The Final Countdown, Part 2


A safety net for the weak is a safety net for all: Influenza vaccinations for social welfare recipients

   Vaccinations against the influenza virus began in October. Normally, this responsibility falls to The Setagaya Medical Association, but this year, Matsuzawa Hospital has kindly been allowed by the Association to administer vaccinations as well. The reason is that many of the patients who regularly visit Matsuzawa Hospital are not treated anywhere else. Thus, these patients customarily pass the winter without receiving the influenza vaccine. For obvious reasons, this cannot be allowed to happen this year; should the influenza virus begin spreading amid the current COVID-19 pandemic, which currently shows no signs of abating, the public health crisis will most certainly be out of control. However, despite the urgency of the situation, it became clear even as preparations were underway to begin the vaccinations, that patients receiving social welfare support would be required to pay the cost of their inoculation because of the lack of public funding. The cost of a vaccination is \5,000 per person—a hefty sum for a patient on social welfare support. Could needy patients be expected to bear this cost? Is it reasonable to expect that they would dip into their budget for living expenses to be vaccinated?

   Not everyone is equally vulnerable to pathogens, whether we are talking about the novel coronavirus or the influenza virus. Those who are vulnerable are naturally at a higher risk of getting ill. Vaccinations for the elderly are provided entirely at government expense precisely because being elderly poses a greater health risk. But does this logic not also apply to patients with mental disabilities who are reliant on social welfare support or the disability pension?

   The life expectancy of a patient with schizophrenia is on average 20 years shorter than that of a healthy individual; ten years are claimed by a high rate of suicide while another ten years are claimed by the many physical complications that plague their life. Patients with mental disabilities are especially susceptible to influenza and coronavirus infections because they have a high rate of respiratory and cardiological complications. In addition, the fact that they are usually economically disadvantaged increases their susceptibility.

   Those of us who have the luxury of passing our time in the comfort of our own home–perhaps in the company of a beloved pet, relaxing on our sofa, preparing a delicious meal in a spacious kitchen whenever we’re hungry, using clean toilet facilities, sleeping in a cozy bed, and having our food delivered to us so that we hardly need to step outside our home—can scarcely imagine what it is like to live alone in a room no larger than a closet, without a bath or shower, and having your ability to prepare meals, even if you can do so yourself, limited to a tiny set of gas burners.

   Being affluent, or at any rate having enough money, is the difference between being able to have your food and other necessaries delivered to you as opposed to braving the crowds willy-nilly to eat at cheap restaurants or making a daily trip to the local public bath. When you don’t have money, you can’t stay at home. Yet we are told that the likelihood of disease transmission rises as the number of people we come into contact with increases. Thus, patients with mental health issues who are entirely reliant on social welfare support or the disability pension, even if they are not elderly, are extremely vulnerable to both influenza and coronavirus infections.

   Concurrent novel coronavirus and the influenza virus epidemics would pose an enormous threat to society and the medical establishment. Ever since the COVID-19 pandemic erupted this spring, many patients at Matsuzawa Hospital presenting with a fever and flu-like symptoms have been asked to receive PCR testing at the fever care section of the outpatient department. But while we have added testing for influenza, there is a distinct possibility that some cases were overlooked because the incubation period of the viruses differs. Formulating the measures to be taken in the event of a concurrent infection and tackling issues of testing accuracy in relation to the timing of the tests are taxing the resources of physicians and nurses alike. Chaos is likely to ensue despite our best efforts to deal with a concurrent epidemic, but at least influenza can be contained to some extent, thanks to the availability of an effective vaccine.

   If we all continue to take precautions against infection, we will be able to prevent an explosive epidemic of the flu. And if that is the case, would not vaccinating the needy using public funds be the most efficient decision the government could make? At present, Shinjuku is the only ward in Tokyo to have made this determination. But this is not merely an issue related to social welfare; it is a matter of protecting all of society against the spread of infection.
If needy patients on social welfare support become infected, they are likely to suffer in ways that are unimaginable by the affluent. Yet the disaster wrought by disease will not confine itself to the poor; clusters of infection thus generated will soon cross the artificial barriers of wealth to involve all of society.

   From the time of the Koizumi administration, the trickle-down effect, which holds that making the rich richer would result in the excrescences of their well-being trickling down to be sopped up by the less privileged, was screamed from the rooftops, so to speak, as though it were biblical truth. The short course of history from those times to the present has demonstrated the falsity of this notion. Nevertheless, the same economic policies are still in place, and fault lines are beginning to emerge in a nation which until recently was notable in the developed world for being affluent, yet having a small disparity in wealth among its citizens.

   We need to realize that the unedifying spectacle of widespread chaos in American society occasioned by the presidential election is a harbinger of Japan’s own future. Instead of a society where the poor are dependent on the charity of the rich, I believe a society that allows the poor to contribute according to their own abilities and thereby to live without loss of dignity is far better.

   Some people claim that such a society is likely to have poor economic efficiency. Yet the example of the Nordic nations today clearly reveals the error of this criticism. Article 25 of our Constitution states that all citizens have a right to lead a “minimally cultural life” and that the government of Japan has a duty to provide the assistance necessary to achieving this end. Government funding of vaccinations for people on social welfare support is not charity; it is the right of all those who live in this land.