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Thursday, Jan. 12, 2012
Governor sidesteps foot-dragging ministry on safer immunizations
For nearly 22 years, Yuji Kuroiwa was one of Fuji Television's best-known anchors. Today, the 57-year-old is recognized as Kanagawa's rebellious governor who went ahead and introduced the inactivated polio vaccine to its citizens before the planned approval by the central government later this year.
"This is the first step in changing the medical system in Japan," he said in a recent interview with The Japan Times.
Unlike many industrialized countries that use the inactivated polio vaccine because the alive-attenuated vaccine presents a higher risk of paralytic poliomyelitis, the latter is still common in Japan.
Although the possibility of contracting the disease from oral vaccinations is rare — 1.4 per 1 million children, according to the health ministry — the public has called on the government to approve and introduce the inactivated vaccine, internationally regarded as having even fewer risks.
Kuroiwa received widespread support for his October announcement that the prefectural government would import the inactivated polio vaccine, which began in December. The backing was especially strong by parents, who were eager to have their infants protected from vaccine-preventable diseases.
The move, however, was not welcomed by the health ministry. It said the prefecture's new direction prompted parents in other prefectures to avoid having their babies immunized with the oral polio vaccine for fear of side effects.
Health minister Yoko Komiyama expressed concern over Kuroiwa's decision in October, saying "immunization with vaccines that haven't been licensed has no compensation program. It's not desirable from the perspective of vaccine administration."
But Kuroiwa took a political gamble to start using the inactivated polio vaccine regardless of the criticism.
"I'm not saying oral polio vaccinations are dangerous," Kuroiwa said in the interview. "But a safer vaccine is already developed overseas, so it's natural to choose it."
As he promised, the prefecture imported 1,200 doses of the inactivated polio vaccine in December and began the mass-immunization of children living in Kanagawa. Despite the relatively high price, ¥24,000 for four shots, more than 1,400 children were booked as of Dec. 16.
Amid growing criticism, the health minister announced in December that approval of the inactivated polio vaccine would be speeded up so it can be used this fall instead of the originally planned March 2013.
Kuroiwa believes this is not enough.
"If the approval takes that much time, they should at least import the inactivated polio vaccine until autumn," he said, adding that health minister Komiyama should show more leadership.
Kuroiwa became concerned that Japan was late in approving vaccines considered necessary and safe overseas after he joined a health ministry panel on boosting the nation's lagging vaccination standards two years ago.
When the panel discussed polio vaccines, Kuroiwa said he urged the government to consider the inactivated polio vaccine since it is both safer and commonly used overseas.
"But all I got was an indication that I should shut up because I'm not a medical expert," Kuroiwa said. He also told the panel the inactivated polio vaccine should be imported if it is not developed domestically.
However, according to Kuroiwa, panel members told him to be patient as a Japan-made vaccine would soon be approved.
"They weren't speaking from the perspectives of those who get vaccinated," Kuroiwa said.
After being elected Kanagawa governor in April, Kuroiwa was determined to push use of the inactivated polio vaccine. But the process wasn't a smooth one, he said.
"I urged prefectural officials to import the vaccine," he said. "It shouldn't be a problem because some clinics have already been importing it individually, I thought. They nodded but there was no response for a while."
After some time, Kuroiwa discussed the subject again with the prefectural officials to see if any progress had been made.
"All they told me were reasons why they couldn't do it. They said they couldn't when the central government hadn't approved it."
But then the World Health Organization confirmed in September that the WPV1 strain of polio was found in China for the first time since 1999 after the disease spread from Pakistan.
As the WHO warned about the risk of the strain spreading, the health ministry urged parents to have their children given the oral vaccine.
"I was surprised to hear that they were still recommending the oral polio vaccine." Kuroiwa said. "I told prefectural staff to immediately import the inactivated polio vaccine. This time, they understood why it's so important."
The journalist-turned-governor said his enthusiasm to improve the nation's medical system dates to 1989, when he reported on emergency medical services during his evening news broadcasts on weekends.
In those days, ambulances were not manned by paramedics, as was common in the U.S. In Japan, ambulance crews under fire departments were not allowed to administer medical treatment based on a medical law.
"At that time, I was saying if the law didn't allow firefighters to provide medical treatment in emergency cases, we should change the law," Kuroiwa said. "That's why we have a Diet."
Kuroiwa reported on the issue for two years, which eventually raised awareness of the situation among the public and lawmakers. This prompted the government in 1991 to allow those who are trained to provide emergency medical care to ride in aid cars.
"I'm not a medical expert, but what I can do is voice opinions based on patients' perspectives," he said.