In the first TUPReP Crosstalk, under the theme of “The COVID-19 Pandemic from a Humanities Perspective―Exploring Factors Associated with Lower Mortality in Japan than in Western Countries,” participants discussed the COVID-19 pandemic from the Japanese cultural perspective. First, Professor Hitoshi Oshitani provided an overview of the Japanese and global response to COVID-19, followed by Professor Hiroo Sato’s presentation on Japan's unique philosophy compared to the West. Professor Toshiaki Kimura then provided information regarding the Japanese worldview from a folkloric perspective. In the following discussion, participants discussed the future directions and attitudes(positions? approaches?) of both Japan and the (rest of the) world.

•Introduction
Hitoshi Oshitani (Professor, Tohoku University Graduate School of Medicine)
　The TUPReP Crosstalk—held today for the first time—is part of the TUPReP project, which is one of the research projects of SOKAP (Sustainability Open-Knowledge-Action Platform): an open platform at Tohoku University that aims to realize a sustainable society by solving social issues through knowledge convergence. The global impact of the COVID-19 pandemic was not limited to health but had major economic and social implications. Although COVID-19 caused significant damage in Japan, Japan experienced a lower mortality rate compared to the West..In consideration of this fact, the TUPReP project—i.e., "Interdisciplinary Research for Solving Social Problems of Pandemics"—will bring together researchers from the natural sciences, social sciences, and humanities to examine the historical background, cultural background, health disparities, and global health governance of Japan and other countries’ COVID-19 responses. This project aims to elucidate the factors behind why the damage attributed to COVID-19 was relatively less severe in Japan, and ultimately improve the global “Pandemic Prevention, Preparedness, and Response” system by making recommendations from the Japanese perspective. The TUPReP Crosstalks will serve as a forum for such interdisciplinary discussions.

•Topic 1: "The Japanese and Global Response to COVID-19”
Hitoshi Oshitani (Professor, Tohoku University Graduate School of Medicine)
　Essentially, the COVID-19 pandemic was the product of a new highly contagious and lethal virus (SARS-CoV-2). The global spread of this virus and the continuous emergence of more contagious mutant strains prolonged the pandemic, and damage continued to expand.

　In response to the COVID-19 pandemic, Western countries, Asia, and Japan took different measures. In the West, each country led their own damage reduction measures, where they attempted to slow the spread of the virus based on a pre-COVID mindset. However, this was not enough to mitigate damages due to the pandemic, which—as mentioned earlier—was caused by a new highly contagious and lethal virus, resulting in many deaths. Contrarily, in light of the explosive increase in deaths in China, Europe, and the US during the early stages of the pandemic, Japan’s goal was to control the speed of the spread and reduce the number of severe cases and deaths as much as possible. However, the measures taken in Japan—different from those in other countries— centered on calls for non-coercive self-restraint. Consequentially, although some deaths occurred in Japan, the number of deaths per million was less than a fifth of that of the US and the UK. On the other hand, Asian countries other than Japan, such as China and South Korea, continued to take measures centered on containment through strict laws and regulations. Their containment measures kept the number of COVID-19 deaths in their countries lower than in Japan in the early stages of the pandemic. However, maintaining such containment policies for a long period imposed a significant social burden in Japan. Furthermore, the emergence of mutant variants, such as the Delta variant, caused many deaths, but the COVID-19 mortality rate in Japan was still lower than in Western countries.

　The difference in COVID-19 mortality between Western countries and Japan has been attributed to the difference in pandemic response. Additionally, many other factors are significant when comparing Japan and the West, such as Japan's so-called "prosocial behavior," its unique worldview of "symbiosis," its cautious response to COVID-19 in the early stages of the pandemic, and its strongly empathetic national character. These are all important keywords when considering factors that led to the difference in pandemic response outcomes. Moreover, the West tends to seek a "sole correct solution" when resolving social issues. Western countries’ inability to respond to questions without answers, i.e., "negative capability," is considered to be the reason behind their failed pandemic response.

•Topic 2:“The Scenery Witnessed by the Coronavirus: <Philosophy of Autonomy> and <Philosophy of Relationship>
Hiroo Sato (Professor, Tohoku University Graduate School of Arts and Letters)
　In our daily lives, we do not think about our worldview. However, worldviews govern our consciousness, words, and actions. The modern worldview, i.e., the worldview of people today, has matured mainly in the West. In Western culture, based on trust in reason, human beings are treated as privileged beings. Living an autonomous life and following one's beliefs is considered the ideal way of living. This can be called the “philosophy of autonomy,” a philosophy from which ideas such as human rights are derived. In contrast, the Japanese archipelago has long possessed a unique worldview that believes the ideal way of living is to live in harmony with everything in the world; that is, human beings should not stand out. This idea can be understood as the “philosophy of relationships,” which emphasizes the relationships among humans, and between humans and “others.” In this worldview, people do not develop philosophies by discussing head-on how one should live but rather seek ideas from fables and rituals that depict ideal relationships with various things. These two philosophies are thought to be rooted in two of the true natures of living things: the philosophy of autonomy comes from survival instinct, while the philosophy of relationships is concerned with the survival of the species or group to which an individual belongs.

　According to this “philosophy of relationships” that exists in Japan, the Japanese have co-habited with infectious diseases as plague gods. The plague gods are entities that cannot be eliminated, but rather their grievances should be listened to. It was believed that plagues and natural disasters are the result of disturbed relationships between humans and those gods, and that it is important to restore the disturbed harmony, i.e., to reconcile with the plague gods. When we examine the COVID-19 pandemic response in contemporary Japan through this lens, the relatively low mortality in Japan can be attributed to "peer pressure"—peculiar to the Japanese—but it is also possible to say that this peer pressure originates from an unconscious “consideration for coronavirus,” not just consideration for humans.

　In the modern age, where the philosophy of autonomy has become overly prominent, the philosophy of relationships can provide a new perspective that enables us to relativize human beings by listening to the voices of those who do not speak. For example, when we examine the issues of the COVID-19 pandemic from the perspective of the philosophy of relationships, we can examine issues from the perspective of the virus. We ask, "What is the novel coronavirus trying to tell us?" Listening to the voice of the virus in the modern world, where human relationships are becoming increasingly scarce, will most likely lead us to listen to the "voice of those next to us."

　In modern times, various non-human entities have been removed, and intense clashes of self-assertion have broken out among people, communities, and nations that have lost their buffers. Considering our current situation, we realize that in the philosophy of relationships, God(s?) used to function as a buffer: a veil that softly enveloped conflicts between individuals and communities. Thus, individuals did not confront each other. For instance, the "yuru-kyara (ゆるキャラ)" popularity seen in recent years can be seen as a cry of modern people trying to call back God as a cushion in the midst of suffocation. We can learn from history by reconsidering what it means to "be together" and paying respect to the things we live with.

Topic 3: "The Views of Disease in Folk Beliefs"
Toshiaki Kimura (Professor, Tohoku University Graduate School of Arts and Letters)
　Naoya Shiga, a novelist whose career flourished from the Meiji era to the Showa era, published the novel "Ryuko Kanbo" (Influenza) in 1919. Against the backdrop of the Spanish Flu epidemic, the protagonist, a typical modern elite of the time, encounters through a maid the worldview of the rural people–his opposites– and their attitude toward infectious diseases.

　Through the maid’s worldview, the protagonist witnesses common Japanese folk beliefs and practices from that time: when infectious diseases were worshipped as gods. The belief in the “Hoso shin” (God of smallpox) was prevalent in many places, but this god possessed a diverse and complex character. The God did not only cause smallpox, but cured it, memorialized those who died from smallpox, and symbolized the dead themselves. Through this example, we can see a unique Japanese idea from that time: "The dead who have suffered from diseases become gods to save those who are suffering from the same disease.”

　As evidenced by the formalized responses to smallpox and literature on it from the Edo period, the Japanese did not perceive the “Hoso shin” as an enemy that should be erased. Rather, the God was perceived as an entity which the people could negotiate with. Thus, for the Japanese, the dead and various spirits were not entities that transcended humans. Rather, they were perceived as entities who suffered and were afflicted in the same way as humans. The Japanese believed they could restore a harmonic relationship with the dead/spirits by understanding and healing their sufferings through memorial services. This belief led to a unique worldview of "the world of mutual suffering and empathy," in which the spirits could be saved through memorial services. In this example, we can also find an aspect of the "philosophy of relationship," which was presented by Professor Hiroo Sato. We should note that it is also frequently pointed out how suffocating this rigid relationship can be.

　While the difference in COVID-19 casualties between Japan and the West is significant, differences in damage were also observed between regions in Japan. Cultural differences between regions may be at play here, such as attitudes toward memorial services for the dead in the Tokyo metropolitan area versus the Kansai region. By closely examining such differences, we may be able to discuss from a different perspective than merely comparing Japan with Western countries.

Discussion

•The Problems with the Western-led Framework
　Current discussions regarding a "post-pandemic society," including the formulation of a "Pandemic Treaty," have been largely led by Western countries. It is important to note that Western-led discussions tend to seek a single solution. For example, based on the lessons learned from the COVID-19 pandemic, Western countries proposed the "100-day mission," which aimed to implement crisis-response drugs, including vaccines, within 100 days of the emergence of a new infectious disease. However, this mission completely disregards pandemics for which vaccines cannot be produced. As a matter of fact, there are many infectious diseases for which vaccines have not yet been developed, even decades after their discovery.

　Moreover, some simulations suggest that a pandemic of the same scale as the Spanish Flu in the modern era would cause a significant number of deaths in the first wave—or within 100 days of the pandemic—which indicates that the 100-day mission is not a complete solution. Thus, this Western approach that relies on a single countermeasure, as opposed to considering a variety of possibilities, is extremely dangerous.

•The Actual Situation of Africa during the COVID-19 Pandemic
　The COVID-19 pandemic caused a significant number of deaths in low- and middle-income countries, especially during the Delta variant, when hospitalization facilities faced extreme supply shortages. However, since proper data collection was not conducted, official mortality statistics underrepresent the true number of deaths.

•The Japanese Philosophy of Relationship and Negative Capability
　In lawsuits during the Edo period, "naisai (内済)"—a settlement between the party concerned and an intermediary—commonly took place before civil trials. Naisai can be interpreted as an example of a Japanese cultural practice where people established individual norms and self-discipline based on human relationships, rather than absolute law. Taking this practice into consideration, we must first understand that everyone is committed to a single "justice." When a conflict occurs, it becomes a question of which justice is to be upheld. What underlies the Western tendency to pursue a single solution is most likely the attitude of "pushing through one's justice as fast as possible.” However, when one respects their relationship with the other party, resolution will inevitably take time, even if the result does not align with one's personal justice, one must accept it to some extent. This trial-and-error method fosters what is called "negative capability," and in the long run, it may contribute to realizing a more resilient society.

•Combining Multiple Measures Rather than Taking a Single Measure
　Masks and quarantines were most likely effective against the Spanish Flu outbreak that occurred between 1918 and 1920. Japanese people were less resistant to masking than people in Western countries, so they used masks widely. This may have limited the Japanese death toll. During the COVID-19 pandemic, Japan’s mortality rate was lower than Western countries. This was likely due to a combination of factors, instead of a single factor. In future pandemics, damages may only be reduced by combining multiple measures, such as masking and voluntary quarantines, instead of simply relying on vaccines and therapeutics. The effectiveness of each measure may be limited, but the combination and implementation of multiple measures may enhance their effectiveness.

•The "Strength of Communities" is Being Lost
　In the past, Japanese local communities—centered around temples and terakoya (寺子屋)—were the backbone of people's lives, and people lived within such connections. This "local connection" is said to be Japanese society’s strength. However, since the Meiji Era this "strength of communities" has been diminishing due to social changes. This is especially true for metropolitan regions. This diminishing "strength of communities" might be the reason why the COVID-19 pandemic in Japan was centered in metropolitan areas until the sixth wave in 2022. If a pandemic similar to COVID-19 were to occur 20 years from now in Japan, when the "strength of communities" has been further lost and immigrants have increased, Japan would most probably be unable to respond the way they did in this pandemic.　

•The Critical Need to Consider the Current state of Society.
　It is not difficult to imagine that deaths from existing infectious diseases will continue to increase and that new infectious diseases will continue to emerge. Given this situation, the most important thing to consider now is how society ought to be. Today, the concept concerning the relationship between the living and the non-living is fading away. In other terms, the dead are being expelled from society, and people today are expected to face the pitch-black world of death without any form of mediation. This is one source of anxiety among modern people. In the post-COVID era, we should not only focus on suppressing deaths, but also reevaluate where we stand today in the long period—between the past and the present—regarding the social system supporting us, and how it should work in the future.

•Ethics of Care and Negative Capability
　In 1982, the American ethicist Carol Gilligan proposed the concept of "ethics of care" in her book, "In a Different Voice." This concept challenged Lawrence Kohlberg’s "morality of justice,” which emphasized the sustenance of relationships among humans. Back then, in the West, "issues surrounding care" had not been addressed and its introduction induced a public response. The "ethics of care," which emphasized human relationships that prevent separation, gave rise to "negative capability.” There are no simple answers to problems society faces today, such as pandemics, environmental issues, and the depletion of fossil fuels. Nevertheless, if we try to seek a single solution to these issues based on Western thoughts—overconfidently believing in scientific technology—we will surely come to a dead end. However, in Japan, there remains a characteristic of negative capability, nurtured through relationships between humans and other entities, although this characteristic is being lost. This characteristic may have some suggestions regarding problems which cannot be easily solved.

•The Baby Boom Generation and the Younger Generation
　The older generation, mainly the baby boom generation, is a generation with a strong sense of autonomy, coordinating their own rights and identities. Even when behavioral restrictions were imposed during the COVID-19 pandemic, the middle and older generations did not change their behaviors; rather, the younger generation, those born after the collapse of the bubble economy, was more obedient to social rules. As this younger generation becomes the core of Japan, there will most likely be a swing back from the "philosophy of autonomy" to the "philosophy of relationships" in the Japanese consciousness. This shift will hopefully provide solutions to many of the problems we face.

•Evidence that is Not Scientific, but Narrative
　The purpose of this crosstalk is to elucidate factors that contributed to the relatively small COVID-19 damage in Japan compared to the West, and to share such factors with the world in English through recommendations from the "Japanese perspective." There are calls for scientific evidence, however, strictly speaking, scientific evidence is very scarce because the "pandemic cannot be repeated," making it impossible to reproduce the event. Furthermore, because each country has implemented multiple infection control measures simultaneously, it is impossible to scientifically evaluate the effectiveness of each measure individually. Therefore, we do not aim to claim that the factors identified in this crosstalk are the absolute solutions to suppress damages from a pandemic; and of course, we will not claim Japan's superiority. Notably, an editorial published in Science in January 2023 ("'Storylistening' in the science policy ecosystem") stated that an interdisciplinary attempt to synthesize scientific evidence—such as data—with "narratives and stories"—such as individual experiences—is a powerful tool for policy formation.

Japan incurred relatively less damage from this pandemic than the rest of the world, while Western countries suffered more serious damage. Our goal in this crosstalk is to organize the Japanese experiences of this pandemic to find some "narrative or story" that can illustrate how Western approaches were not effective.

•Realizing a Society in which People Examine Data and Act Autonomously
　When dealing with disasters and pandemics, is is important to not seek a single solution and be comfortable with it, but to be flexible, adapt, and change ways of dealing with unanticipated situations. In this respect, the Japanese government and administration are extremely poor at promptly responding to problems; however, the Japanese public is capable of promptly changing behaviors based on the data that is presented to them. Furthermore, we tend to have illusions about medical care: that "medical care will somehow take care of health-related problems.” In reality, medical care can only prevent 10% of premature death. What Japan needs is a society in which people actively examine data and act autonomously, rather than simply relying on the government, administrative agencies, and medical services for countermeasures.

•Changes in the View toward the History of Medicine
　Western medicine and hygienic knowledge that were introduced to Japan after the Meiji era were scientific and modern. They became widely known throughout Japan, but simultaneously, traditional medicine disappeared. This is the history of modern medicine from a historical perspective. However, by focusing on how the "Japanese way of thinking" has persisted, we can most likely discover something different than the conventional history of medicine.

•Pandemics, the Issue of Death, and Quality of Death
　When disseminating policy proposals in a narrative form, it is important to understand the concept behind its premise. The key is that the way of coming to terms with death during the COVID-19 pandemic, or what is called the "Quality of Death," may have differed between Japan and the West, and between different age groups. In Japan, the way people treated victims differed between the Great East Japan Earthquake and the COVID-19 pandemic; this difference raises the question of how society perceived those who died from COVID-19.

　Death is inevitable no matter the time we live in. However, in the past, each era and region in Japan had its own tradition of repetitively listening to death in a narrative form to naturally familiarize themselves with death. As the traditions disappeared, people began to feel anxious about the inexplicable nature of death, and this distorted people's minds. Today, this distortion is amplifying like a wave. We need to make efforts to understand how our present situation can be positioned over as long a span as possible.

　In addition, these issues regarding death should not be considered solely within the context of the COVID-19 pandemic. That is, the COVID-19 pandemic was a very unique pandemic from a historical perspective, given that children were less likely to become critically ill and the global spread of the disease. For past four influenza pandemics, the majority of deaths were among children. During of the Spanish Flu, most deaths were among young people in their 20s to 40s. Children and young people may be the main victims of future pandemics as they have been in the past. When faced with such a pandemic, a serious discussion is needed regarding how we should think about the concept of death.

•Japan's Strengths are Not Being Fully Exploited
　In the US, the "strength of communities" is weak; it is said that no one will take action unless the CDC takes the lead and establishes a manual that "can be successfully executed by everyone." Japan, on the other hand, the power of communities is strong. Logically, the Japanese should take advantage of this strength and concentrate efforts on health centers and community health care. In reality, the Japanese government is heading in the opposite direction, currently attempting to strengthen the functions of national headquarters and establish a Japanese version of the CDC. We are concerned that if this situation continues, Japan will lose its strengths and be diverted in a more fragile direction.

•Preserving Stories of People's Experiences Fighting the Pandemic
　During the COVID-19 pandemic, medical personnel in small to medium-sized hospitals—hospitals not classified as core hospitals—and medical personnel engaged in home-visit healthcare fought to support local medical services while enduring both harassment from outside and understaffing due to an increase in retirements. Leaving their experiences behind in tangible form would be of great significance.

•Avoiding Mere Praise of Japan and Criticism of the West
　When comparing Japanese perspectives with those of the West, such as through major keywords introduced in our discussion including the "philosophy of autonomy" and the "philosophy of relationships," there is danger in arguing that Japan was superior to the West, or that the West has downfallen. For example, the "philosophy of relationship," can also be found outside of Japan. It is essential to understand that the factors found in our discussion are "omnipresent in the world."

•The Dangers of "Lessons Learned"
　Narratives and stories are of great significance in sharing the Japanese experience. However, "lessons learned" make the stories abstract, and may ruin them. It is extremely dangerous to communicate the "lessons learned" in abstract forms as if they are the "correct" answers.

•Concluding Remarks
　In our crosstalk today, many keywords including the "philosophy of autonomy," "philosophy of relationships," and "negative capability" were introduced, and meaningful discussions centered on those keywords. We would like to continue to deepen the discussion, compile the products of our discussion into a single form, and share the "Japanese narratives and stories" with the world, hoping to enlighten Western countries.