What happened to the Human Papillomavirus (HPV) vaccination program in Japan?

The HPV Vaccination Crisis in Japan

In 2013, Japan's Ministry of Health, Labor, and Welfare suspended its official recommendation for HPV vaccination despite scientific evidence supporting the vaccine's safety, causing vaccination rates to plummet from 70% to nearly zero, a situation that persisted until 2021 when the suspension was finally lifted. 1

Timeline and Key Events

• In 2010, Japan began providing subsidies for HPV vaccination of girls aged 13-16 1
• By April 2013, HPV vaccines were fully integrated into Japan's national immunization program for girls aged 12-16 1, 2
• In June 2013, following media reports of alleged adverse events, Japan's government suspended its recommendation for HPV vaccination while still keeping the vaccine in the national program 1, 2
• The vaccination rate rapidly declined from approximately 70% to almost zero following this suspension 1
• The suspension remained in place until 2021, despite evidence supporting vaccine safety 1

Causes of the Suspension

• Media extensively reported alleged adverse events following HPV vaccination, including claims of pain and motor disability 3
• These reports stoked public doubts about the vaccine's safety despite limited scientific evidence supporting these claims 2
• The Japanese Vaccine Adverse Reactions Review Committee (VARRC) found no high-quality evidence supporting a causal relationship between reported adverse events and HPV vaccination 2
• A Japanese murine model of "HPV vaccine-associated neuro-immunopathic syndrome" (HANS) was described, but there were no human studies demonstrating the same effects 3

Global Impact

• News of Japan's suspension spread globally through online and social media networks 4
• Anti-vaccination groups applauded the decision, while the global scientific community did not support it 4
• The prolonged uncertainty around Japan's HPV vaccine recommendation allowed public concerns to spread further 4

Consequences

• The World Health Organization warned that Japan's HPV vaccination suspension would likely result in harm to unprotected girls 1
• Japan has historically experienced high rates of vaccine-preventable diseases compared to other developed countries due to vaccine hesitancy 3
• Previous decades of vaccine reluctance in Japan had already caused reemergence of pertussis and measles 3

Attempts to Improve Vaccination Rates

• Despite the national suspension, one local government (Isumi City) attempted to increase vaccination rates by sending informational leaflets about cervical cancer and HPV vaccines to target populations 5
• This local initiative resulted in a vaccination rate of 10.07% compared to 0% in areas without such information campaigns 5
• Among those who heard negative news during their vaccination period, 60% continued vaccination, 29% discontinued, and 11% continued without awareness of the news 6
• Those who consulted doctors after hearing adverse news were significantly more likely to continue vaccinations 6

Ethical Concerns

• Critics argue that the Japanese government's approach to vaccine policymaking fundamentally differs from other countries and WHO standards 2
• While other countries base vaccine policy on evidence of effectiveness and safety, Japan maintained a "pseudo informed consent" approach that reinforced public perceptions against the vaccine 2
• Arguments for the suspension have been criticized as not ethically appropriate 2

Current Status and Path Forward

• The governmental recommendation suspension finally ended in 2021 1
• Despite this, Japan has struggled to reestablish credible levels of HPV vaccination 1
• To reinvigorate the HPV vaccination program, Japan must address vaccine hesitancy through stronger cervical cancer control measures 1
• Local governments have been encouraged to provide appropriate information about cervical cancer and HPV vaccines to target populations 5

Lessons Learned

• The Japanese experience demonstrates how media coverage and governmental policy decisions can dramatically impact vaccination rates 1, 4
• Consulting healthcare providers after hearing negative news about vaccines significantly increases the likelihood of vaccination completion 6
• Strong promotion of vaccine usage and cancer screening is needed after recommendation suspensions are retracted 6