TOKYO -- Japanese localities have begun a scramble to secure medical personal to carry out a mass vaccination campaign against the coronavirus slated to start next week, with estimates predicting that 11,000 physicians are needed per day nationwide.
The health ministry is expected to approve Pfizer's vaccine on Sunday, which will pave the way for the inoculations to start as soon as Wednesday. Between 10,000 to 20,000 health care professionals will be given priority.
The vaccinations will be expanded in April to those aged 65 and older. Pfizer's vaccines are given in two doses three weeks apart, and the two-step vaccination of the elderly is due to be completed in a span of 12 weeks.
Those aged 65 and older number 35.3 million, according to resident registry data as of Jan. 1. If vaccinations take place five days a week, that would equate to more than 1.56 million shots a day.
Under the Ministry of Health, Labor and Welfare's model, two doctors and five nurses would vaccinate 280 people. Using simple math, that would mean the inoculation program will require roughly 11,000 physicians per day, who will be teamed with 28,000 nurses and nurse's assistants.
Since Japan has over 300,000 doctors, 11,000 seems like a low bar to clear at first glance. But the central government is slow in providing vaccination schedules to local authorities, which has caused delays in preparations at the local level.
Local governments have started putting out calls for doctors to take part in the vaccination programs through medical associations. Doctors and nurses who participate would need to take a leave of absent from their regular workplaces.
Since local governments do not have the authority to formally request doctors to cooperate, officials have no choice but to rely on the discretion of medical societies and the physicians themselves.
In Sagamihara, a city just west of Tokyo, there has been no forethought at all on how many doctors and nurses will be recruited, according to a source from the disease control bureau. This is due to the uncertainties in the volume and delivery dates of the vaccines to the city.
Yokohama plans to set up at vaccination centers in at least two venues in each of the city's 18 wards. Officials are currently talking to the city's medical association, but a specific number of doctors who will participate has not been settled.
People can receive vaccines separately at clinics rather than at vaccination centers. Some places, such as Tokyo's Nerima ward, plan to vaccinate citizens mainly through this route.
This approach will eliminate the need for people to arrive at venues and will ease the burden on doctors. At the same time, it would require a larger number of doctors to administer the vaccines within the intended time frame.
Osaka's vaccination model has a team of one doctor and one nurse administering 32 shots a day. That would mean the prefecture's vaccination scheme would need a total of 49,000 physicians paired with 49,000 nurses and nurse's assistants. The headcount equates to 47% of doctors working at the city's clinics, along with 19% of the nurses and nurse's assistants.
"Doctors will become unable to perform normal medical care for a long period of time," said Kazunori Oishi, head of the Toyama Institute of Health.
"It will be difficult to get the cooperation of medical associations if the plan is to just allow mass vaccinations," Oishi added, arguing administering the shots at individual clinics under set schedules should be an option.
Who is qualified to give vaccinations has been subject to debate. Japan limits vaccine administration to doctors and nurses, but the U.S. and the U.K. has expanded the list of those eligible to do so.
In the U.S., pharmacists can be trained and certified to administer vaccines. The U.S. Department of Health allows doctors and nurses with certifications expired within the past five years to continue administering vaccines.
The U.K. has tapped volunteers to administer shots, even those who have had no medical experience. The charitable organization St John Ambulance is training 30,000 people for the job, including those with just a high-school education. This type of approach is not being considered in Japan.
Fujita Health University Hospital in Aichi Prefecture held a mass vaccination training session Friday at a university gymnasium. The training confirmed that seven health care professionals can vaccinate 50 people in an hour, exceeding the rate of 40 people anticipated by the health ministry.
Having pre-vaccination paperwork filled out beforehand saves time while assistants can help interview arrivals. Fujita hospital will share its findings with other hospitals and with government officials.