of infectious virus. In order to curtail the number of infections in the population, it is vital to vaccinate large majority of the public. However, as with any vaccinations, there is a risk of possible side effects, making it impossible to prevent a small percentage of people who receive the vaccination from developing side-effects and in rare cases, even dying.  In order to encourage people to get vaccinated, it is essential to alleviate concerns for any ramifications from serious side-effects. Japan has already established the government compensation system for the possible financial ramification to be caused by side effects from the vaccination.

The Japanese Vaccination Act[1] mandates the government offer vaccinations to the population in order to prevent the occurrence and spread of infectious diseases. The vaccination is divided into two categories:

1. Routine vaccination, which needs to be offered regularly on designated dates or periods.
2. Ad hoc vaccination, which can be offered depending upon the circumstances.

However, neither option is mandatory.

Japan used to have a mandatory vaccination system in place for certain listed infectious diseases, making it criminally punishable for any violation. However, concern of possible side-effects has forced the government to give up the idea of mandating the public to get a vaccine. The major vaccination is now offered under the Vaccination Act and is merely recommended: vaccination for category A infectious disease, most important vaccination, is strongly endorsed by the government, and the public are mandated to strive to get a vaccine. But there is no legal obligation to get vaccinated and no criminal punishment for a violator. Other vaccinations, that can be administered by doctors or hospitals are treated as regular medical services, and have a separate compensation system for such voluntary vaccinations under the separate statute.^[2]

Under the government compensation system, a person who suffered injury or a family who have lost a family member due to suspected side-effects of a government endorsed vaccination, can apply for  benefits to the municipal government. The application will be forwarded to the prefectural government and eventually to the Ministry of Health, Labour and Welfare (MHLW). Here the application will be reviewed by the Injury and Disability Finding Committee, by experts. If the Committee finds that the injury or disability was caused as a result of the vaccination, the Health Minister will decide to grant benefits to the persons who applied.  No fault requirement exists. The benefit is paid regardless of the negligence of the vaccine manufactures, vaccine givers or the government. The benefits to be granted include:

• Medical expenses
• Treatment and hospitalization expenses
• Support for parents whose children under the age of 18 are disabled
• Support for persons over the age of 18 who are disabled
• Benefit for surviving family that lost a family member as a result of the vaccination
• Funeral expenses
• Support for surviving family who were depended upon deceased as a result of vaccination or
• One-time support for surviving family other than those that was depended upon the deceased as a result of vaccination

The benefit amount to be paid is stipulated. This amount differs depending on whether the disease against which vaccination is offered is classified as category A or category B, and whether the vaccination is a routine vaccination or an ad hoc vaccination.[3]

The most common type of vaccination, is the routine vaccination for category A infectious disease, and will cover all medical expenses except for those covered by the mandatory public health insurance.  Treatment and hospitalization expenses start at 35,000JPY (390CAD) per month for the initial three days of treatment, and 35,000JPY per month for initial eight days of hospitalization. Any longer treatment or hospitalization will be covered at 37,000JPY (410CAD) per month. If a child under the age of 18 is disabled, the support benefit for parents is offered at 1,581,600JPY (17,600CAD) per year for a serious disability, and 12,66,000 JPY (14,100CAD) per year for a less serious disability as pension. The support for adults who are disabled will be paid at 5,056,800JPY (56,500CAD) per year for a serious disability, 4,045,200JPY (45,200CAD) per year for a moderate disability, and 3,034,800JPY (33,900CAD) per year for less serious disability as pension. One-time benefit for surviving family who have lost a family member will be paid at 44,200,000JPY (493,901CAD). Funeral expense is also covered up to 212,000JPY (2,300CAD). If any additional care is needed, an additional care benefit could be offered at 844,300JPY (9,400CAD) per year for a serious disability or 562,900JPY (6,290CAD) per year for less serious disability.

For those persons who suffered as a result of routine vaccination for category B infectious diseases, the amount of disability benefit and surviving family benefit is somewhat lower. It is 2,809,200JPY (31,300CAD) per year for those who were seriously disabled as a result of vaccination or 2,247,600JPY (25,100CAD) per year for those who were less seriously disabled. The amount of benefit for surviving family who have lost a member as a result of a vaccination is also different: one-time 7,372,800JPY (82,300CAD) for surviving family that was not depended upon the deceased or 2,457,600JPY (27,400CAD) per year for family that was depended upon the deceased up to ten years as a pension.

Therefore, if someone dies as a result of regular, common types of government endorsed vaccinations, the surviving family can receive 44,200,000JPY. This is higher than the amount of benefit to be awarded to family that lost a family member due to a traffic accident under the mandatory traffic accident insurance system (maximum of 30,000,000JPY or 334,200CAD).

The new coronavirus infection is treated as a category A disease. As a result, the compensation system just outlined above is available for persons who were injured or disabled or for family who lost a family member as a result of vaccination.[4] Of course, this kind of promise of compensation is not sufficient to persuade everyone to get a vaccine. There is a strong distrust of government, pharma industry, and hospitals over vaccination, prompted by the sensational mass media reports over side-effects. This is why the vaccination rate among Japanese population is always so low.[5] The Japanese government was slow in making arrangements to import COVID-19 vaccination to Japan, and as a result, as of May 6, 2021, the vaccinated people are less than 3% of total population.[6]  The Japanese government will face significant hurdles in the facilitation of the COVID-19 vaccination drive.

But Canada can learn an important lesson from the Japanese experience. Currently Canada does not have a vaccination compensation system like Japan. The Canadian government announced its plan to introduce the national no-fault vaccine injury compensation program in late 2020 amid COVID-19 pandemic and rushed to facilitate the vaccination program. However, so far it has not materialized yet.[7] It is definitely an appropriate time for the Canadian government and citizens to look around the world.

Footnotes:

[1] Yobosesshuhō [Vaccination Act]].

[2] Dokuritsu gyouseihojin iyakuhin iryō kiki sougo kikohō [Independent Administrative Organization Medicine and Medical Equipment General Administration Act].

[3] Class A infectious diseases include diphtheria, whooping cough, polio, measle, rubella, Japanese encephalitis, tetanus, tuberculosis, HPV, and other infectious diseases which are “stipulated by cabinet order as diseases against which vaccinations are especially deemed required in order to prevent the occurrence of infectious disease by infection and to prevent spreading or prevent the patients from getting seriously ill or capable of getting seriously ill.” Class B infectious diseases on the other hands include influenza and others infectious diseases that are “stipulated by cabinet order as diseases against which vaccinations are deemed especially required in order to prevent the patient from getting ill or from getting seriously ill, thus contributing to the prevention of pandemic.”  Routine vaccinations need to be offered to residents by the municipal government for the prevention of class A and stipulated class B infectious diseases and are provided for by cabinet order by designating a date or a period. Ad hoc vaccinations can be offered when necessary to prevent the spread of class A and class B infectious diseases stipulated by the MHLW regulation.

[4] Ministry of Health, Labour and Welfare, Shingata corona wakuchin Q&A [Q&A for Vaccination for New Coronavirus Infection], https://www.cov19-vaccine.mhlw.go.jp/qa/0003.html.

[5] Statista, Where Most People Are Skeptical about Vaccine Safety, https://www.statista.com/chart/18435/countries-with-most-vaccination-skeptics/ .

[6] Out World in Data, Coronavirus (COVID-19) Vaccinations: Japan, https://ourworldindata.org/covid-vaccinations?country=~JPN.

[7] Terry Murray, Canada’s long road to a vaccine injury compensation program, CMAJ (Feb 22, 2021), https://www.cmaj.ca/content/193/8/E294.

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