On May 28, 2020, Dr. Kazuto Suzuki, Vice Dean and Professor of International Politics at Public Policy School of Hokkaido University, discussed Japan’s unique approach to managing Covid-19. Its pragmatic strategy is driven by the desire to wage a long-term, sustainable battle against the virus. Cultural norms and public cooperation have also helped to reduce the virus’ spread.

“Hammer and Dance” Strategy
Japan’s strategy does not aim to eliminate the virus but to distribute its spread over a longer period of time, creating a sustainable balance between public health and the economy. The switch from the “hammer” to the “dance” phase (and back if necessary) is not determined by a specific threshold of new cases but by the overall trend and rate of transmission (R0). The “hammer” refers to the imposition of draconian measures when there is an exponential increase in new cases, whereas the “dance” refers to the use of containment measures to mitigate the spread of Covid-19. The two main elements of the dance are:

• A cluster-based approach: This approach is based on the hypothesis that not all infected individuals pose the same transmission risk. Relying on data collected from Wuhan, China and the Diamond Princess cruise ship outbreak, Japanese epidemiologists determined that only 20 percent of all infected individuals pose a high transmission risk — giving rise to “clusters.” Resources (contact tracing and testing) are allocated to prioritize the risk posed by such clusters.
• The three Cs: Japan recommended citizens avoid the “three Cs” — closed spaces with poor ventilation, crowded places with many people nearby, and close-contact settings such as close-range conversations. The Three Cs approach did not include social distancing measures, allowing some high-risk activities to continue unaffected, such as shopping and office working.

Insight: Coming out of a months-long “hammer” phase, Hawaii could seek to prolong the next “dance” phase of containment without shutting down business or social life, instead raising awareness of the Three Cs. It could re-impose lockdown measures based on the overall trend and rate of transmission.

Limited resources guiding testing and tracing regimes

• Testing as a strategic tool: The role of testing has been limited due to low supplies of testing kits and concerns over the accuracy of results (false positives and negatives). Japan uses testing to achieve three main purposes: understanding trends of infections, identifying cases with high transmissibility to isolate them, and protecting healthcare workers.
• Analog Contact Tracing: Local health centers in each community have been integral in conducting research and contact tracing by phone. With limited cases this has been a manageable model, but potentially bigger outbreaks (like the late-March wave in Hokkaido) have made clear that this approach is not sustainable. Mobile tracing apps similar to the Apple and Google models that put a premium on user privacy are being developed.

Insight: Hawaii has mostly used testing as a strategic tool thus far and can continue to do so. It could also collaborate with regional countries like Japan as they develop their contact tracing apps.

Role of culture and social stigma
Dr. Suzuki highlighted the advantages of certain social norms in Japan that support compliance with public health measures such as good hygiene and high scientific literacy. In addition to low-contact gestures such as bowing, face coverings are widely used in Japan. Dr. Suzuki noted that Japanese don’t want to be personally responsible for spreading the virus. The high value placed upon family and community guides everyday decisions to protect the health of others, even in the absence of legislation.

Insight: Aloha is traditionally characterized by high-contact gestures such as lei giving, hugs, and honi. Redefining aloha in action for the “new normal” can promote the continuation of healthy practices even after emergency orders are terminated.

This document was prepared by Eugenio Benincasa, Ariel Stenek, and Keoni Williams. For more information, please contact Dr. Crystal Pryor ([email protected]), Director of Nonproliferation, Technology, and Fellowships at Pacific Forum. These preliminary findings provide a general summary of the discussion. This is not a consensus document. The views expressed are those of the HIF chair and do not necessarily reflect the views of all participants. The speaker has approved this summation of their presentation.