Care Practice and Responsibility of Primary Care Physicians in Japan during the COVID-19 Pandemic

Abstract (English)

This presentation focuses on the care practice and responsibility of primary care (PC) physicians in Japan during the COVID-19 pandemic. PC physicians played critical roles in responding to the pandemic, including managing fever clinics, administering vaccinations, and providing medical care to patients isolating at home.
In this context, PC physicians can be described as “proxies of public health administration” [Latour 2011], as they were positioned to implement national-level policies—formulated with the advice of experts—at the local level. Moreover, if infectious disease specialists, although located outside of formal state structures, partially substituted for state functions “alongside the state” as a form of “para-state” [Hamada 2024; Geissler 2015], then PC physicians might be considered a kind of local-level “para-state.”
However, unlike the registered general practitioner (GP) system in the UK, Japan operates under a “free access” model, where patients can choose any healthcare provider without restriction. During the pandemic, this system led to confusion amid resource constraints such as limited medical personnel and vaccine supply. This confusion has been linked to both the absence of clear responsibility and inequitable access to care. Furthermore, the healthcare system—largely dependent on the discretion of individual private practitioners—resulted in patient distrust and disorientation, revealing structural deficiencies and ethical challenges within the system.
This presentation draws on a longitudinal series of online interviews conducted every few months between 2020 and 2024 with ten PC physicians actively involved in COVID-19 response in Japan. By examining their experiences, this study explores the relationship between care and responsibility in the context of the pandemic, with particular attention to the PC physicians’ position as a para-state entity and their relationships with patients, local communities, other medical professionals, fellow PC physicians, administrative bodies, and the state.