Medical workers receive doses of the Pfizer-BioNTech vaccine at a Tokyo hospital on March 5. (Yoshikazu Tsuno/AP)

TOKYO — Japan's coronavirus vaccination program is in disarray — mostly from self-inflicted wounds.

Vaccinations are at a crawl, upending hopeful predictions that life could start to return to normal by the summer. Even before a third wave of infections is under control, many health experts are predicting another possible surge ahead of this summer's Olympics.

Japan’s government boasts of its success in containing the worst of the pandemic. But medical experts tell a different story — a failure to meet the moment, and of a slow-moving government and bureaucracy struggling to adapt to a fast-moving pandemic.

It adds up to a jolting contrast as many other wealthy nations have their feet on the gas to accelerate and expand vaccinations. Japan’s very slow rollout also is likely to undermine support for beleaguered Prime Minister Yoshihide Suga and delay Japan’s economic recovery.

“I’m almost convinced a so-called fourth wave will come,” said Kentaro Iwata, a leading infectious-disease expert at Kobe University.

Vaccines developed by Oxford-AstraZeneca and Moderna are still not approved for use in Japan, leaving the country dependent on a trickle of deliveries from Pfizer.

Two weeks into Japan’s vaccine campaign, only about 40,000 health workers have received a single dose of the vaccine, while vaccinations for those over 65 years old, initially scheduled to start next month, will not meaningfully get underway before May.

Shhh: No cheering or shouting at Olympic torch relay in Japan. Clapping is allowed.

Confident predictions that the country would have secured enough doses to cover the entire population by the middle of this year — and in time for the Olympics opening ceremony in July — have given way to vague hopes that medical workers and the elderly might be vaccinated by then.

“If the general public [in Japan] get vaccinated toward the end of this year, they’ll be lucky,” said Kenji Shibuya, director of the Institute for Population Health at King’s College London.

What worries Shibuya and Iwata is that new virus variants first spotted in Britain and Brazil have already entered Japan, with 15 percent of newly infected people in the western city of Kobe in mid-February found to have a variant.

Scientists at Keio University said last week that a variant thought to have some resistance against vaccines may have originated in Japan.

At the same time, the government’s contact-tracing efforts have already been overwhelmed. The public, meanwhile, has grown extremely weary of life under restrictions, and the government is unwilling to impose the sort of lockdown that might make a real difference.

On Friday, Suga extended by another two weeks a state of emergency in the greater Tokyo area.

The restrictions mean restaurants are asked to close at 8 p.m. But Tokyo’s famously packed subway trains are full during rush hour, and sports events still admit some fans.

Widespread mask use has helped dampen the impact of the pandemic here. Yet it has still been felt in many other ways. Japan’s economy contracted 4.8 percent last year and suicides are rising, especially among young women.

A third wave of the virus has already seen total covid-19-related deaths more than double this year to nearly 8,000.

Iwata fears that the state of emergency will be relaxed later this month, just in time for the office-party season at the end of the fiscal year, and also in time for cherry blossom season.

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It is all a far cry from last summer, when outgoing Prime Minister Shinzo Abe announced that Japan had secured a promise of 120 million doses from Pfizer by midyear, a similar amount from AstraZeneca and 50 million from Moderna, easily enough to cover its entire population.

But Abe had overpromised. In fact, Pfizer had not made a firm commitment to the midyear deadline. When it came time to actually negotiate a contract, Pfizer delayed the delivery deadline to the end of the year.

Meanwhile, Japan’s Health Ministry erected barriers in the way of vaccine suppliers by demanding they conduct clinical trials inside Japan. Those trials, of about 160 to 200 people for each vaccine, are so small as to be scientifically meaningless but have slowed down the approval process, experts say.

Japan’s government says it is proceeding cautiously because of the need to convince a skeptical public about vaccine safety, and many people in Japan are in no rush to get vaccinated.

Japan’s government retreated into its shell after a number of vaccine scares in recent decades.

Instead of defending vaccine safety, it decided it didn’t want to be blamed for possible side effects and left the decision about whether to be vaccinated up to individuals. That reluctance to take responsibility had a knock-on effect on Japan’s vaccine industry, and the country became something of a vaccine backwater.

Out of 76 vaccines undergoing clinical trials around the world, just one is from Japan, according to the World Health Organization, despite it having one of the largest pharmaceutical industries in the world.

“This is not the usual routine bureaucratic process, this is national security,” said Shibuya. “I can’t only blame bureaucrats because this shows a lack of true leadership in a time of crisis. This is really a lack of political leadership and the vision to tackle this.”

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In an attempt to reassure people about vaccine safety, Japanese doctors based domestically and in the United States, Britain and France have launched a chatbot on the popular Line messaging service to educate people about the coronavirus vaccines and counter alarmist rumors.

The service, represented by a friendly cartoon dog mascot dressed in a white coat, has already been accessed by 57,000 people, 70 percent of whom are women.

In the medical profession, though, there is another anxiety emerging — that overburdened health-care workers will have to administer a mass vaccination program as they also treat a fresh upsurge in infections.

“Vaccinating residents widely across regions would be difficult amid a fourth wave,” Toshio Nakagawa, president of the Japan Medical Association, told reporters last month. “It will cause a large disruption in the health-care spaces.”

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