As the countdown to the Tokyo Olympic and Paralympic games reaches 100 days, plans to hold the games this summer must be reconsidered as a matter of urgency, argue experts in The BMJ today.
Kazuki Shimizu at the London School of Economics and Political Science and colleagues say huge uncertainty remains about the trajectory of the pandemic and they warn that international mass gathering events such as Tokyo 2020 "are still neither safe nor secure."
Instead, they say "we must accelerate efforts towards containing and ending the pandemic by maintaining public health and social measures, promoting behaviour change, disseminating vaccines widely, and strengthening health systems."
They acknowledge that substantial scientific advancements have occurred over the past year, but say vaccine roll-out has been inequitable, reducing access in many low and middle income countries.
And although a special scheme for vaccinating athletes - marshalled by the International Olympic Committee - may help save lives, they argue that "it could also encourage vaccine diplomacy, undermine global solidarity (including the Covax global access scheme), and promote vaccine nationalism."
They point out that, unlike other countries in the Asia-Pacific region, Japan has not yet contained covid-19 transmission.
"Even healthcare workers and other high risk populations will not have access to vaccines before Tokyo 2020, to say nothing of the general population," they write.
To properly protect athletes from covid-19, "Japan must develop and implement a clear strategy to eliminate community transmission within its borders, as Australia did before the Australian Open tennis tournament."
Japan and the International Olympic Committee must also agree operational plans based on a robust science and share them with the international community, they add.
Waiving quarantine for incoming athletes, officials, broadcasters, press, and marketing partners "risks importing and spreading covid-19 variants of concern" and while international spectators will be excluded from the games, "cases could rise across Japan and be exported globally because of increased domestic travel - as encouraged by Japan's official campaigns in 2020."
An overwhelmed healthcare system combined with an ineffective test trace and isolate scheme "could seriously undermine Japan's ability to manage Tokyo 2020 safely and contain any outbreak caused by mass mobilisation," they write.
Finally, they point out that very little has been said officially about the Paralympic games and how to protect the health and rights of people with disabilities during international competition.
"The whole global community recognises the need to contain the pandemic and save lives. Holding Tokyo 2020 for domestic political and economic purposes - ignoring scientific and moral imperatives - is contradictory to Japan's commitment to global health and human security," they argue.
"We must reconsider this summer's games and instead collaborate internationally to agree a set of global and domestic conditions under which international multisport events can be held in the years ahead. These conditions must embody both Olympic and Paralympic values and adhere to international principles of public health," they conclude.