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  4. September 2022 - Volume FOCUS September 2022 Volume 109
  5. Viral Disruption and Labor Rearrangement: 
COVID-19 and its Impact on the Procurement of 
Migrant Healthcare Workers for Japan

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FOCUS September 2022 Volume FOCUS September 2022 Volume 109

Viral Disruption and Labor Rearrangement: 
COVID-19 and its Impact on the Procurement of 
Migrant Healthcare Workers for Japan

Mario Lopez

Since the mid-2000s, Japan has experienced a dynamic demographic shift. In 2008, the nation was officially classified as a "super-aging society" and demographic contraction has become a key focus of public policy. By 2050, the Japanese population is predicted to shrink from one hundred twenty-six to one hundred million and with a low fertility rate, dynamic societal transformations will be inevitable. Neither supplementary migration of pro-fertility policies will be able to halt the demographic changes that Japan will experience over the next fifty years. In 2020, over 65s accounted for just over 28.7 percent of the population. This will rise to 32 percent in 2030 and then 41 percent by 2055. Since 2008, nurses and care workers started to enter Japan under Economic Partnership Agreements (EPAs) signed between Japan, Indonesia, the Philippines, and Vietnam and to date, 7,991 entered Japan and 2,950 candidates have sat and passed the Japanese national licensure examination to work in Japan. However, this small number did not alleviate the chronic shortage of nurses and care workers who were needed for medical and social welfare services. In 2014, the Japanese government announced a revitalization strategy with consensus on introducing care workers under its technical training system (tokutei gino seido). Then in 2016, the Japanese Ministry of Health, Labor and Welfare (MHLW) clarified that by 2025, there would be a shortage of 550,000 nursing care personnel or better put, 60,000 per year. In the following year, revisions were adopted that finally paved the way for the entry of technical intern trainees in the area of care, predominately from Southeast Asia. Nursing care students were offered opportunities to become certified nursing care workers with "specified skills" (tokutei gino) and the expectation was that a new floating migration stream (albeit a temporary one) would help alleviate shortages. Then in 2020, the severe acute respiratory syndrome corona-virus (SARS-CoV-2 hereforth COVID-19) worldwide pandemic struck disrupting what was newly emerging care nexus and Japan's fragile dependency on migrant labor. In what ways did the pandemic disrupt labor flows and how did different actors respond? This article offers a brief overview of the impact of the pandemic taking Fukuoka Prefecture for the period 2020-2022 as a case study.

COVID-19 and the Reorganization of Migrant Care Worker Streams

In 2020, the COVID-19 pandemic hit Japan. Although the country was able to avoid some of the high levels of mortality, infection rates and hospitalization that were witnessed in other nations, this was partially due to regional and national lockdown restrictions on international and domestic movement including the strengthening of both quarantine and border controls. Since then, the pandemic has reoriented Japanese society, impacting work patterns, forms of social contact and employment opportunities. However, it played out with particular intensity in the care sector and long-term care facilities located in Japan, many were increasingly employing migrant workers. As of October 2021, the total number of non-Japanese workers in Japan was 1,727,221 and among these a new rising proportion were working in medical and social care welfare services. In 2020, figures from the MHLW showed that those working in the care sector numbered 43,4461 and these shot up to 57,788 for October 2021.2 These figures suggest that in spite of a restrictive pandemic control regime, the need for migrant care workers led to a continued increase in the sector to cover the chronic shortfalls in long-term care facilities.

Fukuoka is a long-term research site I have worked in over a period of fifteen years. It is a well-known gateway to East Asia, a vibrant livable city, and a home to numerous migrant communities. However, in line with the national trend, the population is decreasing while the proportion of the elderly 65 years or older is expected to reach 35.3 percent by 2040. As with other cities in Japan, Fukuoka city suffers from a shortage of care labor and the city has employed several approaches to alleviate this. One of the earliest was through inviting certified nurses through the EPA program and since 2008, one hundred and twelve have come to work in the prefecture, but with negligible effect. However, the impact of the COVID-19 pandemic led to a reconfiguration in the types of workers placed at care homes within the prefecture; re-organizing how different actors, institutions and care workers themselves responded under the pandemic. In collaboration with academics, not-for-profit organizations (NPOs) and other stakeholders an idea of circulating knowledge experience and know-how aims to see Fukuoka develop as a model city where workers can come, train, learn and work. Ultimately, this functions as an extended care regime which can circulate Japanese care knowledge and know-how through training and practice within the prefecture and then more broadly within Asia. Civil servant representatives who I have interviewed over the past few years hope to set a precedent and model through the idea of circulation within the field of care. This has been fostered through instituting a working group of different organizations and stakeholders to promote the appeal of nursing care, increase workers, improve business efficiency and the quality of workers entering the prefecture and raise the profile of the city. The prefecture has also worked alongside companies that has been recruiting and training local non-Japanese residents, mainly Filipinos, many of whom arrived in Japan in the 1990s and early 2000s and are married to Japanese. Since 2006, one company, Interasia, has trained over three hundred Filipinos as certified care workers and is now collaborating to train technical intern trainees from Vietnam, Myanmar and other nations. This in itself is a form of recycling earlier migrant streams and shows the ways in which migrant labor is being reshuffled to meet the needs of the care sector. Prior to and during the pandemic, non-Japanese students and technical interns were also becoming another stream of labor. This suggests a re-configuration as care homes, care giving course providers and other institutions diversified their strategies to procure flexible labor streams that respond to shortages.

Impact of COVID-19 on Long-term Care Homes

A number of care facilities I visited as part of team-led research project presented the challenges they have faced under the pandemic. One facility, part of a social welfare service corporation located just outside Fukuoka city employs thirty care workers from four different streams from different Asian nations: EPA nurses, graduates from local junior colleges with recognized qualifications, technical trainees, and non-Japanese students. Interviews with the director stressed that the pandemic proved a positive opportunity to reappraise the role of migrants as essential key workers supporting the Japanese health care system during a time when it was tested. At present, the social welfare service corporation has diversified its strategy to secure care workers and through a partnership with a Vietnamese nursing college it started to receive nursing students training under an internship exchange program for one year. Candidates receive training in Japan, return home and then reapply to return under the specified skills visa category. The goal is to train to be certified care workers under specified skills visa category, foster knowledge cultivation and circulate human resources within the group home with a secure supplier (university). Ongoing fieldwork has examined the advantages and disadvantages of hiring non-Japanese workers. One finding showed that there is a higher turnover risk when employing workers with "specified skills." Wage disparities mean that if workers change visas they can move to the Kansai and Kanto regions where salaries can vary by 20-30,000 Japanese Yen. EPA and specified skill caregivers can and do move on.

Diversifying Forms of Recruitment and Wage Stability

One clear pattern observed during the pandemic was the stability that the care sector offered to a diversifying pool of workers. In 2020, certain sectors temporarily shut down due a collapse in work opportunities in the food, retail and hotel industry, ones which students have often worked in. Students and workers on the TITP program have traditionally acted as part of a buffer workforce in Japan and the pandemic reoriented the flow of their labor. As a result, some vocational colleges that provide caregiver courses started to sell training packages to facilities who would be guarantors for students. One college official interviewed noted how they were being contacted by other companies to see if their workers could shift to the care sector and be retrained. Students who graduated from one program could be guaranteed a monthly salary of 190,000 Japanese Yen (1,738 US dollars) working day and night shifts. Prior to the pandemic, one trend observed was a rise in "migrant students" (dekasegi ryugakusei), but the pandemic triggered a rise in what we might call "care migrant students" (kaigo ryugakusei). This shuffling around of labor makes clear that the care sector offered some stability, but migrant workers act as a temporary buffer workforce.

A Future with Migrant-fed Care Regimes?

The examples above show that the future of care work in Japan may, to a certain degree, be migrant-driven. We are starting to witness the rise of multicultural care homes that circulate care and knowledge from those from different cultures. The influence non-Japanese care workers wield, may lead to a more multidimensional workforce feeding into how care will be provisioned. The pandemic provided a positive opportunity for Japanese care workers and managers to acknowledge and appraise migrant workers as valuable and essential key workers. And the experiences facilities had, in tandem with local government initiatives, show us what challenges care homes faced in maintaining and training a diverse pool of workers from different countries and migration streams under testing conditions. These experiences align with the model of knowledge circulation that local government in Fukuoka has been fostering in the hope of creating a system which can be replenished by future migration streams. Migrants, be they long-term sojourners, or those here for five years, should not just be seen as part of a portfolio of strategies to alleviate labor shortages. As we move into a "living with corona" era, shoring up deficits in the care sector will not be alleviated through dependency on a floating buffer workforce. After all, the care sector demands a high level of expertise, language acquisition and attention to the needs of elderly at different stages of aging. Japanese politicians and policy makers need to be more aware of the fragile dependency on migrants who, as "essential workers," provide care for the elderly. This will require a more open, public, and serious discussion on who will constitute Japanese society and care for it in this age of demographic transition.

Mario Lopez is Associate Professor at the Center for Southeast Asian Studies (CSEAS), Kyoto University. He currently researches the transnational flow of healthcare personnel within the Asia-Pacific region in response to demographic change and labor shortages. Over the last two years he has worked on how the COVID-19 pandemic impacted the Procurement and Lives of Migrant Healthcare Workers in Japan's healthcare sector. He is also one of the editors of the Corona Chronicle Website that was set up to document the effects of the pandemic in Southeast Asia (

For further information please contact: Mario Lopez, Center for Southeast Asian Studies, Kyoto University, e-mail:

1 Ministry of Health Labour and Welfare, Gaikokujin Koyou Jyokyo no Todokede Jokyo Matome, Reiwa 2-nen 10-gatsu-matsu Genzai [Summary of Employment Status of For-eign Nationals as of Oct. 2021] (In Japanese),
2 Ministry of Health Labour and Welfare, Gaikokujin Koyou Jyokyo no Todokede Jokyo Matome, Reiwa 3-nen 10-gatsu-matsu Genzai [Summary of Employment Status of foreigners as of Oct. 2022],