The Jab: A Report from Japan’s COVID Vaccine Frontline

Giving the jab has been an eye opening experience. I am a dentist, but since July, I have regularly travelled from my home in Setagaya, Tokyo, to administer COVID-19 vaccines at a mass vaccination site in neighboring Minato. Japanese law technically only allows doctors, or nurses under the instruction of a physician, to administer vaccines, which is considered a medical procedure. However, the government has relaxed rules and enlisted other medical workers, including dentists, in an attempt to get more shots into arms. Being involved in the national vaccination drive has given me a new appreciation and understanding of the challenges of immunizing so many people at once.

Call to Arms

I volunteer at a vaccination site run at the historic Tokyo American Club. TAC has been an integral part of the capital’s diverse expat community since its founding in 1928. The club is normally only open to members, and when it was announced that it would host a vaccination clinic, local residents jumped at the rare chance to take a glimpse inside, with most of the available appointment slots filling up in quick order.

A sign points people to the vaccination site at the Tokyo American Club.

Sam Rogan, TAC’s first vice president, was the force behind the club serving as a vaccination clinic. Like other businesses in the hospitality industry, TAC has felt the financial effects of the pandemic, with many of its venues remaining empty amid a sharp downturn in events like weddings and conferences. Rogan, who spent much of his career in the semiconductor industry, says he was heartened by the development of effective COVID-19 vaccines, but was worried by Japan’s slow rate of immunization compared to the United States and countries in Europe. Wanting to lend a hand in accelerating the rollout, he reached out to the vaccination section at Minato City Hall. After working out the details, TAC agreed to offer an event hall, free of charge, as a mass-vaccination site.

Rogan sent out an email to TAC members looking for medical professionals willing to staff the clinic, which is how I came to be involved in the project. More than 150 people answered the call, and with the help of numerous TAC members and others, the vaccination center opened on July 5. Rogan has remained at the center of the effort, visiting the site daily and handling any issues that arise.

Sam Rogan (right) and vaccination center staff member Dr. Naoko Fleming

Learning the Ropes

The vaccination process is fairly simple and takes around an hour from start to finish. Individuals first fill out a screening questionnaire detailing their temperature on the day, allergies, and other pertinent medical information, and then proceed to the check-in desk. After their appointment and other details are verified, they meet with a doctor who looks over the questionnaire. If there are no issues, they are shown into a booth where they are vaccinated. After an observation period of 15 to 30 minutes to monitor for rare anaphylactic reactions, they receive a certificate verifying that they are vaccinated. If it is their first time, they can make a reservation for their second shot before going about the rest of their day.

The vaccination booths are simple affairs. There is a long table for necessities like alcohol swabs, small bandages to place over the injection site, gloves, and a trash receptacle. There is also a chair each for the person being vaccinated and the medical staff administering the shot. When starting a shift, I first check if there is a suitable stock of supplies. If everything is in order, I open the booth for business.

The author (right) conducts a pre-vaccination consultation.

Like Rogan, I watched Japan’s halting vaccine rollout with concern and worried that the country would continue to lag in getting shots into arms if it relied solely on doctors and nurses to administer doses. I was encouraged when the government announced that it was considering enlisting emergency medical technicians, pharmacists, and other healthcare workers in a bid to speed things up. Dentists were among the first group to be authorized, and when the opportunity arose to volunteer, I leapt at the chance.

There was more to it than merely signing up for a shift, though. Needles and dentistry go hand in hand, but even though I consider myself skilled with a syringe, I realized that numbing a patient’s mouth is not quite the same as giving a person a shot in their shoulder. To prepare for the task, I took a short training course on the correct method for administering intramuscular injections, as with the COVID-19 vaccines.

The author’s certificate of completion from her training course. (Courtesy of the author)

Overcoming Hesitancy

The TAC vaccination center is open to residents of Minato, and owing to the numerous embassies and foreign corporations located in the municipality, the crowd at the clinic is an international mix. Most foreigners receiving vaccinations are able to communicate in Japanese, and I only switch to Chinese or English as needed to help put individuals at ease. This has led to some spirited encounters and candid reactions from people, which has added to the enjoyment of giving the vaccine.

Japanese visiting the clinic are an equally eclectic bunch, representing every age group and social status. Some individuals stand out more than others, though, and memorable characters stepping into my booth have included celebrities, well-to-do individuals decked out in brand-name outfits, and no small number of beauty-conscious older women. There have been some challenging encounters, such as one junior-high aged boy who was less than thrilled about his parents’ insistence that he get the jab. There was also a well-built man who came in wearing an arm band that once removed revealed a colorful array of tattoos on his left shoulder. I admit that the intricate body art made me a little unsure at first as to where to insert the needle, but I overcame my hesitancy when the man kindly informed me that “anywhere will do.”

The author administers a shot.

Understandably, many people coming to the clinic are nervous about getting vaccinated. I have found that men make up a majority of this group, and they are also more likely to hide their anxiety than their needle-averse female counterparts, who tend to be upfront about not liking injections. If a person tenses up right as I am about to administer a shot, I hold off and engage in small talk to help take their mind off the matter at hand, then move in quickly to give the shot once they have relaxed. It is not uncommon for people to faint or feel ill directly after being vaccinated, but this is the result of nerves rather than an adverse reaction to the vaccine.

Admittedly, getting a shot is seldom a fun experience. However, I have been impressed at the determination of people to overcome their hesitancy. Like those of us giving the shots, people seem to want to do their part to beat the pandemic by protecting themselves and those around them from the coronavirus.

People at the clinic wait to be vaccinated.

Staff Diversity

Behind the scenes, a team made up mostly of nurses and pharmacists work hard to prepare the vaccines. This involves taking vials of the Moderna vaccine from the freezer and transferring the content to syringes. Each vial contains enough for 10 doses of 0.5 milliliters each, but it takes skill and concentration to get the amount right so that none of the vaccine goes to waste. Other challenges include coaxing the last dose from bottles without inadvertently introducing air bubbles, which must be diligently expelled from the syringe, slowing down the process.

Staff prepare vaccines at the clinic.

The staff at the clinic are an impressively diverse bunch of professionals from around Japan. There are nurses from Japan’s Self-Defense Force (they are easily recognized by their camouflage scrubs), a paramedic volunteering from distant Kagoshima Prefecture, a nurse who has returned to work after 10 years off, doctors from as far away as Kyoto and Sendai, a freelance pharmacist, and dentists like me. Everyone plays a different role in the vaccination process depending on their profession and skills, but we are all bound by the same goal of putting the pandemic in the rearview mirror. If anything, the project has given me a new appreciation of the unflagging commitment of healthcare workers in the struggle against COVID-19.

The clinic offers reservations for 1,600 people a day and most slots fill quickly. With such a steady flow of people, staff are kept busy preparing syringes and administering shots. The Moderna vaccine must be kept at subfreezing temperatures, and once it is thawed and prepared for injection it has a shelf life of only six hours. When the inevitable cancellation or no-show occurs, Rogan quicky reaches out to TAC members and others in the community so that every dose gets used.

A vial containing the Moderna COVID-19 vaccine. (Photo courtesy of the author)

Troubleshooting

There is no denying that Japan could have followed the lead of other developed countries and taken steps earlier to speed up its vaccine rollout. The United States, for instance, has made vaccines widely available, including at places frequented by the public like supermarkets and pharmacies, and enlisted the likes of medical students and even veterinarians to get more shots into arms quicker. As of August 14, around 60% of US residents had received at least their first dose, one of the highest rates in the world, compared to 49% of Japanese residents.

In my native Taiwan, the government started its vaccination program in March, but progress creeped along at a snail’s pace, largely because other preventative measures were keeping coronavirus transmissions in check. Less than 1% of the population was vaccinated when in May an outbreak of COVID-19 forced authorities to quickly shift gears. With the help of countries like Japan, which was the first nation to donate vaccines, the government since June has ramped up immunizations. Taiwan already has a national ID number system in place that has aided in the administration of the program and made it easier to track progress. A reservation app was also developed that enables residents to book and manage appointment with ease. As of August 14, around 38% of residents have received at least one dose, and if Taiwan can maintain its current rate, it will surpass Japan before long.

The author’s ID card for the vaccination clinic identifying her as a dentist. (Photo courtesy of the author)

Japan, for its part, has boosted its flagging vaccination rate since June by increasing the number of large-scale vaccination clinics, like the one at TAC. However, there is still room for improvement, particularly with the allocation of human resources. For instance, I was struck by the number of doctors and nurses at the site coming from far outside the Tokyo metropolitan area. This puts an extra burden on medical professionals, whose skills are presumably in equal demand at home. Authorities need to improve the efficiency of the current dispatch system rather than staffing on a site-by-site basis, as is often the case now.

One improvement would be to bolster coordination among government agencies, municipalities, healthcare workers, and the various professional associations so that when people step forward their skills can be quickly and effectively put to use. Staffing agencies can also play a greater role in recruiting doctors and dentists who do not belong to the Japan Medical Association or Japan Dental Association, a situation that limits their access to information on contributing to the vaccination effort.

I typically vaccinate around 200 individuals during a shift at the TAC clinic. I feel proud to play a small part in the ongoing struggle to bring the pandemic under control. However, I would like to see dentists play a greater role in delivering shots. It has been over a year and a half since COVID-19 emerged, and even as new challenges arise, I am certain that through the earnest and steady efforts of authorities and medical professionals we can speed up vaccinations even further and get closer to reaching the goal of a society free of the constant fear of the coronavirus.

(Originally published in Japanese. Banner photo: The author at the vaccination clinic at the Tokyo American Club. All photos courtesy of Sam Rogan, unless otherwise noted.)