By Tilman Ruff
Professor Kiyoshi Kurokawa, who chaired the Nuclear Accident Independent Investigation Commission, Japan’s first ever independent parliamentary investigation commission, has written recently that since the Commission submitted its recommendations to the national Diet in 2012, “little progress of significance can be observed”. He describes the regulatory changes as “only amounting to cosmetic changes”. This textbook case of regulatory capture, with Japanese nuclear regulatory agencies serving the interests of the nuclear power industry instead of protecting the safety of the people, has changed relatively little. Kurokawa describes the changes prompted by the Commission’s report amongst governmental bodies “have been formalities at the minimum required level”. He writes “that the structures of regulatory capture are still firmly maintained”.
It is the people of Japan who not only suffer the impacts of the disaster, but largely bear the cost, such as through the US$119 billion interest-free loan TEPCO secured from the government, paid by citizens’ taxes.
In light of the mainly indirect but strong evidence that radioactivity began leaking from Unit 1 as a result of the earthquake, before the tsunami hit, the Commission recommended that the implications should be seriously considered for all other nuclear power plants in Japan. This has not happened. Since 2011, 9 nuclear power reactors in Japan have been re-started. One can have little confidence, should things go wrong again in Fukushima or elsewhere, that crisis management would be much better than in the debacle that unfolded in Fukushima 8 years ago.
By 2017, a total of 40,000 workers had been involved in the extensive decommissioning work which will be required for many decades. About 8000 work at any one time. Over 90% of these are subcontractors, who have poorer training and conditions and receive on average more than twice the radiation exposure compared with TEPCO employees. Maximum exposures for subcontractors in Jan 2018 were documented at over 10 mSv/month. Thus far 5 cases of cancer among clean-up workers have been officially recognised as occupationally-related – including 3 cases of leukemia, one thyroid cancer, and 1 case of lung cancer.
The Japanese government has been aggressively pushing the lifting of restrictions orders for contaminated municipalities in Fukushima. This artificially reduces the number of officially recognised evacuees. While attempting to create a misleading illusion of return to normality, the government is still now, 8 years after the disaster, applying an allowable radiation annual dose limit for the public of 20 mSv. It is the only government worldwide to accept such a high level so many years after a nuclear disaster. It has even established 4 reconstruction sites in areas where residents would accumulate more than 50 mSv/y, and scheduled returns to these areas by 2023. People who have relocated from areas where restriction orders have been lifted are under significant pressure to return to an unacceptably hazardous environment, or lose all financial support. Despite these pressures, only 3-29% of citizens have returned to 5 municipalities where restriction orders have been lifted, and up to half of former residents have decided not to return, with many undecided.
Consistent with its failure to prioritise the safety and health of its citizens, the government of Japan still continues to promote the scientifically fraudulent position that less than 100 mSv of radiation is not associated with proven health harm.
Important data on population radiation exposures have emerged regarding external gamma exposure measurements from extensive glass badge individual monitors undertaken from 2012 among more than 50,000 residents of Date City. Just northeast of Fukushima City, most of Date is more than 50 km from the Fukushima Daiichi plant, and it is not one of the most contaminated municipalities. Two published papers yield some important findings:
- External radiation exposure measured by glass badge individual monitors correlated well with airborne survey data; 
- No effect of exposure reduction was observed related to decontamination activities;
- Allowing for a 3-fold underestimate of estimated lifetime doses in the published paper  recently acknowledged by the senior author, the estimated lifetime average doses for residents in different zones in Date range from 33 to 54 mSv, while the 99th centile doses range from 60 to 105 mSv. These are significant doses based on actual exposure measurements; much greater than those typically estimated for people outside the most contaminated areas.
Regrettably very serious ethical and integrity issues have been raised in relation to the conduct of this research.
By Sep 2018, the Japan Reconstruction Agency identified 2202 deaths as related to the nuclear disaster – principally through suicide and interrupted or diminished medical care. However comprehensive long-term prospective mechanisms linked to radiation exposure have not been established to monitor population health impacts of the nuclear disaster. If you don’t look, you won’t find. Given the fragmented and incomplete nature of cancer registries in Japan, it is quite possible that health effects would not be detected.
The one area that promised to be an exception was monitoring for thyroid cancer through regular ultrasound screening among those in Fukushima aged under 18 years at the time of the disaster. By Dec 2018, 166 surgically confirmed thyroid cancer had been identified among 207 cytologically suspected cancers. Independent analysis has strongly indicated that while a screening effect is also present, the incidence is much higher than nationally, with a gradient mirroring contamination levels in Fukushima Prefecture,  and no indication that cases identified tend to be benign, with 92% of operated cases reported as having evidence of metastases and/or extrathyroidal extension. However, the screening program is being curtailed, timely and transparent release of data is lacking, cases diagnosed or treated outside Fukushima Medical University are excluded, and participation rates in successive surveys are falling, likely reflecting declining public confidence in the program. Participation rates in the 3rd round survey, both initial and confirmatory examinations, have declined to around 60%, and only 16% among those aged over 18. 
Effects in other animals and plants
Evidence continues to accumulate of harmful biological effects in direct proportion to the degree of radioactive contamination, without any apparent threshold, in virtually every species and ecological community studied – soil bacteria and fungi through trees, various insects, spiders, diverse birds, and large and small mammals – in the contaminated regions of both Chernobyl and Fukushima. In the intertidal zone along the Fukushima coast, there are much lower numbers of species and populations of molluscs within 30 km of the nuclear plant. Most effects are apparent across the range of 1–10 mGy/y. Like for human radiation health effects, the more we know, the worse it looks.
Much of this important work has been by Timothy Mousseau and Anders Møller. They have documented effects at every biological level, including increased genetic mutations; adverse developmental effects, including albinism, asymmetry, reduced brain size, cataracts, reduced fertility and sperm number with increases in abnormal and immotile sperm; increased tumours; behavioural abnormalities such as in bird calls; reduced abundances and biodiversity. Their findings indicate that populations living under the full range of natural stressors (biotic and abiotic) are almost 10 times more sensitive to ionising radiation than predicted by conventional laboratory-based approaches.
It is biologically implausible that humans would be somehow immune to similar effects.
While Japan responded that it was or would implement these recommendations (but not any particular provisions for second and subsequent generation survivors), no corresponding measures have yet been taken.
It is important that the international public health and medical communities monitor continuing health needs related to the disaster and advocate for the policies, resources and other measures to address them, and support the efforts of those in Japan working for public and environmental health. We should utilise the 2020 Olympics in Japan to shine a light on the lessons of the Fukushima nuclear disaster, the impacts and needs from the disaster, and ensure that they are not swept under the carpet.