Abstract
The global spread of coronavirus disease 2019 (COVID-19) poses a threat to human life. Many national governments ordered mandatory lockdowns, whereas the Japanese government requested the citizens to stay home and restrain business activities without mandatory enforcement. Additionally, fewer polymerase chain reaction tests have been conducted in Japan compared with those in other countries. 1 Intellectuals severely criticised the government policies for ambiguity, inconsistency and lack of concreteness. Nonetheless, most Japanese citizens have obediently accepted the policies and some have started contriving various grassroots countermeasures on their own. So far, the small number of COVID-19-related deaths in Japan has been regarded as a curious phenomenon. 2 Several possible explanations exist for this phenomenon, including hygiene habits; a traditional culture maintaining sufficient distance; devoted critical care medicine; and some genetic immunological aspects. Besides these points, I believe that particular demotic attitudes toward the dissemination of COVID-19 are essential associated factors. The attitudes are based on Japanese demotic traits, which have been chronologically changed up to date. Herein, I elucidate the vicissitudes in Japanese demotic traits from a historical perspective.
Vicissitudes of demotic traits
In the 16th century of the Age of Exploration, Japanese society dramatically changed owing to two significant historical events: the introduction of Christianity by missionaries from Europe and the introduction of firearms by Portuguese merchants. The Christian doctrine of equality before God was a novel concept for the Japanese, which justified a demotic identity and a power shift. Surprisingly, the Japanese analysed the structure of the gun and managed to mass produce firearms barely two years later. With the novel concept and tactical innovation supported by the new strong weapons, many Japanese fought as samurai for diverse reasons including defiance against unreasonable rule or fulfilling personal ambitions. Moreover, merchants actively conducted overseas trade with Portuguese, Spanish and Chinese traders. Of note, a Portuguese missionary compared Sakai, the autonomous city ruled by Japanese merchants, to the longstanding Italian city-state, Republic of Venice (697–1797), in the report ‘Cartas do Japão’. 3
The formation of the Japanese identity became rapidly attenuated at the beginning of the 17th century. Through the civil war, the new ruler of Japan, who had conquered other lords, brought the country under a unified rule. Peace ensued, and the defeated samurai, guns, Christianity and international trade exchanges were regarded as potential threats to the political legitimacy of the ruler. Defeated samurai were killed, lost their status or were exiled from Japan. Guns owned by the general populace were confiscated. Christianity and international trade exchange were strictly prohibited. Among Europeans, only Dutch merchants who did not proselytise Christianity were permitted to engage in limited trade under strict bureaucratic supervision. From a contemporary sense of values, these policies appear feudalistic and exclusive. However, ironically, the isolation policy may have effectively prevented the influx of infectious diseases. For instance, the plague did not reach Japan during the period of the isolation policy.
During this period, social classes were fixed, with no switching of the ruling classes. The ruler established a firm social structure where the ruled class, comprising the majority of the population, sustained the small ruling class. The ruled classes mostly lived in rural communities, wherein attitudes of obedience and cooperation were demanded and may have been beneficial for increasing the productivity of group work. This system was sustained from the beginning of the 17th century to the mid-19th century. It is possible that people with strong identities were weeded out and only obedient people propagated their gene pool during this long period, which might have genetically influenced the current Japanese traits including docile adherence to ‘implicit rules’ during the COVID-19 pandemic.
Nonetheless, there is no direct evidence of the abovementioned selection during this period, although some associated findings can be identified. Silver foxes are known for their aggression and difficulty to tame; however, it was ascertained that deliberate inbreeding of the friendliest foxes made them obedient within only eight generations. A recent study identified a candidate gene, SorCS1, for the tame behaviour of foxes. 4 In human studies, genetic polymorphisms associated with anxiety about alienation and preference for social behaviour are especially frequent in the Japanese population. 5 Additionally, the 7-repeat allele of the DRD4 gene, which is related to the expression of characteristics that are unsuitable for group behaviour in an exclusive society, such as novelty seeking and attention-deficit hyperactivity disorder, is almost never identified in the Japanese population unlike in populations of other countries. 6 These findings suggest that some human interventions have resulted in genetic modifications that facilitate social conformance.
Effort of smallpox vaccination
At that time, smallpox outbreaks occasionally spread throughout Japan. Vaccination, an immunisation method that used material originally derived from cowpox, was introduced in Japan in the early 19th century. Although Japanese doctors soon realised the efficacy of vaccination, the irresolute ruler of Japan could not judge the validity of vaccination (however, a few provincial lords acknowledged the validity). Consequently, the doctors decided to disseminate the practice of vaccination throughout Japan ‘by themselves’.
Some individuals had superstitious fears that they would become cows after vaccination; for their edification, the doctors created a woodblock-printed picture, wherein a brave boy with a cow fought against the devil of smallpox (Figure 1). Some of the doctors were willing to vaccinate their own children, which assured nervous people to some extent.
The picture appealing for vaccination. To break down superstitions and inform about the usefulness of vaccination, doctors used the Nishiki-e picture, a type of Japanese multi-coloured woodblock printing. In this picture, a vaccinated brave boy and a cow, from which vaccines were originally generated, are shown fighting together against the devil of smallpox. (This picture is made available under the Creative Commons CC0 1.0 Universal Public Domain Dedication.)
A crucial concern for the doctors was the supply of cowpox strain samples (seed lymph), which were easily destroyed and needed continuous transplants from a vaccinated source to another individual within one week. A single feudal domain maintained a sufficient stock of the vaccine seed lymph, which was difficult to access for people in other areas of Japan owing to authority and sectionalism. Thus, seemingly, the nationwide dissemination of the smallpox vaccine occurred over a long period. Against this difficulty, the doctor Koan Ogata (1810–1863) and his colleagues conceived an admirable idea. They petitioned the provincial lord to let them make ‘buckups’ of the vaccine seed lymph and maintain them in other domains for emergency use. Under this pretext, the doctors managed to obtain sufficient seed lymph and distributed them throughout Japan. Consequently, many Japanese could be vaccinated in a short period. People soon recognised the excellent effect of vaccination and acknowledged the benefits of foreign technology.
Perspective
The doctors who made an effort to disseminate vaccination in 19th-century Japan may have been obedient to the ruling class. However, they managed to overcome feudalistic difficulties by their various virtues: conscience, sincerity, tolerance and discipline. In Japan, as in other countries, there are currently some people who are struggling with the COVID-19 pandemic under difficult conditions without depending on the government; these include healthcare providers, researchers and local politicians. In some regions, hospital doctors and local politicians worked together to attempt to construct a healthcare system that allocated patients with COVID-19 according to their disease severity and matched them to the functions of each hospital. Furthermore, during the summer of 2020, a resting phase of the pandemic, one prefectural governor managed to prepare a field hospital consisting entirely of intensive care units for patients with severe COVID-19. This hospital became operational in the winter of 2020. As of today, four Nobel laureates in Physiology or Medicine have made a joint statement in support of medical policies such as boosting polymerase chain reaction tests and supporting healthcare providers for the sustenance of regional medicine. Their efforts may be perceived as an expression of their virtues. In any difficult period, the final hope is the virtue of an individual.
