The widely respected international medical journal The Lancet, which has been publishing medical research since 1823, has called for a public debate on whether the 2020 Olympic Games in Tokyo should go ahead.
In a hard-hitting editorial published on Saturday, The Lancet, which acknowledges there are arguments both ways, has targeted governments, WHO, and other international health organizations for not speaking out, or offering guidance.
"This silence is a deflection of responsibility. The risks of the Games, and how they are being managed, need wide scrutiny and approval. There needs to be a global conversation about the Games, and it needs to happen now," The Lancet editorial said.
"With 6 weeks until the Tokyo 2020 Olympic Games begin, concerns over the safety of the Games amid the COVID-19 pandemic are intensifying. Public health experts have expressed strong reservations about how well the risks are being mitigated in articles and before parliamentary committees. The Olympic and Paralympic Games are now deeply unpopular in Japan: lengthy petitions have been signed, 10000 volunteers have resigned, and several opinion polls have shown that most respondents thought the Games should be postponed or cancelled. The International Olympic Committee (IOC) has the ultimate power to decide on the Games but has huge economic and reputational incentives to continue, as does the Japanese Government. Both insist that the Games will go ahead safely," the editorial said.
"Writing on June 4, Kaori Yamaguchi, executive member of the Japanese Olympic Committee, suggested that the decision is a fait accompli. "We have been cornered into a situation where we cannot even stop now. We are damned if we do, and damned if we do not." Is Yamaguchi right? Are we sliding into a dangerous Games? And shouldn't all who have a stake also have a voice?"
The Games are a global event, happening amid a global health crisis. Control and prevention of COVID-19, including vaccination, are highly variable worldwide. Although international spectators have been barred, 15000 athletes from more than 200 countries will travel to Tokyo, as well as nearly 80000 officials, journalists, and support staff. Their vaccination is not mandatory and mixing could risk avoidable transmission of SARS-CoV-2, including emerging viral variants, seeding fresh outbreaks when attendees return home. The Games might also adversely affect the COVID-19 situation within Japan, where case numbers are falling, but several regions remain under a state of emergency. Japan's vaccination roll-out has been sluggish, with 34% of the population immunised.
"As The Lancet goes to press, no final decision has been made on whether domestic fans can attend, but doctors are concerned about the pressure on health services. The Tokyo Medical Practitioners Association, representing around 6000 primary care doctors, has written to Prime Minister Yoshihide Suga calling for the Games to be halted, saying that Tokyo's hospitals "have their hands full and have almost no spare capacity," the editorial stated.
"The IOC has taken extraordinary measures to minimise the risk of transmission. The number of attendees has been halved. Participants have been given a stringent 60-page rule book for COVID-19, developed with WHO and public health experts: non-compliance could see expulsion from the Games. Two negative COVID-19 tests are required before departure for Japan as well as daily testing during the Games. Strict non-pharmaceutical interventions will be in place, and most events will take place outdoors. All possible places attendees might visit must be approved in advance, and use of public transport is barred. Historically, the overall number of travellers to a host country changes little during the Games. Narita airport in Tokyo is receiving close to 100000 international passengers per month. The IOC might well also point to events such as the European Football Championship. Matches are being played, with spectators, in the UK, which had 30724 infections in the week of May 31 and rising, compared with Japan, which had fewer than 19000. Finally, the Olympic and Paralympic Games could encourage physical activity, provide a worldwide morale boost, and promote unity, showing how the global community can come together, after 18 traumatic and fractious months."
"But has the global community come together? All nations have an interest in the COVID-19 pandemic and the safety of the Games, yet discussions have largely rested with the IOC and the Japanese Government. Even Tokyo could not unilaterally cancel the Games without risking a multibillion-dollar fine for breach of contract. The IOC, whose risk assessments are not publicly available, is the only one with the mandate to halt the Games. But the 2020 Games are not solely a sporting issue," The Lancet editorial argued.
"Global health organisations have been largely silent on whether the Games should proceed. WHO refuses to be drawn on whether they should go ahead. The ECDC has told The Lancet it has not specifically performed or even discussed a risk evaluation for the Olympics. In 2016, amid Zika, US CDC director Tom Frieden, declared there was no public health reason to cancel or delay the Rio Games. The CDC has not responded to several requests from The Lancet to clarify its stance on Tokyo 2020."