HPV vaccination in Japan

The human papillomavirus vaccine was approved in Japan in 2009 and added to the national immunization schedule in 2013. However, recommendations were suspended that year due to safety concerns, leading to a sharp decline in coverage.^[1] After scientific review and advocacy, recommendations resumed in 2022, and uptake has since begun to recover.^[2] Cervical cancer remains a major public health issue in Japan, with incidence and mortality rates largely unchanged for decades,^[3] in contrast to declines observed in other developed countries.^[4] Broader vaccination and screening are expected to reduce this burden.

HPV vaccines were first introduced in WHO member states in 2006.As of 2024, most high-income countries maintain routine HPV vaccination programs. Australia reports over 80% coverage among adolescent girls and boys through school-based delivery,^[5] while Sweden and the United Kingdom consistently achieve rates above 70% under gender-neutral national programs.^[6][7] In the United States, coverage varies by state but averages around 60% nationally.^[7] France, which expanded its program to include boys in 2021, reports approximately 40% coverage.^[7]

In contrast, Japan's HPV vaccine coverage remained below 1% for several years following the suspension of proactive recommendation in 2013.According to WHO estimates, 36% of females had received their first dose of the HPV vaccine by age 15 as of 2024.^[8][9]

Cervical cancer is one of the most common cancers affecting young women in Japan. Each year, more than 10,000 women are diagnosed with cervical cancer, and approximately 3,000 die from the disease. In addition, about 1,000 women under the age of 40 lose their fertility each year due to cervical cancer treatment.^[10] In 2021, there were 10,690 diagnosed cases of cervical cancer in Japan, and in 2023, the number of deaths from the disease was 2,949.^[11]

These figures have remained largely unchanged for the past 30 years, in contrast to declining trends observed in other developed countries such as the United States, the United Kingdom, European nations, and Australia. One of the main contributing factors is the low uptake of cervical cancer screening by cytology and the absence of an organized screening system. Many women undergo irregular, ad hoc screenings, and the self-reported screening rate within two years among women aged 20 to 65 is approximately 40%. Under these circumstances, widespread use of the HPV vaccine is expected to play a major role in reducing the burden of cervical cancer in Japan.^[12][13]

• 2009 – HPV vaccine approved in Japan.^[14]

• Apr 2013 – Added to the national routine immunization program (Preventive Vaccination Act).^[15]

• Jun 2013 – MHLW suspended proactive recommendations while routine immunization continued.^[16]

• 2013–2020 – Coverage declined to below 1%.^[17]

• Nov 2021 – Expert committees approved resumption of proactive recommendations.^[18]

• 2022 – Proactive recommendations resumed; catch-up program launched.^[19]

• Apr 2023 – 9-valent vaccine added; two-dose schedule approved for <15 years.^[20]

• 2024–2025 – Catch-up demand caused supply constraints; public funding extended for starters by Mar 2025.^[21]

In December 2008, a parliamentary group titled "Lawmakers' Association for Promoting Public Health through Vaccination"—commonly known as the Vaccine Promotion Parliamentary League—was established to promote disease prevention, reduce morbidity rates, and improve public health through the use of vaccines.^[22]

Cervarix (GlaxoSmithKline) was approved in October 2009 and released in December.^[23] Gardasil (Merck & Co.) was approved in July 2011 and released in August.^[24][25]

Routine vaccination for girls in Grade 6 through Grade 10 was incorporated into the Immunization Act on April 1, 2013.^[26]

In Japan, the standard HPV vaccination schedule consists of three doses. However, for individuals up to age 14, only two doses of the 9-valent HPV vaccine (Gardasil 9) are recommended.^[27]

In a 2013 session of the National Diet, Upper House member Michiko Ueno expressed concern regarding HPV vaccine promotion, stating that the government may not have provided sufficient consideration to sexual education in relation to administering the vaccine to girls in their early teens.^[28] Fellow Councillor Eriko Yamatani also opposed public vaccination, arguing that it "presupposes sexual experience in early adolescence," and claimed that regular medical checkups alone could prevent nearly 100% of cervical cancer deaths.^[29]

In street demonstrations organized by the Unification Church, banners reading "Sexual ethics education over HPV vaccine subsidies" were displayed, and participants chanted slogans opposing public funding for the vaccine. At the time, a misconception that cervical cancer resulted from sexual promiscuity was prevalent in some circles. Given the church's emphasis on purity education as a doctrinal priority, HPV vaccination was seen as incompatible with its moral teachings.^[30]

In June 2013, Japan's Ministry of Health, Labour and Welfare suspended its recommendation for the HPV vaccine following media reports of alleged side effects.^[31] The suspension was widely reported internationally.^[32]

The claimed side effects included chronic pain.^[33] Although routine vaccination remained available, uptake dropped below 1%.

In Tokyo's Suginami Ward, a junior high school student reported difficulty walking for over a year following vaccination. The ward initially declined compensation but reversed its decision after public criticism.^[34]

In Japan, suspending proactive vaccine recommendations has been a recurring public health strategy in response to safety concerns. This approach was previously applied to other vaccines, including the measles-mumps-rubella (MMR vaccine) in the early 1990s and the Japanese encephalitis vaccine between 2005 and 2010, following reports of adverse events.^[35]

These suspensions typically involved halting individualized outreach, such as sending vaccination vouchers or reminders, while continuing to offer the vaccine upon request. Although the suspension of proactive HPV vaccine recommendations from 2013 to 2021 followed this established pattern, its unusually long duration and the scale of its impact on public health outcomes—particularly the projected excess cases and deaths from cervical cancer—have drawn significant attention from researchers and policymakers.^[36]

Although vaccination remained available, uptake dropped below 1%.

In a 2019 interview, former MHLW official Tokumasa Shoubayashi stated that the suspension of proactive recommendation was primarily influenced by media coverage. He attributed the decline in public trust to Japan's prevailing "zero-risk" mindset and suggested that without a shift in public opinion, resuming recommendation would be difficult to justify.^[37]

Junko Mihara, a member of the House of Councillors and herself a cervical cancer survivor, became a vocal advocate for resuming proactive HPV vaccination. Although Mihara was never vaccinated herself, her personal experience with cervical cancer—including undergoing a hysterectomy—motivated her to campaign for broader access to the vaccine and stronger government support for inoculation programs. In public statements and interviews, she emphasized the urgency of protecting young women and expressed frustration over the years lost to misinformation and policy hesitation. Mihara described her advocacy as part of a broader fight against cancer, drawing on her own suffering to push for systemic change.^{[38][39][40][41]}

After the suspension of proactive recommendation in 2013, Japanese television repeatedly broadcast footage of girls experiencing alleged adverse effects, such as involuntary movements and difficulty walking. According to Yutaka Ishiwata, then-president of the Japan Society of Obstetrics and Gynecology, such images were aired "more than 80 times in a single day," amplifying parental fears and fueling vaccine hesitancy.^[42]

BuzzFeed Japan reported that many parents were alarmed by repeated television broadcasts, which created a powerful impression despite the absence of scientific evidence of causality.^[43]

A 2014 report by the Center for Strategic and International Studies (CSIS) concluded that local government recognition of adverse cases in Suginami Ward, combined with sensational newspaper, television, and online coverage, contributed to the national halt of promotion.^[44]

Journalist and physician Riko Muranaka argued in Wedge Online in 2015 that the gap between scientific evidence and media portrayal left affected families in distress and reinforced public distrust.^[45]

In Japan, the HPV vaccine was officially introduced under the name "cervical cancer vaccine", a framing that emphasized its relevance to women's reproductive health. This naming may have contributed to public perceptions that the vaccine was exclusively a women's issue, potentially influencing media narratives and policy decisions.

Hanako Jimi, a pediatrician and member of the House of Councillors, criticized the prolonged suspension of proactive HPV vaccine recommendations. In a 2021 interview, she stated: "If this were a prostate cancer prevention vaccine, even with some hesitation, it would likely have been reinstated within a year."^[46]

Kanako Inaba, an obstetrician-gynecologist and representative of the advocacy group "Minpapi!", expressed similar concerns. At a press conference following the submission of a citizen petition, she remarked: "Over the past eight years, sufficient evidence has accumulated regarding the vaccine's efficacy and safety. There is no longer any reason for the government to delay. If this were a disease causing penile loss in men in their 20s to 40s, would the government have left it unaddressed for so long?"^[47]

Japan's persistent gender disparities have been cited as a contributing factor to delayed policy responses and limited public engagement regarding HPV vaccination. In the 2025 Global Gender Gap Report published by the World Economic Forum, Japan ranked 118th out of 148 countries, placing last among G7 nations. The report highlighted significant gaps in political and economic participation, with projections indicating it may take over a century to achieve gender parity at the current pace.^{[48] [a]}

In 2016, the National Liaison Association of Cervical Cancer Vaccine Victims filed lawsuits in four district courts. As of May 2023, there were 117 plaintiffs: 92 received Cervarix and 25 received Gardasil.^[55][56]

Legal proceedings related to alleged adverse events from the HPV vaccine have been ongoing in Japan since 2016. The lawsuits, filed by individuals claiming long-term health effects, target both the national government and pharmaceutical companies. After years of expert testimony and plaintiff hearings across multiple district courts, a final ruling is currently scheduled for April 2027.^[57]

In 2017, a peer-reviewed article published in the Indian Journal of Medical Ethics offered a critical analysis of Japan's HPV vaccine policy from a medical ethics perspective. The authors highlighted unresolved adverse reactions involving multiple organ systems, questioned the adequacy of the Ministry of Health's response, and criticized international safety assessments—particularly those by the WHO—for failing to account for genetic susceptibility and complex symptom patterns. The authors included two lawyers representing plaintiffs in HPV vaccine-related lawsuits and a university-affiliated supporter of the litigation movement.^[58]

In August 2024, MSD, the defendant in the HPV vaccine lawsuit, issued a public statement addressing the claims. The company noted that many plaintiffs reported symptoms more than one year after vaccination, and emphasized that there is no scientifically or medically reliable evidence linking such delayed symptoms—or even those occurring shortly after vaccination—to the vaccine itself. MSD further stated that some reported conditions may have predated vaccination, and stressed the importance of accurate diagnosis and appropriate treatment. ^[59]

Under Japanese law, the responsibility for implementing routine vaccinations lies with local municipalities. For diseases classified as Category A under the Immunization Act (Japan), municipalities are legally obligated to promote vaccination among eligible individuals and their guardians. "Proactive recommendation" refers to targeted outreach efforts such as sending postcards or screening forms directly to households prior to the standard vaccination period, encouraging timely uptake of the vaccine.^[60][61]

In June 2013, the Ministry of Health, Labour and Welfare issued a notice to prefectural governors, based on Article 245-4, Paragraph 1 of the Local Autonomy Act, requesting that they inform municipalities—the entities responsible for administering vaccinations—of the national government’s recommendation to refrain from sending individual notifications to residents regarding the HPV vaccine. As a result, municipalities complied with the national policy and discontinued their HPV vaccine notifications. The Ministry also produced a leaflet designed to emphasize that it was not actively recommending the vaccine^[62][63].

On June 14, 2013, concurrent with the suspension of proactive recommendation, the Ministry of Health, Labour and Welfare (MHLW) issued a directive to prefectural governors pursuant to Article 245-4, Paragraph 1 of the Local Autonomy Act. The directive stated that when municipalities inform eligible persons about HPV vaccination availability, notification methods "should not include individual notification."^[64] This restriction remained in effect until October 9, 2020, when the MHLW amended the directive, removing the restriction on individual notification and instead encouraging municipalities to send individual notifications to eligible persons.^[65][66] On the same day, the MHLW issued an administrative notice to the Japan Medical Association, requesting cooperation in disseminating updated information materials about HPV vaccination. On October 13, 2020, the Japan Medical Association forwarded this request to its member societies.^[67] Municipal implementation surveys The MHLW conducted surveys to monitor municipal implementation of information provision policies. A March 2021 survey of 1,714 municipalities (99% response rate) found that 1,056 municipalities (61.6%) had sent individual notifications with leaflets during fiscal year 2020, while 658 municipalities (38.4%) had not.^[68] A May 2024 survey of 1,741 municipalities found that by December 2023, 92.2% had completed individual notification distribution for routine vaccination, while 67.4% had completed distribution for catch-up vaccination. Among municipalities that did not send notifications, one cited reason recorded in the survey was "considering past adverse reactions, we are proceeding cautiously with recommendations."^[69]

During the suspension of proactive HPV vaccine recommendation, some local governments reportedly responded in ways that discouraged potential recipients. For example, individuals were told that "vaccination is not recommended," that "there are side effects," and even asked whether a - pre-vaccination screening form was truly necessary given that "not even 0.01% of people choose to get vaccinated." Such remarks caused hesitation among those who wished to receive the vaccine. Other accounts include being warned strongly about adverse reactions—prompting questions like "Are you really going to get it?"—in a manner perceived as obstructive. In one case, a recipient requested that - pre-vaccination screening form be sent to a friend's address in time for the vaccination deadline, but it was delivered too late. These experiences were reported to physicians by affected individuals.^[70]

Amid a sharp decline in HPV vaccination rates, Ryuta Ibaragi, the governor of Okayama Prefecture and a graduate of the University of Tokyo who later earned an MBA from Stanford Graduate School of Business, launched an independent public information campaign. He issued a leaflet promoting the HPV vaccine under his own name. Motivated by concern that many women in their 30s and 40s could die from cervical cancer, he undertook these efforts; however, he received little support from other governors or from municipal governments within the prefecture. Ibaragi stated, "Regardless of how actively the WHO Director-General sends out messages or whatever they may do, municipalities do not listen to the United Nations or the WHO—they listen to the Ministry of Health, Labour and Welfare." ^[71][72]

Tomonori Kiyoyama, the mayor of Miyazaki City and a medical doctor, promoted the HPV vaccine based on the principles of evidence based policy making (EBPM). He conducted public awareness activities through various events and succeeded in increasing vaccination rates. He also introduced financial support for male HPV vaccination, a measure that had not yet been initiated at the national level. ^[73]

In low-income countries, vaccines are procured at low prices with the support of the GAVI Alliance, a global partnership organization launched at the Annual Meeting of the World Economic Forum (Davos) in 2000. Japan is one of the donor countries.^[74]

In the European Union, during the COVID-19 pandemic, the European Commission represented EU member states in concluding “Advance Purchase Agreements (APA)” with individual vaccine manufacturers, and vaccines were allocated to each country based on population proportion.^[75] A 2018 study on HPV vaccine pricing in European tender-based settings concluded that, since HPV vaccines are widely procured across Europe, the average tender price decreased to one-quarter of the list price. The study suggested that tendering is an effective cost-containment strategy and may expand cost-effective HPV vaccination to previously excluded target groups.^[76] Furthermore, a 2024 study on HPV vaccination program implementation strategies in EU member states, particularly procurement processes, found that the primary criterion in national tenders for selecting vaccine suppliers was the lowest price offered. The study suggested that greater harmonization of procurement and implementation strategies could enhance the effectiveness and equity of HPV vaccination across Europe.^[77]

In Japan, under Article 5 of the Immunization Act, the responsibility for routine immunization lies with local governments. Vaccines are purchased by individual medical institutions through wholesalers from vaccine manufacturers. The national government does not engage in price negotiations with manufacturers, and vaccine procurement is carried out by medical institutions or, in some cases, by municipalities. As a result, “for vaccines designated as routine immunizations, municipalities must purchase them at any price, creating a price formation mechanism favorable to sellers.”^[78]

In 2020, shipment adjustments occurred in response to increased demand for HPV vaccines.^[79]

Supply management during demand recovery In 2020, shipment adjustments occurred amid increased demand for HPV vaccines.^[80] Following the November 2021 announcement to resume proactive recommendations, the MHLW conducted surveys to monitor municipal implementation. Survey responses documented operational challenges including staff shortages, difficulties managing multiple age cohorts simultaneously, complexities in tracking vaccination history for mobile populations, and reported concerns about explaining vaccine safety given historical controversies.^[81]

In March 2016, a research team led by Dr. Shuichi Ikeda reported that 80% of patients with neurological symptoms shared the HLA-DPB1*0501 gene type.^[82] Mouse experiments suggested autoantibody deposition in the hippocampus.

Dr. Shuichi Ikeda, who had received a research grant from Japan’s Ministry of Health to study potential adverse effects of the HPV vaccine, publicly suggested a causal relationship during a televised appearance on TBS’s News 23 program on March 16, 2016. His remarks were widely reported in the press the following day, prompting heightened public concern.^[83][84][85]

In June 2016, Shinshu University established an external investigation committee in response to a whistleblower report alleging research misconduct.^[86]

In November, the committee concluded that "it cannot be denied that information suggesting the mouse experiment results were scientifically proven has spread throughout society." The experiment did not observe the condition of NFκ-βp50-deficient mice after HPV vaccination, but instead extracted serum from vaccinated mice and applied it to brain tissue of naïve mice. The experiment used only one serum sample per group, and in subsequent replication attempts, no reaction was observed in any brain tissue samples. The committee requested that Professor Ikeda conduct a new experiment starting from the initial vaccination stage using scientifically validated knockout mice, and to publish the results. Additionally, concerns were raised about a designated professor (referred to as Professor B), who had collected serum from multiple mice but reported results based only on a single sample (n=1), calling into question the research integrity. The committee concluded by stating that "a serious reflection is required for having caused public confusion."^[87]

In 2016, Dr Ikeda and colleagues published a mouse study in Scientific Reports suggesting that combined administration of an HPV vaccine and pertussis toxin caused neurological damage in mice.^[88] The paper attracted media attention in Japan and was cited by vaccine-hesitant groups. However, the methodology was criticized as lacking reproducibility and having inadequate controls.^[89] In May 2018, Scientific Reports formally retracted the article, citing methodological flaws.^[90] Japan's Ministry of Health, Labour and Welfare and medical societies also stated that this animal study did not provide evidence of causality in humans.^[91]

On November 24, 2016, the Ministry of Health, Labour and Welfare (MHLW) issued a statement saying, "Due to Professor Ikeda's inappropriate presentation, a situation has arisen that misled the public. We consider his social responsibility to be significant and deeply regret the matter." The ministry further stated, "The research results presented by the Ikeda team do not provide any evidence that the symptoms observed after HPV vaccination were caused by the vaccine itself."^[92]

Dr. Ikeda filed a defamation lawsuit against journalist Riko Muranaka and the magazine Wedge. The court ruled in favor of Ikeda. Nobel laureate Tasuku Honjo submitted an expert opinion criticizing the scientific basis of the study.^{[93][94] [95]}　He publicly addressed the HPV vaccine issue during a press conference in Stockholm, calling the situation in Japan "outrageous and serious."^[96] He also met with the Minister of Health to urge the resumption of proactive HPV vaccine recommendation.^[97] Honjo later stated that although he explained the issue to journalists, his comments were repeatedly rejected by editorial desks.^[98]

Following the court ruling, Muranaka announced her intention to appeal, stating that she viewed the lawsuit not only as a legal challenge but also as an opportunity to advocate for scientific integrity and to build connections within the medical and journalistic communities.^[99]

Commenting on the case, Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, emphasized that the outcome should not be interpreted as a validation of Dr. Ikeda's scientific claims. She noted that the ruling was based on issues of tone and expression, rather than scientific merit.^[100]

In 2017, Japanese physician and journalist Riko Muranaka was awarded the John Maddox Prize, jointly presented by Nature and the Sense About Science foundation. The award recognized her efforts to communicate scientific evidence about the safety of the HPV vaccine in Japan, despite facing public hostility, professional backlash, and legal threats. Muranaka's reporting challenged widespread misinformation and highlighted the consequences of Japan's prolonged suspension of proactive vaccine recommendations, including the projected rise in cervical cancer cases and deaths.^[101][102]

International commentators noted that Japan's suspension had broader implications. Okita (2020) analyzed the suspension as a case study in the intersection of science, ethics, and policy, concluding that political decisions departed significantly from scientific consensus.^[103]

In 2015, the city of Nagoya commissioned a large-scale survey to investigate potential adverse symptoms following HPV vaccination. The study, led by Professor Sadao Suzuki of Nagoya City University, targeted approximately 70,000 young women born between April 1994 and April 2001, comparing symptom prevalence between vaccinated and unvaccinated groups. A peer-reviewed study analyzing the survey data concluded that there was no statistically significant difference in the frequency of reported symptoms—such as chronic pain, motor dysfunction, or memory impairment—between the vaccinated and unvaccinated cohorts.^{[104][105][106]}

In 2018, Professor Sadao Suzuki of Nagoya City University published a peer-reviewed study concluding no statistical association between HPV vaccination and 24 reported symptoms among young women. The study was criticized by advocacy groups for methodological flaws, including inadequate age adjustment and potential selection bias. Suzuki responded that no formal rebuttal had been submitted to the journal and defended the study's scientific validity. In 2022, he publicly called for the retraction of a critical nursing science article, citing concerns over its influence on public understanding. The journal declined to respond.^[107]

In December 2015, the World Health Organization's Global Advisory Committee on Vaccine Safety (GACVS) issued a statement explicitly criticizing Japan's continued suspension of proactive recommendation for the HPV vaccine. The committee noted that Japan had not resumed recommendation despite expert consensus that no causal link existed between the vaccine and reported symptoms. GACVS warned: "Political decisions based on weak evidence may hinder access to safe and effective vaccines and cause real harm." ^[108]

Japan was the only country named in the statement, marking an unusually direct rebuke from an international health authority.^[109]

This international appeal was intended to urge the Japanese government to resume proactive recommendation and align with global scientific consensus.

The Lancet also described the situation as an "HPV vaccination crisis in Japan".^[110]

In August 2016, a group of senior Japanese medical experts—including the presidents of the Japan Medical Association and the Japan Association of Obstetricians and Gynecologists—submitted a letter to the Director of the Health Bureau at the Ministry of Health, Labour and Welfare. The letter included signatures from 341 researchers from over 50 countries who had participated in EUROGIN 2016 (European Research Organization on Genital Infection and Neoplasia). The statement warned: "The symptoms reported in Japan have not been shown to be causally related to the HPV vaccine. Japan's inappropriate policy decisions are having a negative impact on global vaccine confidence."^[111]

In April 2016, 17 Japanese medical societies issued a joint statement urging the resumption of proactive HPV vaccine recommendation. The statement cited data from the Ministry of Health indicating that only 186 individuals—approximately 0.002% of total doses administered—remained under medical care for unresolved adverse events.^[112]

In response to public concern over adverse events following HPV vaccination, the Ministry of Health, Labour and Welfare commissioned a large-scale epidemiological study led by Dr. HirokazuSofue at the Osaka Center for Cancer and Disease Prevention. The study aimed to evaluate the prevalence of reported symptoms among vaccinated and unvaccinated adolescent girls across Japan. The researchers found that symptoms such as chronic pain, motor dysfunction, and cognitive complaints were not significantly more frequent among vaccinated individuals compared to unvaccinated controls. In fact, similar symptom patterns were observed in both groups, suggesting that the reported conditions may not be causally linked to the vaccine itself but rather reflect broader psychosocial or developmental factors. The study emphasized the importance of establishing specialized clinical systems to assess and manage post-vaccination symptoms, regardless of causality, and contributed to the scientific basis for Japan's resumption of proactive HPV vaccine recommendation in 2022.^[113]

Some researchers have conducted immunological and neurological examinations of cases that developed central nervous system–related symptoms after HPV vaccination. Takahashi Yukitoshi and colleagues at the National Hospital Organization Shizuoka Institute of Epilepsy and Neurological Disorders analyzed 39 cases that exhibited prolonged neurological symptoms after vaccination and reported findings such as increased Th2 cytokines in the cerebrospinal fluid, the presence of autoantibodies against NMDA receptors, and reduced cerebral blood flow on SPECT imaging, although a causal relationship has not been established. These findings are sometimes cited in support of the plaintiffs’ claim that immunological abnormalities may underlie the neurological symptoms that appeared after vaccination.^[114]

On December 4, 2020, the MHLW approved Gardasil for use in males.^{[115][116][117]}

In Japan, the approved indications include prevention of anal cancer, precancerous lesions, and genital warts. Internationally, the vaccine is also approved for oropharyngeal cancer, and G7 countries have adopted gender-neutral vaccination policies.^[118]

In September 2023, Tokyo Governor Yuriko Koike stated during a session of the Tokyo Metropolitan Assembly that HPV vaccination for males could help prevent male-specific cancers and contribute to herd immunity when administered to both sexes. She announced that the Tokyo Metropolitan Government would consider financial support for municipalities implementing such programs.^[119]

Tokyo also indicated its intention to urge the national government to accelerate consideration of routine HPV vaccination for males, while simultaneously exploring support for municipalities that had already begun subsidizing such programs. In its fiscal year 2024 budget request, the Tokyo Metropolitan Bureau of Social Welfare and Public Health allocated approximately ¥380 million for municipal subsidies related to male HPV vaccination.^[120]

In January 2024, following the governor's budget review, Tokyo announced its policy to cover half the cost of HPV vaccination for boys in grades 6 through 10 (ages roughly 12–16), provided that local municipalities offer financial assistance.^[121][122]

In March 2024, an advisory committee of the Ministry of Health, Labour and Welfare (MHLW) reviewed the cost‑effectiveness of introducing routine HPV vaccination for boys. Using a Markov model to estimate the direct preventive effects on various HPV‑related diseases in males, the analysis reported that, when limited to the prevention of male HPV‑related conditions, the cost‑effectiveness of male HPV vaccination substantially exceeded commonly used thresholds.^[123] In a subsequent review in September 2025, the committee again concluded that additional evidence was required before routine vaccination could be considered, and the discussion was continued without a decision.^[124]

In response, a coalition of 32 academic societies—including the Japan Pediatric Society and the Japanese Urological Association—submitted a formal request to the MHLW in October 2025 calling for the introduction of routine HPV vaccination for males.^[125] On November 20, [Norihisa Tamura]], a member of the House of Representatives and chair of the bipartisan Parliamentary League for Promoting HPV Vaccination, expressed concern at a joint meeting with the League of Local Assembly Members for Promoting HPV Vaccination that, if Japan were to remain the only country where male oropharyngeal cancer persists due to the absence of routine male vaccination, the government might face future litigation for administrative inaction. He strongly urged the government to move forward with routine vaccination for boys.^[126]

In Japan, the HPV vaccine is classified as a Category A disease under the Immunization Act (Japan), and Article 9 of the Act stipulates that eligible individuals and their guardians have a "duty to make efforts" to receive the vaccination. Although the government continued routine vaccination, it suspended proactive recommendations in June 2013 following reports of adverse reactions. However, as no specific safety concerns were identified, proactive recommendations resumed in November 2021.^[127]

The decision was reported internationally, including in Lancet Oncology.^[128]

A petition calling for free vaccination for university-aged women who missed the opportunity due to the suspension of proactive recommendations gathered approximately 13,000 signatures in a single day.^[129] In response, the government decided to offer catch-up vaccinations to affected cohorts until March 2025.^[130] Furthermore, those who receive their first dose by March 2025 will be eligible to complete the series free of charge during fiscal year 2025.^[131]

In November 2021, a coalition of local assembly members promoting HPV vaccination was established in Japan. Among its members was Arakawa Ward councilor Aki Natsume, who was diagnosed with cervical cancer at the age of 23. Drawing from her personal experience, Natsume advocated for the importance of HPV vaccination and regular cancer screening.^[132]

In November 2021, Japan's Ministry of Health, Labour and Welfare (MHLW) announced that proactive recommendations for the HPV vaccine would resume starting in April 2022.^[133]

Meanwhile, Norihisa Tamura, who had served as Minister of Health, Labour and Welfare when the government suspended proactive recommendations for the HPV vaccine in 2013, stated at a parliamentary meeting in December 2021—held to discuss resuming active recommendation—that “I feel as though I bear a cross myself.” Media reports described this remark as reflecting his regret over the many years during which the recommendation could not be reinstated. ^[134]

In January 2022, the MHLW finalized the implementation of a publicly funded "catch-up vaccination" program for women born between fiscal years 1997 and 2005, who had missed the opportunity to receive the vaccine during the suspension period. The ministry also announced plans to reimburse individuals who had paid out-of-pocket for HPV vaccination during that time.^[135]

In June 2023, the National Cancer Center Japan published the "2023 Fact Sheet on the Prevention of Cervical Cancer and Other HPV-Related Cancers." The report highlighted that Japan's cervical cancer mortality rate remains higher than in other developed countries, and emphasized the effectiveness and safety of HPV vaccination and screening. The Center recommended both measures as essential components of prevention. During the press conference, officials acknowledged the inadequacy of past countermeasures and expressed regret for the lack of public communication during the suspension of proactive vaccine recommendations.^[136][137]

Proactive recommendation resumed in April 2022. That year, 540,681 individuals received their first dose.^[138]

In fiscal year 2024, total first-dose recipients rose to 1,513,862, including 430,000 routine and 1,080,000 catch-up recipients.^[139]

In August 2025, Japan approved the use of the 9-valent HPV vaccine for males. However, as of that date, the vaccine remains available only through voluntary immunization and has not yet been included in the national routine schedule.^[140]

A 2025 peer-reviewed study published in Scientific Reports examined HPV vaccination behavior among Japanese medical professionals and their families during the suspension of proactive recommendations (2013–2022). The study reported that a senior obstetrician-gynecologist at Osaka University Hospital vaccinated his own daughter, citing confidence in the vaccine's safety and efficacy. The same study also tracked vaccination rates among eligible daughters aged 12–16 across five survey waves, showing a consistent upward trend despite the suspension period. In 2023, 63.6% (35 out of 55) of eligible daughters had received the vaccine, a statistically significant increase compared to earlier years (p = 0.017). ^[141]

In November 2022, Japan's Ministry of Education, Culture, Sports, Science and Technology (MEXT), through its Medical Education Division, sent a notice to universities with faculties of medicine, pharmacy, and related fields. The notice included a request letter from a citizens' group that claims symptoms reported after HPV vaccination constitute "drug-induced harm," and encouraged institutions to conduct classes on pharmaceutical injury based on this material.^[142] A MEXT official later stated that the ministry had not been directly informed by the Ministry of Health, Labour and Welfare (MHLW) about the updated status of the HPV vaccine, which had resumed proactive recommendation earlier that fiscal year. Although the HPV Vaccine Parliamentary League of the Liberal Democratic Party requested a correction, MEXT's follow-up notice in December 2022 did not retract the original guidance. Instead, it added a clarification that the request letter from the citizens' group should be treated as supplementary material, without changing the ministry's treatment of the claims regarding HPV vaccine-related harm.^[143]

During the years following the suspension of proactive HPV vaccine recommendations in Japan, mainstream media provided limited sustained coverage, even as vaccination rates dropped below 1%. Commentators have described this prolonged silence as a distinctive feature of the Japanese case.^[144] As evidence supporting vaccine safety and efficacy accumulated, public anxiety gradually softened. A media analysis noted that coverage became more balanced around 2020, helping to shift public sentiment and enabling the resumption of government recommendations.^[145]

This prolonged silence has been attributed in part to Japan’s kisha club (press club) system, an exclusive network of reporters affiliated with government ministries and agencies. The system has been criticized for promoting uniform, press-release-based reporting and discouraging independent or investigative journalism.^[146] During the suspension period, many media outlets repeated administrative announcements and anecdotal reports without referencing academic literature or international safety data. Even after scientific consensus confirmed vaccine safety, corrective reporting remained limited. Reporters Without Borders has cited the kisha club system as a structural factor limiting press freedom in Japan.^[147]

A 2025 computational analysis of social media discourse identified key shifts in public sentiment in 2013, 2016, and 2020, corresponding to major policy and media events. Using large language models, the study found that misinformation peaked in 2012 and stabilized thereafter, while discourse around vaccine effectiveness gradually increased. The authors also noted that HPV vaccine experiences were frequently invoked in discussions about COVID-19 vaccination, suggesting a cross-vaccine influence on public attitudes.^[148]

On September 25, 2024, the terms "HPV vaccine" and "cervical cancer" trended on X (formerly Twitter) in Japan. Users shared vaccination experiences and praised one another. Obstetricians and vaccine advocates welcomed the change.^[149]

Journalist Eito Suzuki posted courtroom observations from the HPV vaccine litigation on X in August 2024, receiving over 18 million impressions. His reporting highlighted that plaintiffs had pre-existing conditions and psychosocial challenges prior to vaccination. Some had been diagnosed with HANS (Health Anxiety Neuro-Syndrome) and certified for compensation by the PMDA, leading some to abandon cognitive behavioral therapy.^[150]

A 10-year analysis of Japanese-language social media posts by Kyoto University researchers found that discussions about vaccine safety peaked in 2015 and declined thereafter, while discourse on vaccine effectiveness increased. The study concluded that targeted public health interventions are needed to address lingering vaccine hesitancy.^[151]

Journalist Naoko Iwanaga of BuzzFeed Japan documented the experiences of mothers navigating HPV vaccine decisions amid government silence and media confusion. Her reporting highlighted the lack of individualized notifications, the emotional burden of vaccine hesitancy, and the role of misinformation in shaping public perception.^[152] Iwanaga also covered the defamation lawsuit against Dr. Riko Muranaka, noting the chilling effect on scientific journalism and the broader media silence that followed. The work of Dr. Riko Muranaka received international attention and was cited in discussions about vaccine communication and public trust.^[153] Iwanaga's reporting was widely circulated among healthcare professionals and policy advocates in Japan, and she later stated that her coverage of HPV vaccine issues contributed to her departure from a major newspaper.^[154]

Minpapi (short for "Minna de shirou HPV project") is a non-profit initiative founded in 2017 by gynecologist Kanako Inaba. The organization aims to promote accurate public understanding of HPV infection and vaccination through physician-supervised articles, social media outreach, and policy advocacy. Minpapi has collaborated with municipalities, media outlets, and digital platforms to address gaps in vaccine awareness, especially among young women who missed routine vaccination due to the suspension of proactive recommendation.^[155] In 2023, Minpapi partnered with the Florence Group to launch a campaign titled "HPV vaccine for boys too," offering free vaccinations to boys aged 9–18 in selected clinics. The initiative highlighted gender disparities in vaccine access and called for public funding of male vaccination.^[156]

In a 2025 narrative review published in Vaccines, researchers analyzed the sociopolitical roots of HPV vaccine hesitancy in Japan. The review identified three major contributing factors: prolonged governmental suspension of proactive recommendations (2013–2022), intensified media sensationalism, and insufficient direct communication from healthcare providers. The authors cited citizen-led outreach efforts such as the Minpapi project as key responses to this institutional silence.^[157]

A 2021 study published in *Vaccine* by researchers including Takahiro Kinoshita and Michael R. Reich of Harvard Kennedy School analyzed the decline in HPV vaccine confidence in Japan. The authors attributed the drop in coverage to a combination of sensationalized media reports, delayed government response, and erosion of public trust. They emphasized that rebuilding vaccine confidence requires transparent communication and stronger engagement between health authorities and the public.^[158]

HPV vaccination in Japan initially achieved high uptake, with over 70% coverage among eligible girls in some regions. In recent years, following the resumption of proactive recommendation in 2022, catch-up programs and advocacy efforts have gradually increased awareness and access, though disparities persist. The following section presents historical vaccination numbers and cohort-specific coverage.

225,993 girls were vaccinated for the first round of routine vaccination in 2022, and the vaccination rate was 42.2%.^[b] The Osaka University Graduate School of Medicine and Faculty of Medicine reported the first vaccination rate and cumulative first vaccination rate for each year of birth in 2022 at a meeting of the Ministry of Health, Labor and Welfare.^[159]

Subsequent studies documented a rebound in uptake.^[160]

In Japan, HPV vaccine coverage once dropped below 1% following the suspension of proactive recommendations in June 2013. After the resumption of recommendations in November 2021, the first half of fiscal year 2022 saw approximately 160,000 individuals complete their first dose of routine vaccination, resulting in a coverage rate of 30.1%.^[165]

Including catch-up vaccinations, the total number of first-dose recipients reached 540,681 in fiscal year 2022,^[166] 668,012 in fiscal year 2023,^[167] and 1,513,862 in fiscal year 2024.^[168]

In 2025, Oka and colleagues published a population-based cross-sectional study analyzing HPV vaccination uptake in Osaka City, Japan.^[169] The study examined cumulative vaccination coverage among 185,373 girls born between fiscal years 1997 and 2010, using neighborhood-level socioeconomic indicators and access metrics. As of 2022, 18,688 girls in Osaka City had received at least one dose of the HPV vaccine. Uptake was higher in areas with lower deprivation and greater access to vaccination facilities. The authors found significant associations between vaccination rates and both the Area Deprivation Index (ADI) and proximity to medical providers, suggesting that socioeconomic and geographic factors influenced recovery in coverage following the resumption of proactive recommendation.^[169]

According to estimates reported by m3.com and *Vaccine JAPAN*, Japan's HPV vaccination uptake shows substantial regional variation. Among girls in the routine cohort, Yamagata Prefecture recorded the highest first-dose rate at around 67%, while Okinawa Prefecture was the lowest at about 17%. Nationwide, the rate for girls born in 2007 exceeded 70% by FY2023. These figures highlight both the recovery of uptake after the suspension period and the marked differences among prefectures.^{[170][171][172]}

In the 2024 fiscal year, Miyazaki Prefecture recorded the highest routine HPV vaccination rate at 20.8%, followed by Yamagata Prefecture at 19.8%. Okinawa Prefecture had the lowest rate at 7.4%. ^[173]

The HPV vaccination rate for 16-year-olds, specifically the cumulative first-dose vaccination rate showing the proportion of people who received at least one dose, was reported in October 2025 as follows: Yamagata Prefecture had the highest rate at 82.1%, followed by Akita Prefecture (72.7%), with Okinawa Prefecture at the bottom (24.4%). Yamagata Prefecture's high vaccination rate is attributed to the success of awareness campaigns, primarily led by the Prefectural Obstetricians and Gynecologists Association, as well as activities such as posting posters in stores and other locations^[174]

• In January 2021, researchers from the National Cancer Center Japan reported two cases of neonatal lung cancer caused by transmission of HPV-positive cervical cancer cells from mother to infant during birth. The cases, published in The New England Journal of Medicine, highlighted the clinical consequences of delayed cervical cancer diagnosis and underscored the importance of HPV vaccination as a preventive measure.^[175]

• Multiple studies have estimated that the suspension of proactive HPV vaccine recommendations in Japan will result in more than 20,000 excess cases of cervical cancer and over 5,000 excess deaths among women born around the year 2000.^{[176][177][178]}

In several countries, citizen groups have emerged in response to concerns about adverse events following HPV vaccination:

• In the United Kingdom, the group AHVID (Association of HPV Vaccine Injured Daughters) reported that approximately 400 of its 470 members believed they had experienced vaccine-related harm.^[179]
• In the United States, Sane Vax was founded in 2010 by journalists and citizens questioning the safety of HPV vaccines. In 2017, the U.S. Vaccine Injury Compensation Program awarded $250,000 to the family of Christina Tarsell, who died of arrhythmia 18 days after receiving her third dose.^[180][181]
• In Ireland, the parent-led group REGRET (Reactions and Effects of Gardasil Resulting in Extreme Trauma) was established in 2015 to advocate for girls who experienced health issues after vaccination.^[182]
• In Colombia, following a 2014 incident in El Carmen de Bolívar where schoolgirls reported symptoms such as fainting and seizures, a local group called "Hope Reborn" was formed.^[183] Subsequent investigations by neurologist Suzanne O'Sullivan and the Colombian National Institute of Health concluded that the events were consistent with mass psychogenic illness (MPI), though concerns about informed consent remained.^[184][185]

In April 2018, advocacy groups from five countries—Japan, Ireland, the United Kingdom, Colombia, and Spain—issued a joint declaration calling for the suspension of proactive HPV vaccine recommendations. The statement urged governments to halt promotion until long-term health monitoring systems were established and independent safety evaluations could be conducted.^[186]

• "HPV (Human Papillomavirus) Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). 6 August 2021. Retrieved 1 September 2024.
• "Human Papillomavirus (HPV) Vaccines". National Institutes of Health (NIH). 25 May 2021. Retrieved 1 September 2024.
• Papillomavirus Vaccines at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
• "vaccine-japan". ｍ3. Retrieved 25 September 2025.