Japan Cultural Background

Japan’s history of living with infectious diseases

Japan has a long history of dealing with infectious diseases, from cholera, measles, to smallpox. As for smallpox, recorded cases go back as far as middle of 6th century. People had to cope with these infectious diseases despite having limited medical knowledge – so they learned and adapted to live with them.

History of infectious disease and role of religion in japan

Japan’s religious traditions are polytheistic. Among these traditions infectious diseases were often seen as the work of deities. Shrines were built and great festivals were held to comfort these deities when outbreaks occurred. Famous festivals that have become popular destinations today, such as Gion Matsuri of Yasaka Jinja and Tenjin Matsuri of Osaka Tenmangu are both festivals that have its roots in epidemics.

One of the most common deities are the smallpox deities. Shrines and stone monuments that are dedicated to smallpox deities can be found throughout the country in Japan. However, the history and identity of many of these deities are extremely diverse and often ambiguous. Despite such ambiguity, locals still go to these shrines and monuments to pray.

Deities were thought to being the disease, but also the ones who healed. The deities were the savior of the dead, but also those who could be sympathetic with those who lost their lives due to smallpox. As such, people did not work to get rid of these deities; but rather, they tried to calm them or ask them to return to where they came from by treating them with hospitality.

For instance, whenever there was a patient with smallpox in early modern periods, a shelf for deities of smallpox would be setup near the patient’s bed. Things like dolls, rice cakes, gohei (paper ornaments) would be offered to them in these shelves. Red color was considered to be the favorite color of the smallpox deities, so items colored in red would often be placed around the patient. Akabeko, a famous traditional toy from Aizu area in Fukushima, is red because it was originally made to be dedicated to smallpox deities. After 12 or 13 days, the shelves would be taken down, dolls and gohei (used as a medium for the deities) would be thrown into the river, the sea, or the grounds of the shrine.

There are also “Apology of the Smallpox Deities” letters found in houses across eastern Japan that were written in early modern period. These “letters” are thought to have been used as an amulet. In these letters, the deities, who received generous hospitality from the people, regretted that they had brought the disease to them and promised that they would never bring severe disease again.

The deities also leave people with advice in these letters. They tell the sick not to lie until he is fully recovered. They also tell patients to remain patient without scratching where it itches and use a rabbit’s hand if they must scratch. Another advice is to take a bath in liquor after symptoms have subsided.

Modern day Japan

While such religious/cultural traditions can be commonly observed in history, Japan is not the same country that it was back when smallpox deities were treated well so that it would leave with the disease. Japan has Westernized rapidly, particularly in metropolitan areas, and much of these traditions are not widely known. In fact, these stories about smallpox deities are probably new to most people.

A possible explanation to connect the traditions to the role that it may have played in the current pandemic might be Japanese people’s attitude towards religion itself. Traditional Japanese religions are different from monotheistic religions. The religions do not ask whether you believe in a certain god or not. So most people look at Japanese religions as traditions, and say to themselves, “Who knows if gods exist? They may or may not.” This may not be acceptable or considered blasphemous in monotheistic cultures, but this is how people live with many gods today. Perhaps they are more “opportunistic” – praying to them just in case that they do exist.

Japan has advanced in science as much as any other country. Most people are educated and can understand that the virus is causing COVID-19. But this attitude of, “Who knows gods exist” might be allowing them to accept that humans cannot control everything; that there are powers in nature that are difficult to overcome. Japanese people are particularly aware of this as they have been living with frequent natural disasters. This attitude may be allowing them to accept realities and learn to live with what they are given.

Role of traditions in how we treat the infected and the dead

One of the important lessons from history is also around how we treat those who have become ill or have died from these infectious diseases.

Those who suffered and died from smallpox would become deities and were revered by people who were infected with smallpox. This notion, which was not limited to smallpox but could be seen in other infectious diseases, gave way to respecting and honoring those who died from such infectious diseases.

Today, for COVID-19, not every patient is being treated with respect. In some cases, people have to be isolated without the chance to say goodbye to their loved ones and are cremated before they are united again. There are also issues around treating how we treat those who have become infected. In Japan, there is strong peer pressure. This has worked positively in some ways – it helped people to follow guidance from the government without special enforcement measures that likely contributed to bringing the outbreak under control; however, it also creates issues such as discrimination. Virus does not discriminate; we know that while there are higher risk activities, no one can be at zero risk – and that means that there should be no discrimination against those who are infected. We should treat patients who are infected with respect and care, just like we would with any other illness.

Importance of learning from history

There are two important reasons to learning from history and culture. First is that we can learn from the facts of the history. Past infectious diseases can tell us not only patterns of infection and how to intervene, but also tell us how people react to measures, what behavioral changes were effective, etc. New ideas can be drawn from past experience so that we can have a more effective response in face of a new outbreak.

The historical evidence of people seeing infectious diseases as work of deities is an important lessons for today to tell stories about how people coexisted with diseases before science had become advanced. It shows the importance of the role of culture, especially religious culture, to show that even where there is suffering and sorrow, life was still worth living.

Ever since the 2011 earthquake in Tohoku region, there has been a lot of research into the role of cultural heritage, especially around roles or local festivals, folklore, and folk performances. These have become integral part of people’s lives. While they may not help to mitigate such disasters, many survivors have found support and comfort in these events as well as stories and art. Communities revitalize around them. We can see in history that our ancestors have also used these mechanisms to live with tragic pandemics.

Today, we must accept the realities that we must live with COVID-19. How do we accept such reality without losing the joys of life and remind people that life is worth living, particularly when we are restricted from known activities, technology is implemented to limit individual freedom for the sake of public good, and there is no known end in sight? We should be turning to history and culture and take lessons from our ancestors.


Kimura Toshiaki, 2016, Revival of Local Festivals and Religion after the Great East Japan Earthquake, Journal of Religion in Japan 5(2-3).

Hartmut Rotermund, 1991,  Hōsōgami, ou la petite vérole aisément : matériaux pour l’étude des épidémies dans le Japon des xviiie-xixe siècles, Maisonneuve et Larose.

About the author

Dr. Toshiaki Kimura is a professor of Graduate School of Arts and Letters at Tohoku University, Japan. His research interests includes disaster and religion and Indonesian society and religion. 

Dr. Toshiaki Kimura
Tohoku University

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