NIRA OPINION PAPER
No.56 | January 2021

NIRA OPINION PAPER
No.56 | January 2021

The Pandemic Policy Dilemma in Japan: Stopping
COVID’s Spread or Mitigating its Economic Impact
Toshihiro Okubo
Professor, Faculty of Economics, Keio University
Senior Adjunct Fellow, Nippon Institute for Research Advancement (NIRA)
In January 2021, as COVID-19 infections surged in Japan and the country’s
medical infrastructure began to creak under the strain of the increasing load, thegovernment declared a state of emergency. This paper, based on responses to the “Third
Questionnaire Surveys on the Effects of the Spread of COVID-19 on Telework-based
Work Styles, Lifestyle, and Awareness,” ＊ investigates the feelings of the Japanesepeople on the pandemic and their government’s response to it, at this critical juncture,emphasizing three main points.
The first point is that while feelings of fear towards the virus directly correlatewith a desire for the prioritization of measures to limit the spread of infection, factors
such as a person’s income and employment status heavily impact their policy
preferences. Particularly salient is the impact on beliefs about whether the government
should prioritize measures to mitigate economic damage over the aforementioned
measures to prevent the spread of infection. Among survey participants, a larger
percentage consistently supported prioritizing economic measures over limiting the
spread of infection (although as will be shown later, neither option gained even aplurality.) Paradoxically however, even within the face-to-face service industries suchas foodservice and hospitality, where the pandemic has dealt a particularly disastrous
blow to incomes and livelihoods, there is a desire for stronger measures to halt the
spread of infection even if it comes at the cost of the economy. Perhaps, against the
backdrop of what employees in face-to-face service sectors perceive to be the limits ofmitigatory economic measures, the fear of contracting COVID-19 through face-to-faceinteractions has become paramount, prompting workers in these industries to be
increasingly inclined to support more decisive and thorough measures to combat the
spread of the virus.
The second point is that a key piece of achieving a coherent policy to stop the
spread of COVID-19 is the government’s provision of clear, consistent and timely
information on the pandemic in a way that is empathetic and resonates emotionallywith the public. Amongst these efforts, the continued promotion of telework isparamount. The government should push Japanese society to further embrace telework,
as it is among the most effective means of keeping the economy moving whilestrengthening measures to prevent the spread of disease.
The third and final point this paper highlights is the intense toll that the
pandemic has taken on the Japanese public’s mental health, with a sizeable increasein rates of suicide and mental illness being seen throughout the country. The situation
is particularly severe amidst those under 40, and there is an urgent need to mobilize
all resources available, including SNS, to proactively reach out to those in need ofmental health care and suicide prevention.

The survey was conducted in December 2020 by Keio University and the Nippon Institute for Research
Advancement (NIRA).
＊

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
1
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Introduction**
In combatting COVID-19 (or indeed any new, rapidly spreading infectious disease)one of the central questions has been whether to prioritize measures to prevent or slow the
spread of disease or to focus on measures aimed at alleviating the economic fallout caused byit. Japan’s COVID-19 policy has continually wavered between these two important priorities.
Those who favor prioritizing the economy, emphasize the economic damage thepandemic has wrought, and the ways in which it has left many of Japan’s citizens uniquelyvulnerable. They point out how Japan’s social safety net, designed in an era of regular
employment and high-speed growth, is inadequate, failing to adequately protect the large
number of irregular workers, who now comprise roughly 40% of the labor force. They highlightthat if economic activity is curtailed, it is those without savings such as young people andworking families, and those with unstable employment who will be forced to bear the bruntof the economic burden and risk falling into poverty. They charge that without putting the
economy first, Japan risks widening the income gap between the “haves” and the “have nots,”
inciting a mental health crisis that will see suicides increase, while exacerbating social
tensions that could lead to social unrest.
The opposing viewpoint is that prioritizing measures to prevent the spread of COVID19 (that is infection control measures) does not equate to forgoing measures to mitigate theeconomic impact, noting that the two policies are not mutually exclusive. Proponents of thisview highlight how some countries, such as China and Taiwan succeeded in taking aggressive
measures to contain COVID-19, and in doing so managed to stabilize their economies, with
China and Taiwan being the only major economies to post a positive GDP growth rate in 2020.
However, Japan’s political structure, legal system, and population size preclude the use ofmany of the more extreme measures imposed in both populous, authoritarian China, as well
as democratic but relatively small Taiwan. In addition, there is no guarantee that themeasures undertaken by those countries will continue to be effective in the face of current
and future variants of COVID-19. While some countries, such as Sweden, have tried to combat
the virus by forgoing lockdowns in favor of targeted measures to contain the virus’s spread,the sobering reality is that many of those countries are now struggling with a sharp increasein the number of infected people and deaths. Looking at the debate overseas, just as in Japan
there is little agreement even among experts about whether to prioritize mitigating COVID19’s economic impact or controlling the spread of infections in constructing an effective
pandemic policy.
In January 2021, a state of emergency was declared in more than 10 prefectures inJapan, but there was not a lockdown, and there have been no restrictions on rights or
penalties for noncompliance with government ordinances. Although requests have been madeto the restaurant industry to reduce working hours and to the public to refrain from going out,

The questionnaire survey and data analysis were conducted by Toshihiro Okubo, Kiwamu Kato, Senior
Architect for Future Corporation, and Atsushi Inoue, Kozue Sekijima, and Hironari Masuhara of NIRA.
**

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
2This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

it is far from certain that these measures will be sufficient to control the spread of infections
going forward. In light of this challenge, it is necessary to better understand how individuals
feel about the COVID-19 pandemic, the government’s response to it, and how they have or
have not adjusted their own behavior in response. In response to this need, The Nippon
Institute for Research Advancement (NIRA) and Toshihiro Okubo (Keio University) carriedout the “Third Questionnaire Surveys on the Effects of the Spread of COVID-19 on Teleworkbased Work Styles, Lifestyle, and Awareness” as part of an ongoing joint research project
between the two. The results of the survey, presented in this paper, shed light on the Japanesepublic’s feelings about the pandemic, bringing into sharp relief many details previously
obscured.1

Trends in the Telework Rate: Significant Differences in Telework Adoption byIndustry
Both in Japan and around the world, the emergence of the pandemic has led to apreviously unfathomable increase in the popularity and adoption of telework. This surge in
popularity is largely because by enabling people to continue working while reducing direct
human contact, telework can sustain economic activity while reigning in the spread of
COVID-19. Looking at the data, it is clear that, although the number of those commuting towork has crept back up following the end of Japan’s first state of emergency at the end of May
2020, both companies and individuals are continuing to experiment to find the best balanceof telework and time in the office.
Figure 1 shows the change in the telework rate. 2 In January 2020, before thewidespread emergence of COVID-19, the national average was about 6%, and the average for
the Greater Tokyo Metropolitan Area (Tokyo, Kanagawa, Chiba and Saitama Prefectures)
was about 10%. Following the Declaration of a State of Emergency from April to May 2020,
the telework rate increased significantly, reaching 25% nationally, and 38% in the Greater
Tokyo Metropolitan Area. From June 2020, after the Declaration of a State of Emergency waslifted, the telework rate declined significantly. Nonetheless, although the rate has remained
lower than that seen during the first Declaration of a State of Emergency, it has remained
significantly higher than pre pandemic levels, and seems to have stabilized with the second
wave of the COVID-19 pandemic that began in September 2020, and even more so with thethird wave that began in December 2020. Throughout this period the telework rate has
hovered between 16% to 17% nationally and 26% to 29% in the Greater Tokyo Metropolitan
Area.

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
3This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Figure 1 Trends in the Telework Rate in 2020

Figure 2 shows changes in the telework rate by major industries. There are still
significant disparities in the telework rate by industry, and there is a particularly large gap
between those industries most suitable for telework and those that are less so. For example,
the information and telecommunications industry has seen consistently high rates of telework
utilization, while the restaurant, accommodation, medical and welfare industries have seen
consistently lower utilization of telework. This trend has not changed over time.3

Figure 2 Trends in the Telework Rate by Major Industry in 2020

Figure 3 tracks changes in the frequency of telework use amongst those within the
Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
4This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Greater Tokyo Metropolitan Area. Since June 2020, the average number of days spentteleworking has been decreasing, with the percentage of those who spent 5 days per week ormore teleworking decreasing, and the number of those who spent 1 day per week or lessteleworking increasing. This change, which has seen the number of days spent in the officegradually trending upward since June, suggests that both employers and employees aresearching for the best mix of remote and in person work. Although telework has its
advantages, there are still many jobs that cannot be done remotely, and it is clear that theworkforce has been in a state of adjustment since June.4

Figure 3 Frequency of Telework Use by Telework Users in the Greater Tokyo
Metropolitan Area

The Effects of Pandemic Economic Countermeasures on the Continuing
Decline of Incomes in the Restaurant and Lodging Industry
Figure 4 tracks the change in income within major industries between the “First
Questionnaire Surveys on the Effects of the Spread of COVID-19 on Telework-based Work
Styles, Lifestyle, and Awareness,” and the “Third Questionnaire Surveys on the Effects of the
Spread of COVID-19 on Telework-based Work Styles, Lifestyle, and Awareness,” upon which
this paper is based. It shows the ratio of workers in each industry who experienced a change
in income. The worker survey tracks individual samples over time, and it can thus be used tosee the change in income of a single worker over the survey period. The survey asked
respondents to indicate whether their income had increased, decreased, or remained the sameas at the time of the previous survey.
Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
5This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Excluding the restaurant and accommodation industry, approximately half of the
respondents answered “No change in income” within the January to March, March to June,
and June to December periods of 2020. On the other hand, slightly little less than half of the
respondents answered that their income had declined at some point within the January to
December 2020 timeframe. For example, the percentage of those who answered that there
was no change in their income from January to March 2020 but a decrease from March toJune 2020 was relatively high, ranging from 10 to 18% depending on the industry.
Furthermore, 6% to 27% of respondents indicated that their income continually declined fromits figure during the first survey (January to March) through December 2020. Given that halfof the respondents did not see any decline in income despite working in the same industries,
however, indicates that over the course of the pandemic two distinct groups have formed,
those whose income did not decrease, and those whose income has been decreasing. Thishighlights the emergence of a new kind of wage gap within the workforce.
Looking beyond the overall trend, the differences between industries are alsosignificant. The percentage of people working in the restaurant and accommodationindustries whose income did not change between January and December of 2020 was only
19%, while 27% of respondents reported a consistent decline, and 8% of respondents reported
no change from January to March 2020, a decline from March to June 2020, and a decline
from June to December 2020. Despite being within the industries that were the main targetsof the “Go To Campaign” policy and other economic stimulus measures, almost none of the
respondents said that their incomes increased from June to December 2020 after the first
Declaration of a State of Emergency was lifted, and there are many whose incomes have notstopped declining. While this may appear troubling, a positive interpretation would be to saythat the effect of these economic stimulus measures was to reduce or mitigate the extent of
the income deterioration, staving off a much sharper decline in income and the economy.

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
6This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Figure 4 Time Series Change in Income by Percentage of Workers and Major
Industry (%)5

What to Prioritize - Economic Countermeasures or Infection Control
From the end of November to December 2020, as Japan’s third wave of COVID-19
surged, the government shifted its focus from a pandemic strategy focused on economic
countermeasures, the poster child of which was the "Go To Campaign" to one of mitigating
the spread of new COVID-19 infections. The government emphasized that “the next three
weeks are critical” in stopping the unchecked spread of COVID-19 and asked the populace torefrain from behaviors that might further spread infection.
During this period, the authors continued to survey employed workers, asking theiropinions on a variety of policies aimed at both preventing the spread of COVID-19, andstimulating the economy to mitigate the economic impact of the pandemic. Of course, mostpeople would likely agree that both infection control and economic countermeasures areimportant in combatting the pandemic’s impact, but the authors tried to clarify how people
felt by asking them to make a choice on which should be prioritized.
Figure 5 shows the results of the survey on the importance of economic
countermeasures vs infection control. Despite the government’s request for the public to
Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
7
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

abstain from activities that might spread the virus and their admonishments that “the next
three weeks are critical” about 40% answered that neither should be prioritized. Furthermore,nearly 30% of respondents still preferred economic countermeasures (Total of "Emphasis" and"Slightly more emphasis", hereinafter the same), compared to only 20% who preferredstrengthening measures for infection control (Total for "Emphasis" and " Slightly moreemphasis ", hereinafter).
Figure 5 Prioritizing Economic Countermeasures or Infection Control6

Figure 6 shows the results of Figure 5 by income bracket. Up to the 9 million yen plus
income bracket, the higher the income bracket, the higher the rate of emphasis placed on
economic measures. On the other hand, there are a certain number of people in all income
brackets who consider measures to stop the spread of COVID-19 to be of a higher priority. In
general, however, the lower the income level, the lower the percentage of people who place
importance on economic countermeasures, and the higher the percentage of people who place
importance on infection control measures to stop the spread of COVID-19. Regardless of
income, approximately 40% of respondents answered that "Neither" should be prioritized.
Also, it should be noted that the lower the income bracket, the higher the percentage of people
who answered "I don't know" regarding what should be prioritized, with 19% of those with anincome of 2 million yen or less answering as such. As these are the people most likely to be
employed in jobs with a high degree of risk for infection, that is jobs involving face to faceinteraction and or those which cannot be done remotely, it is likely that they feel hesitant toendorse the lifting of restrictions on economic activity. At the same time however, they arealso those least able to cope with the economic disruption of the pandemic, which may lead toa feeling of deep ambivalence on pandemic policy.

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
8
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Figure 6 Prioritize Economic Countermeasures or Infection Control Measures(By Income)The next section (Figure 7) looks at employment patterns. Breaking the data down
by type of employment, there are large differences in the ratio of those who believe thatemphasis should be placed on countermeasures to mitigate the pandemic’s economic damage
versus those who feel that infection control measures to prevent the spread of COVID-19
should take precedence. Regular workers, managers, and self-employed workers (withemployees) tend to place more importance on economic measures than non-regular workers.
It can be said that those in a position of responsibility for a company or business tend toemphasize economic measures to secure profits and maintain wages.

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
9This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Figure 7 Prioritize Economic Countermeasures or Infection Control Measures(By Type of Employment)

Breaking down the results by industry of employment (Figure 8) also yielded notabledifferences of opinion on pandemic policy. Nearly 20% of respondents from across allindustries said infection control measures to prevent the spread of COVID-19 should beprioritized to at least some degree. The percentage of people who said economic
countermeasures should be prioritized however, varies widely by industry. Those working inindustries where the nature of their job is such that in principle it cannot be done remotely,such as manual labor and in-person customer service, held a relatively low level of preference
for economic countermeasures at around 20% to 25%, with those in the medical care, nursing,food and accommodation industries having the lowest percentages. Conversely, in theinformation and telecommunications industry, where telework can be implemented withrelative ease, the preference for economic countermeasures over those aimed at stopping the
spread of COVID-19 accounted for a relatively high percentage at around 30%. This tendency
is even more pronounced when looking only at those who more strongly support economic
measures (excluding those who only moderately support having economic measures takeprecedence).
As seen previously in Figure 4, those working labor centric or direct customer facing
jobs in the service industry, most noticeably in the restaurant and accommodation industries,
have seen significant declines in their income, and it is for precisely this reason that theseindustries became the main targets of the government's economic countermeasures.
Ironically however, those working in these industries are the least supportive of theprioritization of economic countermeasures, perhaps because they felt like they were on thefront line during the first Declaration of a State of Emergency. This is in spite of the fact that
Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
10
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

as many as 27% of those working in the restaurant and accommodation industry have seen
their incomes decline. This may indicate that some people have come to see the government’s
ability to enact effective economic countermeasures to the pandemic as limited, and question
whether an approach prioritizing economic countermeasures can actually make a differencein their lives. It appears that many of them may have written off temporary economic
countermeasures as unable to address their needs, feeling that the only real solution iscomprehensive infection control measures to stop the virus’s spread, end the pandemic, andallow for the return of normal life as soon as possible.

Figure 8 Prioritize Economic Countermeasures or Infection Control (by industry)

Opinions in the Restaurant and Accommodation Industry
As shown in Figure 8, the restaurant and accommodation industries have the lowest
percentage of people who prioritize economic countermeasures over infection control
measures. Figure 9 provides a further breakdown of their views by type of employment,
demonstrating large differences between the self-employed, regular workers, and non-regular
workers. A high percentage of those who are self-employed with employees (37%) and selfemployed without employees (28%) prioritize economic countermeasures to at least somedegree. This is much higher than the percentage of regular and non-regular workers whoemphasize economic countermeasures (20% in both groups). That said, those who are selfCopyright Ⓒ 2021 by Nippon Institute for Research Advancement
11
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

employed with employees were also the group with the highest level of support for prioritizing
infection control measures at 38%. This is in stark contrast to regular workers in the industry,of whom only 12% placed a higher priority on infection control measures versus economic
countermeasures. While some caution is necessary in drawing conclusions due to the small
sample size of the self-employed with employees, the group is remarkable in its near evensplit between a large percentage of individuals who emphasis economic countermeasures(37%) and a slightly larger percentage of individuals who prioritize infection control measures(38%.) The burden of responsibility placed on small business owners during the pandemic is
immense and unrelenting as they struggle to pay wages, rent, and key suppliers to remain in
business. It is thus natural that they are some of the loudest voices in favor of pandemic
policies that prioritize economic support for their battered industries. At the same time
however, it appears that many of them have also come to believe that an approach to thepandemic that prioritizes a thorough infection control regime is the fastest way bring about atrue recovery and the resumption of business activities at full capacity. The polarization of
opinion seen here is a clear outgrowth of just how badly the restaurant and hotel industries
have and continue to suffer under the pandemic. This is further evidenced by the fact that,with the exception of regular salaried employees, over 20% of people in all other groups want
to see the prioritization of measures against infection control, a relatively high rate. This is
likely because, as mentioned above, those working in and around customer facing jobs withdirect interaction are cognizant of the fact that they are among those most at risk of direct
infection.
Figure 9 Prioritize Economic Countermeasures or Infection Control(Restaurant and Accommodation Industry) (By Type of Employment)*Corporate directors and other positions with an extremely small sample size have been excluded from the above
Figure 9.

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12
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Degree of Economic Anxiety Does Not Correlate with a Preference for the
Prioritization of Economic Countermeasures.
In the previous sections, this paper established that people’s pandemic policy
preferences regarding prioritizing either economic countermeasures or infection control
measures differ according to industry, employment status, and income. However, within every
group there is at least a subset of people who want to see the emphasis placed on infection
control measures. The reason for this becomes clearer when digging further into the survey
data. In the later sections, participants were asked about their fear of COVID-19 infection,
along with their preferred approach to pandemic policy, and their level of economic anxiety
about falling into poverty. Figure 10 shows the results obtained by combining these resultswith the responses regarding their preferences for the prioritization of economic
countermeasures or infection control measures.
Figure 10 The Perceived Threat of COVID-19 and the Prioritization of Infection
Control or Economic Countermeasures
Do you feel threatened by COVID-19?
↓

Looking at figure 10, fear of COVID-19 infection tends to correlate with a desire formore stringent infection control measures and for the prioritization of those measures overeconomic countermeasures. For example, 24% of people who feel constant anxiety about
COVID-19 want to see infection control prioritized, dropping to 19% for people who feel only
some anxiety about COVID-19, and just 9% for people who say they do not have any anxiety
about the virus. As fear of COVID-19 increases, so too does the proportion of people who place
importance on infection control measures. While one might infer that the opposite trend could
also be seen in a lack of fear of COVID-19 correlating with a greater degree of support foreconomic countermeasures, this is not borne out by the data, with the level of support
remaining relatively constant regardless of the degree of fear of the virus. The fear of COVID19 clearly appears to be directly linked to a desire for the prioritization of infection control

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
13
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

measures in pandemic policy. In other words, subjective factors such as feelings of fear andperceptions of risk have significant influence on whether one feels that infection control
measures should be prioritized in pandemic policy.
On the other hand, anxiety about economic hardship does not seem to correlate witha desire for the prioritization of economic countermeasures at the expense of infection control.
Figure 11 shows how feelings of economic anxiety translate into support for different types ofpandemic policy. Regarding the percentage of people who wish to see economic measuresprioritized, 29% feel constant economic insecurity, 28% feel it sometimes, and 26% do not feelit at all. While these numbers exceed those who wish to prioritize infection control in eachgroup, in a reversal of what might have been expected, it is actually those facing the greatest
economic hardship, or at least those who have the most anxiety about it, that are most likely
to support pandemic policies prioritizing infection control. Neither the fear of, nor actual
economic insecurity seems to correlate with a desire for the prioritization of economic
countermeasures in pandemic policy.
This is consistent with the findings presented in earlier sections of this paper, andsuggests that, rather than support for a pandemic policy prioritizing economic
countermeasures being tied to subjective factors such as people's anxiety about their economic
prospects, it is much more dependent on objective factors such as a person’s industry of
employment and employment status.
Figure 11 Economic Anxiety and the Prioritization of either Infection Control or
Economic Countermeasures
Did you feel anxiety that your life would become economically difficult?

↓What can be seen thus far is a clear asymmetry between fear of COVID-19 and fearof economic hardship. How can this knowledge be used to better combat the pandemic?
The government’s decision in December 2020 to declare "the next three weeks
critical" in reversing the country’s worsening pandemic trajectory, and then in January 2021,
to release a second Declaration of a State of Emergency, represented the turning point at
which the government’s pandemic policy shifted from a focus on economic countermeasures
to a focus on infection control and containing the spread of COVID-19 within Japanese society.
Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
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This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Nonetheless, the number of people infected with the virus has yet to be fully controlled, andthe medical system remains under growing strain. One potential explanation for this outcome
is that people’s fear of COVID-19 has begun to wane, leading to a dissipation of the sharedsense of crisis that initially promoted collective action aimed at preventing the spread of thevirus. If this is indeed the case, then it is imperative for both national and local government
leaders to reengage with the public on the issue, by demonstrating an attitude of stoicism andrestraint while reemphasizing and clearly explaining the seriousness of the threat posed by
the current situation. Reaffirming public understanding, awareness of, and cooperation in theneed for measures to mitigate the spread of disease is likely to be a key piece in increasing
the effectiveness of measures to contain the spread of COVID-19.

Measures against Infectious Disease in Everyday Life
Opinions on both what should be prioritized in pandemic policy (economic
countermeasures or infection control measures) and the effectiveness of the government’s
pandemic response vary widely in Japan. Despite the lack of a consensus around the directionof the government’s pandemic policy however, it does appear that efforts to encourage
individuals to take steps to prevent the spread of COVID-19 in their everyday lives have been
widely embraced and taken up by a large percentage of the population. Figure 12 shows thedaily measures individuals reported taking against COVID-19. 74% of respondents said thatthey were thoroughly washing their hands and wearing face masks, “all the time”, “usually”,
or at least “sometimes.” In general, the majority of the public appears to be taking measuresagainst the spread of COVID-19, such as wearing masks and social-distancing, when possible,
in a stoic and consistent manner. This may be a manifestation of the fact that Japan has aculture of observing social norms.
Such measures against infectious diseases can be traced back to the “Spanish flu”
epidemic of the early 20th century. When the Spanish flu was rampant between 1918 and 1920,
the government urged people to avoid crowds, wear masks and social distance. As this waslong before the invention of television or the Internet, preventive measures were detailed in
cards distributed to households, signs posted on streets, and local newspaper reports. Each ofJapan’s prefectures also promoted a variety of original measures. The result was that sincethat time, various measures against infectious disease have taken root in Japanese culture,with the most prominent being the widespread wearing of masks as both protection and ameans of preventing the spread of disease when one is sick. Despite a century’s worth ofadvancement in science and medicine, these basic measures to prevent the spread of
infectious disease are still effective today, and as relevant in combatting COVID-19 as they
were in overcoming the Spanish Flu . Given this historical context, it is easy to see the criticalrole played by the central and local governments in disseminating information and carefully
crafting measures against infectious disease. As has been stated earlier, the dissemination of
accurate, reliable and timely information leads people to have an appropriate level of concern,
Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
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presented here.

NIRA OPINION PAPER
No.56 | January 2021

empowering them to practice appropriate measures to protect their own health against bothpandemic and common infectious diseases.

Figure 12 Measures to Prevent the Spread of COVID-19 at the Individual Level

Beyond Economic Countermeasures and Infection Control: The Need forSocial Support and Suicide Prevention Measures
Going beyond the debate over whether to prioritize infection control or economic
countermeasures in fighting the COVID-19 Pandemic, there is an urgent need to pursue othertypes of policies in a more nuanced and holistic fashion. The pandemic has turned people’s lives
upside-down, taking a severe toll on their mental and psychological health.
The survey upon which this paper was based also measured respondents mental statefrom April 2020. Participants mental state was evaluated using multiple indicators and quantified
using an index called “K6” in which the higher the value the worse the participants mental health7.
The survey adopted the same format as the annual survey conducted by the Health, Labor andWelfare Ministry. Figure 13 shows the distribution of K6 as a histogram. Compared with the 2019
figures reported by the Ministry of Health, Labour and Welfare, the situation had worsened
considerably by December 2020. In particular, the percentage decreased across the board at thelower values and increased across the board at the higher values. We can clearly see that thepercentage of people with poor or deteriorating mental health has been increasing significantly.

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
16
This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.

NIRA OPINION PAPER
No.56 | January 2021

Figure 13 Distribution of K6 indicators (Comparison between 2019 and 2020)v

A further breakdown of the time series for the K6 indicators provides more insight
into how the COVID-19 Pandemic impacted participants’ mental health throughout 2020.
Figure 14 highlights how marked differences in the mental health impact of the pandemic bygender and age group deserve special attention. There is a high probability that thesedifferences also correlate with increased rates of suicide and mental illness.
Figure 14 Distribution of K6 by sex and age group (As of December 2020)<Female><Male>

There are many people who say that economic countermeasures should be
paramount, because without them, the number of suicides will increase. While it is true thatthe economic downturn caused by the pandemic, particularly when combined with fear ofcontracting COVID-19, has had a noticeable negative impact on mental health, the degree towhich people are negatively impacted appears to be more highly correlated with age andgender than it is occupation or income. While mental health has declined across the whole ofsociety, the deterioration has been especially prominent amongst those under 40, irrespectiveof gender. It is therefore necessary to implement a broader policy that targets not only those
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who have fallen on hard times economically, but instead targets a broader range of society
with the understanding that the deterioration of mental health goes beyond simple economic
hardship. The government should undertake a “push type” policy that utilizes tools such as
SNS to proactively reach out to those at risk. Government social policy must also come toreflect that the psychological impact of the pandemic goes far deeper than economic insecurity
and is likely to last well into the recovery period.

Conclusion: The Need for a Broader National Discussion on Pandemic Policy
This survey of workers has revealed the broad diversity of attitudes in Japan toward
measures to combat the COVID-19 pandemic including both infection control measures andeconomic countermeasures. Subjective factors such as fear of COVID-19 are directly related
to the importance people place on infection control measures. On the other hand, objective
factors such as income, industry of employment, and type of employment seem to influence
whether a given individual will more strongly support infection control measures or economic
countermeasures in response to the pandemic. The restaurant and accommodation industry
have been particularly hard hit by the pandemic, with the income of people in these industries
continuing to decline. While this would lead one to suspect that people in these industries
would be most inclined to support economic stimulus measures over infection control, thereality is that compared to other industries, they actually tended to show a higher level of
support for prioritizing infection control measures to stop the spread of COVID-19 overeconomic countermeasures. They likely feel that the effectiveness of the government's
economic measures is limited, and the everyday risk and fear of infection from face-to-faceservices is high, so they tend to emphasize thorough measures to prevent the spread of
COVID-19.
Containing the pandemic and preventing another surge will require a shift in the
public consciousness towards prioritizing infection control measures and this can only beachieved by a government that provides clear, up to date, and easy to access information on
the pandemic that resonates with people on an emotional level. It is also critical for thegovernment to continue to push firms to adopt telework where appropriate as it is one of themost effective means of reigning in the spread of disease while keeping the economy going. It
should be more than possible to raise the percentage of those teleworking back to and evenbeyond the peak achieved in June 2020. While it is difficult for jobs in certain industries to bedone remotely, even companies in such industries should be encouraged to do their part topromote telework by reviewing their operations, undertaking appropriate reforms, andpursuing digitalization wherever possible. While reform is never easy, such efforts will enable
an ever-greater number of industries to simultaneously resume more normal economic
activity while also taking necessary measures against COVID-19.
Along with measures to prevent the spread of COVID-19 and mitigate the pandemic’s
economic impact, Japan also urgently needs measures to combat the psychological exhaustion
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This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
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NIRA OPINION PAPER
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and deterioration of mental health caused by the pandemic, a trend that is particularly
noticeable amongst the younger generation. This mental health crisis is emerging largely
along lines of age and gender, not income or employment, and is particularly severe amongst
those under 40 regardless of gender, so the measures must be tailored to proactively reach awide range of society in a “push” manner.
Finally, while measures are debated and taken to prevent the spread of COVID-19,
mitigate the pandemic’s economic impact, and address its psychological costs, it is critical topromote a parallel discussion about what a “Post COVID” society should look. Japan must
engage with its citizens on how society should change in response to what has happened
during the pandemic, so that in the long term the country may emerge stronger, and more
resilient in the face of future challenges. By proactively engaging citizens in the constructionof a long-term vision for the country’s post pandemic future, public support for broad changes
can be secured and both the people and the government will have a better idea of how best to
move Japan forward.

Toshihiro Okubo
Professor, Faculty of Economics, Keio University. Senior Adjunct Fellow, NIRA. Completed
a master's course at the University of Michigan and a doctoral course at the University ofGeneva and the Geneva International Development Institute (Ph.D. in International
Relations and Economics). He specializes in international economics and spatial economics.

Note
The purpose of the “Questionnaire Surveys on the Effects of the Spread of COVID-19 on
Telework-based Work Styles, Lifestyle, and Awareness” is to grasp the actual situation of thechange of working style, life, consciousness and the effect on the business of the workers in thewhole country by the infection expansion of new coronavirus. The survey conducted in December
is the 3rd survey following the 1st survey conducted in April 2020 and the 2nd survey conductedin June. The survey was conducted from Tuesday, December 8, 2020 to Monday, December 21.
Based on the results of the Ministry of Internal Affairs and Communications 'labour force survey'
in FY 2019, we allocated samples according to sex, age (6 Categories), and region (5 Categories),and distributed and collected 10,000 samples of the target number of collected samples using asurvey conducted on the Internet for affiliated monitors of Nikkei Research Inc. Of the 10,523
responses, 9,201 were received from samples continued from the 1st and 2nd surveys (Continued
response rate: 64.6% of the 14,247 respondents in the 1st and 2nd surveys) and 1,322 from new
samples from the 3rd survey. For details of the survey, refer to Toshihiro Okubo, NIRA (2020)“The results of 3rd Third Questionnaire Surveys on the Effects of the Spread of COVID-19 on
Telework-based Work Styles, Lifestyle, and Awareness (flash report)”.
1“telework” in this survey refers to flexible working styles regardless of location, using ICT(information and communication technology) such as the Internet and e-mail. This refers toworking for a certain period of time outside the workplace, such as at home, satellite offices,
cafes, and other public facilities, without going to the usual workplace (Company, customers,
2

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NIRA OPINION PAPER
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locations, etc.). Specifically, this includes telecommuting, mobile work, and facility based work.
However, it does not include the use of ICT in mobile transportation, outside transportation, or
at customers' locations. In addition, when the respondents are sole proprietors, small businesses,
etc., working in SOHO or side jobs (Those who do not have a sufficient degree of independent
self-employment) is also included in telework. The definition of telework in the "Survey of
Telework Population" of the Ministry of Land, Infrastructure, Transport and Tourism and the“Communications Usage Trend Survey” of the Ministry of Internal Affairs and Communications
defines telework as working in a place other than one's usual workplace using ICT. It should be
noted that the definition of telework is different from that in this survey, as it includes the useof telework by customers, by external parties, by means of transportation on the move, instations, and in airports.
Okubo, T. (2020). Spread of COVID-19 and telework: evidence from Japan. See Covid
Economics, 32, 1 -25.
3

4

Okubo, T., Inoue, A., & Sekijima, K. (2020). Teleworker performance in the COVID-19 era inJapan. See Asian Economic Papers, 1 -37.

Of the 14 industry categories, 8 are listed from those with the highest percentage of decline inall 3 periods. The ratio of workers in income change by industry is shown, and the number ofcolumns adds up to 100.
5This is a summary of the results of the responses to the question, “I would like to ask you about
the spread of the new coronavirus. Do you agree or disagree with the government's efforts forthe people as a whole, including the future? (one by one)” regarding “Promotion of policies thatprioritize the revitalization of economic activities rather than the prevention of the spread of
infection”. The answers of “assent” are described as “emphasis on economic measures” and thoseof “opposition” are described as “Emphasis on measures against infectious diseases”.
6

K6 is Kessler et al. A measure developed in (2003) to screen for mental disorders. Furukawa
et al. It is developed in (2008). The questions consist of 6 questions: “Did you feel nervous?”, “Didyou feel hopeless?”, “Do you feel restless?”, “Did you feel depressed and not relieved no matter
what happened?”, “Did you feel that doing anything was painstaking?”, and “Did you feel thatyou are a worthless person?”. They are answered on a 5-step scale. The answers to each question
are scored by “Not at all.” (0 Point), “Just a little.” (1 Point), “sometimes” (Two points), “usually”(3 points), and “all the time” (4 points), and points are calculated by a simple total. It is also usedby the Ministry of Health, Labour and Welfare 'National Basic Survey of Living Conditions' andis widely used as an index to measure mental health.
7

Kessler, R. C., P. R. Barker, L. J. Colpe, J. F. Epstein, J. C. Gfroerer, E. Hiripi, M. J. Howes, S. T.
Normand, R. W. Mandersheid, E. E. Walters, and A. M. Zaslavsky. (2003) “Screening for Serious
Mental Illness in the General Population,” Archives of General Psychiatry, 60, 184 -189.
Furukawa, T.A., Kawakami, N., Saitoh, M., Ono, Y., Nakane, Y., Nakamura, Y., Tachimori, H.,
Iwata, N., Uda, H., Nakane, H., H., Watanabe, M., Naganuma, Y., Hatah, Y., Kobayashi, M.,
Miyake, Y., Takeshima, T., Kikkawa, T. (2008) “The performance of the Japanese version of theK6 and K 10 in the World Mental Health Survey Japan,” International Journal of Methods in
Psychiatric Research, 17 (3), 152 – 158.

Copyright Ⓒ 2021 by Nippon Institute for Research Advancement
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This is a translation of a paper originally published in Japanese. NIRA bears full responsibility for the translation
presented here.