“If South Korea or China announced the same thing, I’m sure that the Japanese government and the vast majority of the Japanese people would also object,” she said.

Governments in the region most likely feel domestic pressure to take a strong stance, said Eunjung Lim, an associate professor of international relations at Kongju National University in Gongju, South Korea, who specializes in Japan and South Korea.

Whether their worries are rational or not, many people in the region “are going to be very, very anxious about what would happen if this radioactive material came into our near seas and contaminated our resources,” she said.

Even under the best of circumstances, Japan would find it “really difficult to persuade its neighbors to accept this kind of decision, because obviously, it’s not our fault. It’s Japan’s fault, so why do we have to experience this kind of difficulty?” she added.

Regional tensions have made surrounding countries even less receptive to the plan. In recent years, territorial disputes and disagreements over trade and historical issues related to World War II have strained Japan’s relations with China and South Korea, with spillover effects on government dialogues across a broad range of issues.

China warned Japan on Tuesday against taking any decision without further consultation with the international community, saying that it “reserved the right to take further action.”

In its statement, South Korea accused Japan of taking “unilateral action” without seeking consultation and understanding with South Korea, which “lies closest to Japan.”

Some in Japan believe that such complaints should be met with more than scientific arguments. Shunichi Tanaka, a former chairman of the Nuclear Regulation Authority, said that the criticism smacked of hypocrisy.

South Korea itself operates four heavy-water reactors that routinely discharge water containing tritium at higher levels than those planned in Fukushima, he said in a recent interview.

“When South Korea makes claims like this, we shouldn’t be quiet, we need to properly refute them,” he said.

But the challenge Japan faces is not just on the global stage. At home, many are reluctant to trust the government or Tepco, the nuclear plant’s operator.

A parliamentary commission found that the meltdowns had been the result of a lack of oversight and of collusion between the government, the plant’s owner and regulators. And Tepco was forced to retract assertions that it had treated most of the wastewater. In fact, it had completely processed only about one-fifth, a problem that arose from a failure to change filters in the decontamination system frequently enough.

Ultimately, Japan is in a battle to alter perceptions, whether of the trustworthiness of its own government or of the risk posed by the treated water, said Hirohiko Fukushima, a professor at Chuo Gakuin University specializing in local governance issues.

In Fukushima, the government’s response to local concerns has often come across as highhanded, he said. Changing that view will require the authorities to improve transparency around their decisions and build new relationships, he said.

“From my perspective,” he added, “it’s probably difficult for Japan to convince foreign countries when it can’t even convince its own people.”

Choe Sang-Hun contributed reporting from Seoul. Albee Zhang contributed research from Shanghai.

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Japan to Start Releasing Radioactive Water From Fukushima in 2 Years

Japan said on Tuesday that it had decided to gradually release tons of treated wastewater from the ruined Fukushima Daiichi nuclear plant into the ocean, describing it as the best option for disposal despite fierce opposition from fishing crews at home and concern from governments abroad.

The plan to release the water in two years was approved during a cabinet meeting of ministers early Tuesday.

Disposal of the wastewater has been long delayed by public opposition and by safety concerns. But the space used to store the water is expected to run out next year, and Prime Minister Yoshihide Suga told lawmakers on Monday that the ocean release was “unavoidable” and could no longer be postponed.

The Fukushima crisis was set off in March 2011 by a huge earthquake and tsunami that ripped through northeastern Japan and killed more than 19,000 people. The subsequent meltdown of three of the plant’s six reactors was the worst nuclear disaster since Chernobyl. Tens of thousands of people fled the area around the plant or were evacuated, in many cases never to return.

Ten years later, the cleanup is far from finished at the disabled plant, which is operated by the Tokyo Electric Power Company. To keep the three damaged reactor cores from melting, cooling water is pumped through them continuously. The water is then sent through a powerful filtration system that is able to remove all of the radioactive material except for tritium, an isotope of hydrogen that experts say is not harmful to human health in small doses.

said last year that both options were “technically feasible.” Nuclear power plants around the world routinely discharge treated wastewater containing tritium into the sea.

But the Japanese government’s plan faces strong opposition from local officials and fishing crews, who say that it would add to consumer fears about the safety of Fukushima seafood. Catch levels in the area are already a small fraction of what they were before the disaster.

expressed concerns.

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A ‘Game Changer’ for Patients With Esophageal Cancer

The chemotherapy has difficult side effects, and the radiation causes a burning sensation that makes it difficult to swallow. “Food won’t go down,” Ms. Mordecai said. “You just feel rotten.”

The next step is major surgery. A doctor takes out most of the patient’s esophagus, the tract leading from the mouth to the stomach, and then grabs the stomach and pulls it up, attaching it to a stump of esophagus left behind.

The result is a stomach that is vertical, not horizontal, and lacks the sphincter muscle that normally keeps stomach acid from spilling out. For the rest of their lives, patients can never lie flat — if they do, the contents of their stomach, including acid, pours into their throats. They can choke, cough and aspirate.

Recovery is difficult, and morbidity and mortality are high. But most patients go through with the operation once they weigh their options. To refuse the treatment means giving up and letting the cancer close off the esophagus to the point where some cannot even swallow their own saliva, said Dr. Paul Helft, a professor of surgery and an ethicist at Indiana University School of Medicine.

The treatment is so long and harrowing that Dr. Helft often uses it to teach medical students and other trainees about informed consent — about how patients must be fully informed before they start any given treatment. Esophageal cancer patients in particular must be told that they are likely to have a recurrence within the first year.

Ms. Mordecai said her husband had his surgery at the end of September 2008. By Dec. 6, he had untreatable metastases in his liver. Now, she said, patients may have a glimmer of hope.

Dr. Ilson, who has spent his career trying to develop therapies to help patients with esophageal cancer, said that he did not expect this treatment to succeed: “We all get nihilistic when faced with years of negative studies.”

“This is really a landmark paper,” he added, and the drug “will become a new standard of care.”

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The Most Intimate Portrait Yet of a Black Hole

The Event Horizon Telescope collaboration, an international team of radio astronomers that has been staring down the throat of a giant black hole for years, on Wednesday published what it called the most intimate portrait yet of the forces that give rise to quasars, the luminous fountains of energy that can reach across interstellar and intergalactic space and disrupt the growth of distant galaxies.

The black hole in question is a monster 6.5 billion times as massive as the sun, and lies in the center of an enormous elliptical galaxy, Messier 87, about 55 million light-years away in the constellation Virgo. Two years ago, the team photographed it, producing the first-ever image of a black hole; the hitherto invisible entity, a porthole to eternity. It looked like a fuzzy smoke ring, much as Albert Einstein’s equations had predicted a century ago.

The group has spent the last two years extracting more data from their observations about the polarization of the radio waves, which can reveal the shape of the magnetic fields in the hot gas swirling around the hole.

Now, seen through the radio equivalent of polarized sunglasses, the M87 black hole appears as a finely whiskered vortex, like the spinning fan blades of a jet engine, pumping matter into the black hole and energy outward into space.

two papers published in the Astrophysical Journal Letters by the Event Horizon Telescope Collaboration, and in a third paper, by Ciriaco Goddi of Radboud University in the Netherlands and a large international cast, that has been accepted by the same journal.

the Event Horizon Telescope, an international collaboration that now comprises some 300 astronomers from 13 institutions.

The telescope is named after the point of no return around a black hole; beyond the event horizon, all light and matter is consumed. In April 2017, when the telescope spent 10 days observing M87, it consisted of a network of eight radio observatories around the globe — “a telescope as big as the world,” as Dr. Doeleman likes to say, able to spot details as small as an orange on the moon. The team then took two years to process the data. The results came together in April 2019, when Dr. Doeleman and his colleagues presented the first-ever images — radio maps, really — of a black hole, the monster in M87.

framed by a swirling doughnut of radiant gas in the center of the galaxy Messier 87.

“We have seen what we thought was unseeable,” Dr. Doeleman said at the time. The picture appeared on the front page of newspapers around the world, and a copy is now in the permanent collection of the Museum of Modern Art in New York.

But that was only the beginning of the journey inward.

It took another two years for researchers to produce the polarized images released on Wednesday.

Jets and lobes of radio, X-ray and other forms of energy extend more than 100,000 light-years from the black hole in M87. Much of this radiation comes from energetic electrical particles spiraling around in magnetic fields.

The newly processed image allows the astronomers to trace these fields back to their origins, in a hot, chaotic ring of electrified gas, or plasma, about 30 billion miles across — four times as wide as the orbit of Pluto. That achievement is made possible because the light from the disk is partly polarized, vibrating more in one direction than in others.

“The direction and intensity of the polarization in the image tells us about the magnetic fields near the event horizon of the black hole,” said Andrew Chael, an astrophysicist at Princeton University who is part of the Event Horizon team.

Astronomers have debated for years whether the magnetic fields surrounding so-called low-luminosity black holes like M87 were weak and turbulent or “strong” and coherent. In this case, Dr. Chael said, the magnetic fields are strong enough to disrupt the fall of the gas and transfer energy from the spinning black hole to the jet.

“The E.H.T. images also provide hints that the bright jet in M87 is actually powered from the rotational energy of the black hole, which twists the magnetic fields as it rotates,” said Michael Johnson another Event Horizon member from the Harvard-Smithsonian Center for Astrophysics.

As a result, Dr. Doeleman said, “This gives the emitted radio waves the azimuthal twist” observed in the curving pattern of the new, polarized images. He noted that azimuthal twist would be a “fine name for a cocktail.”

A byproduct of the work, Dr. Doeleman said, was that the astronomers were able to estimate the rate at which the black hole is feeding on its environment. Apparently it isn’t terribly hungry; the black hole is eating “a paltry” one-thousandth of the mass of the sun per year.

“Yet it’s enough to launch powerful jets that stretch for thousands of light years, and it’s radiant enough for us to capture it with the E.H.T.,” he said.

Dr. Doeleman is already laying the groundwork for what he calls the “next generation” Event Horizon Telescope, which will produce movies of this magnetic propulsion structure in action.

“This is really the next big question,” Dr. Doeleman said. “How do magnetic fields extract energy from a spinning black hole? We know it happens, but we don’t know how it works. To solve that, we will need to create the first black hole cinema.”

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Bringing Rigorous Testing to Health Care Policy

That evaluation method is reminiscent of the traditional approach to assessing new surgical techniques — which have sometimes been shown to be worthless or worse, after being subjected to more rigorous testing. Radical mastectomies, for example, were widely used for decades before randomized trials showed that much less extensive and disfiguring surgery followed by radiation was an equally effective treatment.

Of course, conducting randomized trials can pose more challenges for evaluating a new surgery than a new drug. A surgical technique may be harder to standardize enough to be able to test it on a broad population, and blinding the patient to which treatment she receives can be far more difficult.

But such feasibility issues do not apply to new payment methods, which are well-defined and standardized interventions, and where blinding medical providers to the payment rules is not desired.

Still, as in medicine, not all public policies can — or should — have randomized evaluations. One-of-a-kind government projects — like the “Big Dig” in Boston or the Superconducting Super Collider in Texas — have no natural comparison group, randomized or otherwise. In times of crisis, or when policy disagreements are more about ideology than impact, evaluation itself may be ill advised.

But when — as is often the case — there is an opportunity for prospective evaluation and the law requires it, the Innovation Center’s experience underscores the value and feasibility of randomized trials of social policy. They can often be done at the same speed and cost as any prospective study, and can yield more compelling results. Random assignment where the government chooses by lottery who can receive the program may also be the fairest way to allocate an intervention on a limited basis.

Randomized testing may not be the standard for government evaluation yet, but such things take time. For example, the Food and Drug Administration was empowered in 1962 to obtain “substantial evidence” of a new drug’s safety and efficacy, yet it took more than five years for the agency to embrace randomized trials as the appropriate standard.

Now that the Biden administration is, again, properly emphasizing that all federal agencies need to make “evidence-based decisions” based on the highest scientific standards, perhaps truly rigorous testing of social policy will become as commonplace as it is for new vaccines. That would help ensure that government services are delivered as effectively and efficiently as possible.


Amy Finkelstein is the John and Jennie S. MacDonald professor of economics at M.I.T. She co-directs J-PAL North America, a research center at M.I.T. that conducts randomized evaluations.

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Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings

Yvette Lowery usually gets her annual mammogram around March. But last year, just as the pandemic was gaining a foothold and medical facilities were shutting down, the center where she goes canceled her appointment. No one could tell her when to reschedule.

“They just said keep calling back, keep calling back,” said Ms. Lowery, 59, who lives in Rock Hill, S.C.

In August, Ms. Lowery felt a lump under her arm but still couldn’t get an appointment until October.

Eventually, she received a diagnosis of Stage 2 breast cancer, started chemotherapy in November and had a double mastectomy this month.

an analysis of data by the Epic Health Research Network. Hundreds of thousands fewer screenings were performed last year than in 2019, according to the network data.

“We still haven’t caught up,” said Dr. Chris Mast, vice president of clinical informatics for Epic, which develops electronic health records for hospitals and clinics.

Another analysis of Medicare data suggested that as Covid cases spiked during certain periods in 2020, cancer screenings fell. The analysis — conducted by Avalere Health, a consulting firm, for Community Oncology Alliance, which represents independent cancer specialists — found that testing levels in November were about 25 percent lower than in 2019. The number of biopsies, used to diagnose cancer, decreased by about one-third.

While it is too early to assess the full impact of the delays in screenings, many cancer specialists say they are concerned that patients are coming in with more severe disease.

“There’s no question in practice that we are seeing patients with more advanced breast cancer and colorectal cancer,” said Dr. Lucio N. Gordan, the president of the Florida Cancer Specialists & Research Institute, one of the nation’s largest independent oncology groups. He is working on a study to see if, over all, these missed screenings resulted in more patients with later-stage cancers.

And even though the numbers of mammograms and colonoscopies have rebounded in recent months, many people with cancer remain undiagnosed, doctors are reporting.

Some patients, like Ms. Lowery, could not easily get an appointment once clinics reopened because of pent-up demand. Others skipped regular testing or ignored worrisome symptoms because they were afraid of getting infected or after losing their jobs, they couldn’t afford the cost of a test.

“The fear of Covid was more tangible than the fear of missing a screen that detected cancer,” said Dr. Patrick I. Borgen, the chair of surgery at the Maimonides Medical Center in Brooklyn who also leads its breast center. His hospital treated such large numbers of coronavirus patients early on that “we’re now associated as the Covid hospital,” he said, and healthy people stayed away to avoid contagion.

Even patients at high risk because of their genetic makeup or because they previously had cancer have missed critical screenings. Dr. Ritu Salani, the director of gynecologic oncology at the UCLA Health Jonsson Comprehensive Cancer Center said one woman, who was at risk for colon cancer, had a negative test in 2019 but didn’t go for her usual screening last year because of the pandemic.

When she went to see her doctor, she had advanced cancer. “It’s just a devastating story,” Dr. Salani said. “Screening tests are really designed when patients aren’t feeling bad.”

Ryan Bellamy felt no hurry last spring to reschedule a canceled colonoscopy, even though the presence of blood in his stool had prompted him to look up symptoms. “I really didn’t want to go to the hospital,” Mr. Bellamy said. He decided it was unlikely he had cancer. “They’re not following up with me so I’m OK with Googling,” he told himself.

A resident of Palm Coast, Fla., Mr. Bellamy said that after his symptoms worsened, his wife insisted that he go for testing in December, and he had a colonoscopy in late January. With a new diagnosis of Stage 3 rectal cancer, Mr. Bellamy, 38, is undergoing radiation treatment and chemotherapy.

Colon screening remained significantly lower in 2020, declining about 15 percent from 2019 levels, according to the Epic network data, although overall screenings were down 6 percent. The analysis looked at screenings for more than 600 hospitals in 41 states.

Lung cancer patients have also delayed seeking appropriate care, said Dr. Michael J. Liptay, chairman of cardiovascular and thoracic surgery at Rush University Medical Center in Chicago. One patient had imaging that showed a spot on his lung, and he was supposed to follow up, just as the pandemic hit. “Additional work-up and care was deferred,” Dr. Liptay said. By the time the patient was fully evaluated, the cancer had increased in size. “It wasn’t a good thing to wait 10 months,” Dr. Liptay said, although he was uncertain whether earlier treatment would have changed the patient’s prognosis.

Just as previous economic recessions led people to forgo medical care, the downturn in the economy during the pandemic has also discouraged many people from seeking help or treatment.

“We know cancers are out there,” said Dr. Barbara L. McAneny, the chief executive of New Mexico Oncology Hematology Consultants. Many of her patients are staying away, even if they have insurance, because they cannot afford the deductibles or co-payments. “We’re seeing that, particularly with our poorer folks who are living on the edge anyway, living paycheck to paycheck,” she said.

Some patients ignored their symptoms as long as they could. Last March, Sandy Prieto, a school librarian who lived in Fowler, Calif., had stomach pain. But she refused to go to the doctor because she didn’t want to get Covid. After having a telehealth visit with her primary care doctor, she tried over-the-counter medications, but they didn’t help with the pain and nausea. She continued to decline.

“It got to the point where we didn’t have a choice,” said her husband, Eric, who had repeatedly urged her to go to the doctor. Jaundiced and in severe discomfort, she went to the emergency room at the end of May and was given a diagnosis of Stage 4 pancreatic cancer. She died in September.

“If it wasn’t for Covid and we could have gotten her some place earlier, she would still be with us today,” said her sister, Carolann Meme, who had tried to persuade Ms. Prieto to go to an academic medical center where she might have gotten into a clinical trial.

When patients like Ms. Prieto are not seen in person but treated virtually, doctors may easily miss important symptoms or recommend medication rather than tell them to come in, said Dr. Ravi D. Rao, the oncologist who treated Ms. Prieto. Patients may downplay how sick they feel or neglect to mention the pain in their hip, he said.

“In my mind, telemedicine and cancer don’t travel together,” Dr. Rao said. While he also made use of telemedicine during the height of the pandemic, he says he worked to keep his offices open.

Other doctors defended the use of virtual visits as a critical tool when office visits were too hazardous for most patients and staff. “We were grateful to have a robust telemedicine effort when people simply couldn’t come into the center,” said Dr. Borgen of Maimonides. But he acknowledged that patients were frequently reluctant to discuss their symptoms during a telehealth session, especially a mother whose young children could be listening to what they were saying. “It’s not private,” he noted.

Some health networks say they took aggressive steps to try to counteract the effects of the pandemic. During the initial stay-at-home order last year, Kaiser Permanente, the large California-based managed care outfit, spotted a declining number of breast cancer screenings and diagnoses in the northern part of the state. “Doctors immediately got together” to begin contacting patients, said Dr. Tatjana Kolevska, medical director for the Kaiser Permanente National Cancer Excellence Program.

Kaiser also relies on its electronic health records to make appointments for women who are overdue for their mammograms when they book an appointment with their primary care doctor or even want to get a prescription for new glasses.

While Dr. Kolevska says she is waiting to see data for the system as a whole, she has been encouraged by the number of patients in her practice who are now up to date with their mammograms.

“All of those things put in place have helped tremendously,” she said.

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Fukushima Nuclear Cleanup Is Just Beginning

A resolution to the crisis at the Fukushima Daiichi nuclear power plant remains a distant goal a decade after three of its reactors melted down.

The most challenging part of the cleanup—removing molten nuclear fuel from each reactor—has yet to begin because of high radiation inside the reactor buildings, putting the targeted decommissioning of the plant by 2051 into doubt.

More than 80% of the Japanese public doesn’t feel significant progress is being made and is concerned about further accidents, according to a poll by national broadcaster NHK. Two recent incidents help explain why.

On Feb. 13, a large earthquake centered near Fukushima, an aftershock of the one 10 years ago, caused water to slosh out of a tank containing spent fuel rods, which must be kept submerged to avoid overheating. A week later, a fish caught off the coast of Fukushima was found to contain 10 times the allowed level of radioactive cesium.

The episodes weren’t threats to public health by themselves. The fuel rods weren’t exposed, and food from Fukushima is subject to intensive safety screening. The last fish over the radiation limit had been found two years earlier.

Offloading mackerel in Fukushima. A week after a large earthquake caused water to slosh out of a tank containing spent fuel rods last month, a fish caught found to contain 10 times the allowed level of radioactive cesium.

A fishing boat returns to port. Food from Fukushima is subject to intensive safety screening.

But the incidents show how risks from the plant continue to weigh on those who live and work nearby. Local fish catches were down more than 80% in 2019 compared with before the accident.

“We are still struggling with harmful rumors from the nuclear plant accident,” said Tadaaki Sawada, a spokesman for the federation of Fukushima fishery cooperatives. “How many more years will it continue?”

Buyers bid over the day’s catch.

Before February’s earthquake, the last fish over the radiation limit had been found two years earlier.

By several measures, the worst nuclear disaster since the Chernobyl accident in 1986 has been contained. Only around 2% of Fukushima prefecture, or state, is still a no-go area, down from 12% immediately after the disaster. An extensive decontamination process removed topsoil from areas around the plant.

Still, thousands of people remain forced out of towns closest to the plant.

“There are areas where people can’t return home or have only just begun to return, as well as the problem of agricultural, forestry and fishery businesses damaged by harmful rumors. It’s important to support and soothe those affected by the disaster, including the elderly and children,” Emperor Naruhito said at a memorial event in Tokyo on Thursday

Inside the Fukushima Daiichi nuclear plant grounds, radiation levels are sufficiently low that protective clothing is required only for those who go within about 100 yards of the buildings housing the damaged reactors. The reactors melted down when a tsunami triggered by an earthquake on March 11, 2011, cut the plant’s power and the reactors’ water cooling system failed.

Last year, plant operator Tokyo Electric Power Co., known as Tepco, and the government were close to a decision to start releasing into the sea over a million cubic meters of water from the plant, but plans were suspended amid opposition from local fishermen and concerns raised by neighboring countries.

Contaminated rain and groundwater is stored in large tanks that dominate one side of the plant site. Once treated to remove most radioactive elements, the water still contains tritium, a form of hydrogen that emits a weak form of radiation. Tritium is regularly released into the sea and air from nuclear plants around the world after dilution.

Inspectors from the International Atomic Energy Agency visited the Fukushima plant last year and said disposal of the treated water into the sea would be in line with international practice. “A decision on the disposition path should be taken urgently” to keep the overall decommissioning on track, the IAEA said.

The most challenging part of the cleanup—removing molten nuclear fuel from each reactor—has yet to begin.

The government says it is still discussing the issue and that disposal of the treated water won’t begin for about two more years.

Ian Fairlie, the former head of a U.K. government panel on radiation risks and an opponent of nuclear power, said Japan should add storage capacity for the water and wait for the tritium, which has a half-life of just over 12 years, to decay.

“Whenever you put a large amount of nuclides in the sea, it goes up the food chain, whether you like it or not. Any good environmentalist will tell you we shouldn’t use dispersion,” Dr. Fairlie said.

A shopping street in recently opened Futaba, the residential district closest to the nuclear power plant.

Other cleanup issues haven’t even started to be addressed, such as when to dismantle the reactors and where to put the radioactive fuel once it is recovered. Contaminated soil from near the plant has been stored locally, but Fukushima Gov. Masao Uchibori said the government has agreed it would be taken elsewhere.

An initial experimental phase for clearing up and removing all the molten nuclear fuel on each reactor floor is targeted to begin in 2022, two years behind schedule. A robot arm to be used in the process is under development in the U.K., but work to create it was delayed by a year because of the coronavirus pandemic.

Tepco has yet to get a clear picture of the location of molten fuel in the reactors because the levels of radiation are damaging even to robots. Akira Ono, head of plant decommissioning, said there was no need at present to extend the timeline for the process beyond 2051.

Gov. Uchibori said that gaining an accurate grasp of the molten-fuel situation was critical to making headway.

“If you look at the entire process, right now we are still around the starting point of decommissioning,” he said.

Fukushima 10 Years Later

Write to Alastair Gale at alastair.gale@wsj.com

Copyright ©2020 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8

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Japan’s Tsunami and Nuclear Disaster Unleashed a $300 Billion Effort to Rebuild a Hinterland

In the decade since the strongest earthquake in Japan’s history triggered a 32-foot tsunami that slammed into the eastern coastline, the cleanup effort has become one of the world’s most expensive, costing some $300 billion so far.

Thousands died as the wave hit and more than a half million people were displaced. The world’s worst nuclear accident since Chernobyl unfolded as three reactors at the Fukushima Daiichi power plant melted down.

The country expanded the reconstruction budget four times in 10 years and has laid out the equivalent of $2,400 for every person in Japan to revive Tohoku, the northeastern region hit by the tsunami, and mitigate radiation at the nuclear plant. Even as seawalls rise and homes are rebuilt, many people haven’t returned.

Budget for recovery

$18 billion

Texas winter storm (2021)

$175 billion

(2011 plan)

$110 billion

Japan’s 2011 disaster

Hurricane Katrina (2005)

$18 billion

Texas winter storm (2021)

$175 billion

(2011 plan)

$110 billion

Japan’s 2011 disaster

Hurricane Katrina (2005)

$18 billion

Texas winter storm (2021)

$175 billion

(2011 plan)

$110 billion

Japan’s 2011 disaster

Hurricane Katrina (2005)

$175 billion

(2011 plan)

Japan’s 2011 disaster

$110 billion

Hurricane Katrina (2005)

$18 billion

Texas winter storm (2021)

$175 billion

(2011 plan)

Japan’s 2011 disaster

$110 billion

Hurricane Katrina (2005)

$18 billion

Texas winter storm (2021)

Most of the money was spent on rebuilding homes, adding seawalls and repairing other damaged infrastructure with the goal of bringing people back and reviving the main industries such as fishing, agriculture and tourism.

Expenditure by category, FY2011-2020

Rebuilding infrastructure*

$124.2 billion

Nuclear disaster

Subsidies for damaged cities

Industry recovery

Victims support

Rebuilding infrastructure*

$124.2 billion

Nuclear disaster

Subsidies for damaged cities

Industry recovery

Victims support

Rebuilding infrastructure*

$124.2 billion

Nuclear disaster

Subsidies for damaged cities

Industry recovery

Victims support

Rebuilding infrastructure*

$124.2 billion

Nuclear disaster

Subsidies for damaged cities

Industry recovery

Victims support

The Tohoku region, home to about 7% of Japan’s population, has been experiencing a decline in population for more than a generation as young people relocate to bigger cities. Half of the tsunami victims were 65 or older.

In the three prefectures most affected by the tsunami, Iwate, Miyagi and Fukushima, the collective population has dropped 6% since the disaster.

Change in population since 1980

Earthquake and tsunami

Earthquake and tsunami

Earthquake and tsunami

Earthquake and tsunami

Earthquake and tsunami

Hundreds of miles of seawalls, some of them as tall as 50 feet, have gone up along the coast, costing about $13 billion. About 80% of the planned 268 miles of seawalls has been completed.

In Ishinomaki, waves as high as 33 feet traveled more than 3 miles inland, killing more than 3,000 people—including 74 of the 78 children attending Okawa Elementary School that day. The city is now protected by seawalls that are up to 32 feet tall.

Ishinomaki, the second-largest city in Miyagi Prefecture, was home to more than 160,000 people when the earthquake and tsunami struck on March 11, 2011. Some 4,000 were lost. In the waterfront district of Minamihama, which lost 500 people, memorial parks are being installed where homes once stood. Views of Minamihama in 2006, 2011 and 2020.

Photo: Maxar Techonoliges

The tsunami crashed into more than 1,000 miles of coastline, inundating some communities as far as 6 miles inland. Some cities saw widespread destruction of homes, like Rikuzentakata in Iwate, where 99.5% of homes were damaged. In Ishinomaki, 4,000 people died or are still unaccounted for and 76.6% of all houses in the city were at least partially destroyed.

Japan’s $300 billion coast

The country has spent billions rebuilding homes and erecting seawalls in the decade since the tsunami devastated more than 1,000 miles of coastline.

Note: Shown only the cities where the total of death and missing exceeds 15050.

Sources: Geospatial Information Authority of Japan (inundated area); Fire and Disaster Management Agency (death, missing, destruction); Ministry of Economy, Trade and Industry (evacuation zone); Reconstruction Agency, local governments (annotations); European Space Agency (satellite image); NASA (elevation data)

When the earthquake occurred, the Fukushima Daiichi reactors automatically shut down. Backup diesel generators operated the cooling pumps until two tsunami waves flooded the plant, knocking out the generators. In the days that followed, hydrogen buildup caused explosions in reactors 1, 2 and 3; a fire broke out in 4. Radiation levels rose to as high as 400 millisieverts an hour (people are normally exposed to 2.4 millisieverts a year). The government declared an evacuation zone with a radius of 12.5 miles.

Now, a forest of steel tanks holding more than a million tons of water with radioactive elements grows outside the plant. Water flows through the plant every second keeping the reactors cool, adding to the problem. The Japanese government and Tokyo Electric Power Co. , owner of the plant, are studying releasing water with radioactive tritium into the Pacific. They say it is safe and other countries do the same at their nuclear plants, but people in the fishing industry are concerned.

Officials estimate another 30 years of work remains before Fukushima Daiichi is completely dismantled. The biggest task, which has yet to begin, is removing melted fuel from reactors 1, 2 and 3. Because the inner parts of the reactors are too radioactive for humans and are often inaccessible to robots, they still haven’t been fully mapped or photographed.

Remembering what is sometimes called the “triple disaster”—earthquake, tsunami and nuclear meltdowns—is an annual event in Japan. On March 11 this year, the government will hold a ceremony to commemorate the 10th anniversary of the disaster at the National Theater in Tokyo, offering a minute of silent prayer at 2:46 p.m., the time the earthquake struck. Emperor Naruhito and Empress Masako are set to attend.

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The Mayor’s House Was Firebombed. The Message: Keep Our Town Nuclear-Free.

SUTTSU, Japan — It seemed like easy money. The Japanese government was conducting a study of potential locations for storing spent nuclear fuel — a review of old geological maps and research papers about local plate tectonics. It put out a call for localities to volunteer. Participating would commit them to nothing.

Haruo Kataoka, the mayor of an ailing fishing town on the northern island of Hokkaido, put up his hand. His town, Suttsu, could use the money. What could go wrong?

The answer, he quickly learned, was a lot. A resident threw a firebomb at his home. Others threatened to recall the town council. A former prime minister traveled six hours from Tokyo to denounce the plan. The town, which spends much of the year in a snowbound hush, was enveloped in a media storm.

There are few places on earth eager to host a nuclear waste dump. Only Finland and Sweden have settled on permanent repositories for the dregs of their atomic energy programs. But the furor in Suttsu speaks to the deep anxiety that remains in Japan 10 years after an immense earthquake and tsunami caused the meltdown of three nuclear reactors in Fukushima Prefecture, the world’s worst nuclear disaster since Chernobyl.

promise that the country made late last year to be carbon-neutral by 2050.

Even before the Fukushima calamity, which led to three explosions and a release of radiation that forced the evacuation of 150,000 people, ambivalence toward nuclear energy was deeply ingrained in Japan. The country is haunted by the hundreds of thousands killed by the atomic bombings of Hiroshima and Nagasaki at the end of World War II.

Still, most Japanese had come to terms with nuclear power, viewing it as an inevitable part of the energy mix for a resource-poor country that must import about 90 percent of the materials it needs to generate electricity.

government’s plan to release a million tons of treated radioactive water from the site into the ocean.

The government says it would make small releases over 30 years with no impact on human health. Fishermen in Fukushima say that the plan would wreck their long journey toward recovery.

“We have this potentially dangerous technology and we still rely on it and we need to have a long-range view on nuclear waste and decommissioning, so we better think about a much more democratic way to handle the cost associated with it,” Mr. Miyazaki said in an interview.

Critics of nuclear power in Japan frequently point to the decades of failure to find a solution to the waste problem as an argument against restarting the country’s existing reactors, much less building new ones.

In November, former Prime Minister Junichiro Koizumi took his campaign against nuclear energy to Suttsu at the invitation of local activists. Speaking in the town’s gymnasium, he said that after visiting Finland’s underground waste storage site — a facility much like the one proposed by the Japanese government — he had decided that Japan’s active geology would make it impossible to find a workable location.

Japanese reactors have generated more than 18,000 tons of spent fuel over the last half-century. A small proportion of that has been turned into glass — through a process known as vitrification — and sheathed in giant metal canisters.

Almost 2,500 of the huge radioactive tubes are sitting in temporary facilities in Aomori and Ibaraki Prefectures, waiting to be lowered 1,000 feet beneath the earth’s surface into vast underground vaults. There, they would spend millenniums shedding their toxic burden.

It will be decades — if ever — before a site is selected and the project begins in earnest. The Nuclear Waste Management Organization of Japan, known as NUMO and represented by a cartoon mole cautiously sticking its snout out of a hole, is in charge of finding a final resting place.

Long before he took NUMO up on its offer to conduct a study in his town, Mr. Kataoka, the Suttsu mayor, had taken an entrepreneurial view toward government subsidies.

Suttsu has a population of just under 2,900, spread thinly around the rocky rim of a deep cerulean bay, where fishing boats prowl for mackerel and squid. Beginning in 1999, with government-supported loans, Mr. Kataoka championed an initiative to install a stand of towering wind turbines along the shore.

Many in the town were initially opposed, he said during an interview in his office, but the project has delivered handsome returns. The town has spent the profits from selling electricity to pay off debts. Townspeople have free access to a heated pool, a golf course and a modest ski slope with a rope tow. Next to a sleek community center is a free day care for the few residents with children.

The facilities are not unusual for small-town Japan. Many localities have tried to stave off decline by spending large sums on white elephant projects. In Suttsu, the effect has been limited. The town is shrinking, and in early March, snow was piled to the eaves of newly built but shuttered stores along the main street.

Mr. Kataoka nominated Suttsu for the NUMO program, he said, out of a sense of responsibility to the nation. The subsidies, he admitted, are a nice bonus. But many in Suttsu doubt the intentions of both Mr. Kataoka and the government. The town, they argue, does not need the money. And they question why he made the decision without public consultation.

At a meeting of the town council on Monday, residents expressed concern that once the process had begun, it would quickly gather momentum and become impossible to stop.

The plan has fiercely divided the town. Reporters have flooded in, putting the discord on national display. A sign in the hotel by the harbor makes it clear that the staff will not accept interviews.

In October, an angry resident threw a Molotov cocktail at Mr. Kataoka’s home. It broke a window, but he smothered it without any further damage. The perpetrator was arrested and is now out on bail. He has apologized, Mr. Kataoka said.

The mayor remains bewildered by the aggressive response. Mr. Katatoka insists that the literature review is not a fait accompli and that the townspeople will have the final say.

In October, he will run for a sixth term. He wants voters to support his proposal, but whatever the outcome, he hopes the town can move forward together.

Losing the election would be bad, he said, but “the saddest part of all this has been losing the town’s trust.”

Motoko Rich contributed reporting from Tokyo.

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