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Official Fukushima report says Japanese regulation and culture must change to prevent repeat of 2011 disaster

12 September 2012

The Japanese parliament’s Nuclear Accident Independent Investigation Commission (NAIIC) report summary on the Fukushima disaster says the main reason for the initial incident was erroneous emergency response actions taken at the time. But the root cause, according to the report, was the distorted relationship between the plant operator Tokyo Electric Power Co (TEPCO) and regulatory bodies, which led to the collapse of the nuclear safety monitoring function. 

The Japanese government said two reactors at the Ohi nuclear plant could be restarted on July 1, the first since all nuclear generation was suspended after the Fukushima disaster. Protesters said this was premature
The Japanese government said two reactors at the Ohi nuclear plant could be restarted on July 1, the first since all nuclear generation was suspended after the Fukushima disaster. Protesters said this was premature

The report points out that "there were many opportunities" to take preventive measures prior to the incident, and stresses that the accident was "clearly man-made." It is particularly critical of the Nuclear and Industrial Safety Agency (NISA), part of the Ministry of Economy, Trade and Industry (METI), the regulatory body responsible for supervising TEPCO and other electric utilities in Japan.

It says the utilities had maintained cosy relationships with METI over many years, and had been successful in putting pressure on the regulators to allow them to postpone the implementation of vital safety measures, describing the process as the “regulatory capture” of Japan’s nuclear industry by the utilities.

The six-reactor Fukushima Daiichi nuclear plant was badly damaged after the 11 March, 2011, earthquake and tsunami knocked out the reactors’ cooling systems, leading to meltdowns in three, gas explosions in four and the release of radioactivity over a wide area.

Tens of thousands of residents were evacuated from an exclusion zone around the plant as workers battled to bring reactors under control. TEPCO finally declared the reactors stable in December 2011.

The investigation included 900 hours of hearings and interviews with more than 1,000 people, including senior regulators from other major nuclear plant-operating countries. It was the first independent investigation in Japan to have subpoena power.
The commission described the incident as a disaster that was “Made in Japan”, cataloguing serious deficiencies in both METI and TEPCO's response and blaming Japanese cultural conventions and reluctance to question authority. There is also severe criticism of the Kantei, the Japanese Prime Minister’s office, which although lacking any nuclear expertise, interfered in attempts by on-site TEPCO staff to manage the crisis, 

The panel also found that there was a possibility that Unit 1 was damaged by the earthquake, contradicting the official position that only the tsunami contributed to the disaster.

The report recommends fundamental reform of nuclear regulators, TEPCO, and the laws and regulations governing nuclear activities in Japan.

As regards the first, the commission concluded that the safety of nuclear energy in Japan could only be assured if regulators go through an essential transformation process.

“Japan’s regulators need to shed the insular attitude of ignoring international safety standards and transform themselves into a globally trusted entity. The regulators did not monitor or supervise nuclear safety. They avoided their direct responsibilities by letting operators apply regulations on a voluntary basis. Their independence from the political arena, the ministries promoting nuclear energy and the operators was a mockery. They were incapable, and lacked the expertise and the commitment to assure the safety of nuclear power.”

TEPCO, the report says, also needs a complete overhaul. Amongst many problematic behaviours, it used the utilities’ lobbying body FEPC to manipulate the cosy relationship with regulators to take the teeth out of regulations. Risk management practices were also completely inadequate. “As regards tsunami risk factors, for example, TEPCO would only look at the risk to its own operations, and whether it would result in a suspension of existing reactors or weaken their stance in potential lawsuits. It ignored the potential risk to the public health and welfare.” 

And problems with TEPCO’s management style were based on the government taking final responsibility, which became explicit during the accident. The utility “prioritised the Kantei’s intent over that of the technical engineers at the site. TEPCO’s behavior was consistently unclear…failing to disclose information that it felt was uncertain or inconvenient.”

As regards the reform of laws and regulations, the commission concluded that it was necessary to realign existing laws and regulations concerning nuclear energy. “Laws and regulations related to nuclear energy have only been revised as stopgap measures, based on actual accidents. They have not been seriously and comprehensively reviewed in line with the accident response and safeguarding measures of an international standard. As a result, predictable risks have not been addressed. Mechanisms must be established to ensure that the latest technological findings from international sources are reflected in all existing laws and regulations.”

The commission lists seven recommendations for the Japanese parliament to consider as a matter of urgency.

These cover parliamentary oversight of the nuclear regulatory body, reforming the crisis management system, government responsibility for public health and welfare, monitoring the operators (and ensuring there are fundamental corporate changes at TEPCO), reforming laws relating to nuclear energy and developing a system of independent investigation commissions.

One recommendation sets out the criteria for the new regulatory body, which must be:
1. Independent: The chain of command, responsible authority and work processes must be independent from organisations promoted by the government, operators and politics.
2. Transparent: The decision-making process should exclude operators. All decision-making must be disclosed to parliament, the committee must keep minutes of all negotiations and meetings with promotional organisations, operators and other political organizations and disclose them to the public. Parliament shall make the final selection of commissioners after receiving third-party advice.
3. Professional: Personnel must meet global standards. Exchange programs with overseas regulatory bodies must be promoted, and interaction and exchange of human resources must be increased. An advisory organisation including knowledgeable personnel must be established, and the no-return rule should be applied without exception.
4. Consolidated: The functions of the organisations, especially emergency communications, decision-making and control, should be consolidated.
5. Proactive: The organisations should keep up with the latest knowledge and technology, and undergo continuous reform activities under the supervision of parliament.

Some observers have pointed out that despite all the report’s detail and willingness to criticise the organisations responsible, and indeed aspects of Japanese culture, it does not assign responsibility to any named figures. Its conclusions and recommendations avoid any discussion of prosecution or punishment.

The publication of the report has put further pressure on the government, which recently authorised the restart of two nuclear reactors at Ohi in western Japan. They were declared safe in April, but the plant also sits on top of a fault line and the findings of the report suggest this move could well be premature.


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