As Tokyo Olympics near, why has Japan been so slow to vaccinate its citizens?

Japan is known around the world for its efficiency and organization, a place where the trains, famously, are always running on time.

But in its rollout of COVID-19 vaccines, the country has lagged well behind its peers.

With the 2021 Tokyo Olympics now just 48 days away, Japan still ranks last in vaccination rate among the 38 countries in the Organization for Economic Cooperation and Development, according to online research site Our World in Data. Roughly 8.7% of its 126 million residents had received at least one shot as of Thursday. Only 3% of the Japanese public – mostly health-care workers and the elderly – is fully vaccinated.

Though the Japanese government has dramatically ramped up its vaccine distribution efforts over the past week, its sluggish rollout has led to concerns among the Japanese public about whether the Olympics can be held safely beginning on July 23.

It's also prompted a significant question: Why has a country famous for its efficiency been so inefficient in getting shots in arms?

"A lot of it has to do with the government’s slow response," said Michael R. Reich, a professor of international health policy at the Harvard T.H. Chan School of Public Health. "And the government’s thinking that Japan had solved the pandemic problem with its earlier policies."

Japan did not begin inoculating its residents until mid-February, roughly two months after the first vaccines were approved and distributed in the United States and other major countries. The delay stemmed in part from Japan's desire to conduct clinical trials with the Pfizer-BioNTech vaccine on its own soil, rather than accept international data.

"Even though we are in a state of crisis, we're still using the same rules to approve vaccines that we do under normal times," Taro Kono, who is overseeing Japan's vaccination efforts, lamented in a television interview last month, according to Reuters.

"In the wake of this corona situation, the administration needs to change."

Shihoko Goto, a senior Northeast Asia associate at the Woodrow Wilson Center's Asia Program, said she believes that Japan didn't rush to approve a vaccine this winter in part because it had largely been able to keep COVID-19 under control.

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Roughly 3,500 people in Japan had died due to COVID-19 as of Jan. 1 – a significant number, but only a fraction of the deaths seen in countries like the United States.

"The sense of urgency and the sense of horror that struck (the U.S.), that didn’t really materialize as much in a country like Japan," Goto said.

Several experts have also pointed to a history of vaccine hesitancy among the Japanese people as a reason for the sluggish vaccine rollout. Since the 1970s, dozens of Japanese families have filed highly-publicized lawsuits over side effects of vaccines. The Japanese government stopped mandating vaccines in 1994 and, more recently, withdrew its recommendation for the HPV vaccine after alleged side effects generated significant media attention in 2013.

Reich, however, said the notion of the Japanese people as "vaccine hesitant" is a gross oversimplification.

In an academic paper on the subject that is scheduled to publish next month, he and co-author Andrew Gordon explain that Japan's acceptance of vaccines has ebbed and flowed over time, as it has in other countries. They also note that, for routine recommended vaccines, Japan has one of the highest rates of use in the world.

"Looking at Japan’s response to COVID-19," said Reich, who has studied health policy issues in Japan for four decades, "it seems that the government is more hesitant towards the vaccine than the people are."

As the Olympics approach, Japan's vaccine push has intensified. The country had distributed about 11.7 million doses of vaccine as of Thursday, according to Our World in Data – including a whopping 2.8 million in the past seven days alone. Its stated goal is to inoculate medical workers and those older than 65 by the end of July, though that would still leave a majority of the Japanese public unprotected when the Olympics start.

Reich said it almost feels like we will witness two separate competitions this summer – the Olympics, and Japan's race to vaccinate its people and fend off COVID-19.

"It’s sad both for Japan and for the world," Reich said, "that this wasn’t handled more effectively."

Contributing: The Associated Press

Contact Tom Schad at tschad@usatoday.com or on Twitter @Tom_Schad.

This article originally appeared on USA TODAY: 2021 Olympics: Why has Japan struggled to vaccinate its citizens?