Navigating Japan's COVID-19 Vaccination Challenges: A Shift in Legal Classification and the Opt-out System.

On January 20, 2023, the Japanese government announced easing the legal handling of the novel coronavirus disease 2019 (COVID-19) under its Infectious Diseases Control Act, effective May 8, 2023. While free vaccines will continue in fiscal year 2023, the future of mass vaccinations remains uncertain. The opt-out system, wherein local governments schedule vaccinations on behalf of the residents, may potentially alleviate issues associated with the currently adopted opt-in approach, such as procedural intricacies and scheduling difficulties, thereby facilitating the recovery of vaccination rates and simultaneously addressing vaccine wastage concerns. Given that COVID-19 still presents a substantial risk to specific groups, such as the elderly, recognizing the benefits of the opt-out system and the ethical and geographical challenges it poses is essential. With the collaboration of local governments and healthcare institutions, ongoing surveillance and scientific assessment are indispensable.

How can we promote vaccination of the mass population?-Lessons from the COVID-19 vaccination defaults.

While vaccines are pivotal in combating COVID-19, concerns about side effects and complex procedures have hindered complete vaccination. Prior studies suggest that individuals defaulted to opt-out exhibit higher COVID-19 vaccination rates compared to those in opt-in systems. However, these studies were conducted in countries with a tolerant attitude towards vaccination and default changes, targeting specific age groups, and did not address potential deterrents like the increase in cancellation rates on the day, discomfort towards changing defaults, or the possibility of the opt-out effect being a one-time occurrence. Under the hypothesis that the default nature of the COVID-19 vaccination system influences attitudes towards vaccination even in countries conservative about vaccination and default changes like in Japan, we aimed to examine the differences in the first and second dose vaccination rates, cancellation rates, and the number of complaints between the opt-in and opt-out systems for COVID-19 vaccination. An email survey was conducted in 10 cities in A Prefecture, Japan. The results showed not only higher COVID-19 vaccination rates across all comparable age groups in the opt-out group but also a notably smaller decrease in the second-dose vaccination rate compared to the opt-in group, all achieved without any complaints about the system's introduction. Consequently, it can be inferred that the potential inhibiting factors were largely overcome. Despite some limitations, such as regional specificity, the study suggests that opt-out systems might increase COVID-19 vaccination coverage without leading to significant cancellations or complaints, presenting a promising strategy to facilitate vaccination efforts.

Assessing Hand Sanitizer Usage in Japanese Elderly Day Care Centers: An Observational and Interventional Study.

Purpose Hand hygiene is a vital preventive measure against the novel coronavirus disease 2019 (COVID-19) infection. Though older people are at high risk of infection of COVID-19, there is still a lack of verification of hand sanitization and effective interventions to promote its implementation for older people. This study aimed to validate what kind of intervention can effectively promote hand hygiene among elderly individuals in Japanese day care centers, based on the hypothesis that a particular nudge will significantly promote hand hygiene. Methods We designed two types of interventions that have aspects of the nudge concept based on WHO Guidelines on Hand Hygiene in Health Care. The study was conducted with one-week observation and intervention periods excluding weekends, starting on February 11, 2023. Three groups were defined as follows: control (installation of hand sanitizer dispenser with a basic sign), reminder (additional visual cues using yellow curing tape), and institutional safety (sign appealing to protecting institutional safety by using hand sanitizer). Daily hand sanitizer usage was measured, and statistical analysis was performed using a one-way ANOVA for the number of uses before and after intervention. Results During the observation period, the average number of hand sanitizer pushes per person remained at 0.39 across all facilities. During the intervention period, control, reminder, and institutional safety groups showed increases of 1.13-fold, 1.31-fold, and 1.16-fold, respectively, revealing no significant difference. Conclusions Though these nudges were implemented according to WHO guidelines and the previous study, the older users of day care centers seemed not to react to these nudges significantly. The results underscore the need for tailored interventions to improve hand hygiene among the elderly in day care settings, contributing to the overall goal of preventing infectious diseases.

Preliminary Evaluation of the "Eat, Sleep, Walk" Health Literacy Development Project Using ICT and Nudges.

Health and Productivity Management has been promoted in Japan since 2014. Certification criteria for Health and Productivity Management include the improvement of employee health literacy. This report provides an overview of the "Eat, Sleep, Walk" health literacy development project using ICT+incentives+nudges developed for companies, and describes its preliminary evaluation and challenges.

Validation of the most cost-effective nudge to promote workers' regular self-weighing: a cluster randomized controlled trial.

Regular self-weighing is useful in obesity prevention. The impact of nudge-based occupational self-weighing programs in the cluster randomized controlled trial was examined. The primary outcome was regular self-weighing after 6 months, which we used to compute cost-effectiveness. Participants were Japanese local government employees who underwent 1 h workshops after being assigned to one of the three nudge groups. Each group was designed according to the nudges' Easy, Attractive, Social, Timely framework: quiz group (n = 26, attractive-type nudges), implementation intentions group (n = 25, social-type nudges), and growth mindset group (n = 25, timely type nudges). A reference group (n = 36, no nudges) was also formed. After 6 months, all three interventions were effective for regular self-weighing, with the growth mindset intervention (60.0%) being significantly more effective. The cost-effectiveness of the growth mindset group was 1.7 times and 1.3 times higher than that of the quiz group and the implementation intentions group, respectively. Findings from our study are expected to facilitate the use of nudges for health practitioners and employers, which in turn may promote obesity prevention.

Effects of an mHealth App (Kencom) With Integrated Functions for Healthy Lifestyles on Physical Activity Levels and Cardiovascular Risk Biomarkers: Observational Study of 12,602 Users.

BACKGROUND: Mobile health (mHealth) apps are considered to be potentially powerful tools for improving lifestyles and preventing cardiovascular disease (CVD), although only few have undergone large, well-designed epidemiological research. "kencom" is a novel mHealth app with integrated functions for healthy lifestyles such as monitoring daily health/step data, providing tailored health information, or facilitating physical activity through group-based game events. The app is linked to large-scale Japanese insurance claims databases and annual health check-up databases, thus comprising a large longitudinal cohort. OBJECTIVE: We aimed to assess the effects of kencom on physical activity levels and CVD risk factors such as obesity, hypertension, dyslipidemia, and diabetes mellitus in a large population in Japan. METHODS: Daily step count, annual health check-up data, and insurance claim data of the kencom users were integrated within the kencom system. Step analysis was conducted by comparing the 1-year average daily step count before and after kencom registration. In the CVD risk analysis, changes in CVD biomarkers following kencom registration were evaluated among the users grouped into the quintile according to their change in step count. RESULTS: A total of 12,602 kencom users were included for the step analysis and 5473 for the CVD risk analysis. The participants were generally healthy and their mean age was 44.1 (SD 10.2) years. The daily step count significantly increased following kencom registration by a mean of 510 steps/day (P<.001). In particular, participation in "Arukatsu" events held twice a year within the app was associated with a remarkable increase in step counts. In the CVD risk analysis, the users of the highest quintile in daily step change had, compared with those of the lowest quartile, a significant reduction in weight (-0.92 kg, P<.001), low-density lipoprotein cholesterol (-2.78 mg/dL, P=.004), hemoglobin A1c (HbA1c; -0.04%, P=.004), and increase in high-density lipoprotein cholesterol (+1.91 mg/dL, P<.001) after adjustment of confounders. CONCLUSIONS: The framework of kencom successfully integrated the Japanese health data from multiple data sources to generate a large, longitudinal data set. The use of the kencom app was significantly associated with enhanced physical activity, which might lead to weight loss and improvement in lipid profile.