HPV vaccination in Japan

Legal framework

Japan's immunization system is implemented under the Immunization Act, enacted in 1948.^[16] At the time of its enactment, routine vaccination programs were classified as delegated state administrative functions.^[17] Following the implementation of the Omnibus Decentralization Law in April 2000, they became autonomous functions of local governments.^[18]

Under Article 5 of Japan's Immunization Act, the responsibility for implementing routine vaccinations lies with local governments, such as cities, towns, and villages.^[19] 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.^[20][21]

The Vaccination and Vaccine Subcommittee is an advisory body that makes recommendations to the Minister of Health, Labour and Welfare; formal policy decisions are made and implemented by the Ministry.^[22][23]

Procurement and distribution of vaccines

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.^[24] 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.^[25] 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.^[26] 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.^[27]

Because responsibility for routine immunization rests 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.”^[28]

Vaccine Side Effect Reports

Japan's adverse-reaction reporting system operates through multiple channels: physicians are required under Article 12 of the Immunization Act to report suspected reactions upon becoming aware of them; vaccine manufacturers separately report cases under the Pharmaceuticals and Medical Devices Act; and vaccine recipients or their guardians may also report suspected harm directly to their municipality. According to the Pharmaceuticals and Medical Devices Agency (PMDA), a report may be accepted "even where a causal relationship between the reported symptom and vaccination is not necessarily clear," if reporting is judged necessary from the standpoint of preventing harm to public health.^[29]Common side effects include pain, swelling, and redness at the injection site. Rare adverse reactions, occurring at an undetermined frequency, include anaphylaxis, Guillain–Barré syndrome, acute disseminated encephalomyelitis (ADEM), and immune thrombocytopenia. Vaccination is contraindicated for individuals with known hypersensitivity to vaccine components, and requires medical consultation for those with certain underlying conditions, prior severe allergic reactions to vaccination, seizure history, immunodeficiency, or pregnancy.^[10]

By birth cohort

225,993 girls were vaccinated in the first round of routine vaccination in 2022, and the vaccination rate was 42.2%. 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.^[32]

Human papillomavirus vaccination by birth fiscal year in Japan^{[33][34][35][36][37][38]}

First-time recipients in Japan

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%.^[39] Including catch-up vaccinations, the total number of first-dose recipients reached 540,681 in fiscal year 2022,659,175 in fiscal year 2023,and 1,534,304 in fiscal year 2024.^[40]The catch-up program formally concluded at the end of fiscal year 2025, and first-dose recipients fell sharply that year to 293,635 (291,037 routine and 2,598 catch-up).^{[41] [42]}

Annual number of first-time HPV vaccine recipients in Japan (routine and catch-up)

Regional disparities

In 2025, Oka and colleagues published a population-based cross-sectional study analyzing HPV vaccination uptake in Osaka City, Japan. 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.^[43]

According to estimates reported by m3.com and Vaccine JAPAN, Japan's HPV vaccination uptake — measured as cumulative lifetime doses received among girls in the routine cohort — shows substantial regional variation. Among girls who have ever received a first dose, Yamagata Prefecture recorded the highest cumulative first-dose uptake rate at around 67%, while Okinawa Prefecture was the lowest at about 17%. Nationwide, the cumulative lifetime first-dose rate for girls born in 2007 exceeded 70% by FY2023. These figures highlight both the recovery of cumulative uptake after the suspension period and the marked differences in lifetime vaccination rates among prefectures. ^[44][45][46]

Early development and implementation

In December 2008, 36 members of Japan's National Diet from the ruling coalition (the Liberal Democratic Party and Komeito) established the parliamentary league "Lawmakers' Association for Promoting Public Health through Vaccination", commonly known as the Vaccine Promotion Parliamentary League. Anticipating the imminent approval of the HPV vaccine, the league began by discussing cervical cancer prevention and measures to promote HPV vaccination, including possible public financial support and health insurance coverage.^[58] Cervarix (GlaxoSmithKline) was approved in October 2009 and released in December.^[59] In November 2010, the “Emergency Program to Promote Vaccination Against Cervical Cancer and Other Diseases” was launched, and the HPV vaccine became publicly subsidized.^[60]

Gardasil (Merck & Co.) was approved in July 2011 and released in August.^[61][62] Routine vaccination for girls in Grade 6 through Grade 10 was incorporated into the Immunization Act on April 1, 2013, under the name "cervical cancer vaccine(子宮頸がんワクチン)".^[63][64][65] Proactive recommendations were suspended just two months later, in June 2013(see §Initial suspension and response),leading to a sharp and prolonged decline in coverage(see §International comparison)^[66][64][55]

Suspension of proactive recommendation

Initial suspension and response

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. The claimed side effects included chronic pain. Although routine vaccination remained available.^[70][71] 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.^[72]As of the end of April 2016, the Ministry of Health, Labour and Welfare reported that approximately 3.39 million people had been vaccinated and 2,945 had reported health problems following vaccination.^[73]

In the United Kingdom,^[74] the United States,^[75][76] Ireland,^[77] and Colombia^[78][79][80] citizen groups have emerged in response to concerns about adverse events following HPV vaccination. In March 2018, an international symposium on HPV vaccine adverse events was held in Tokyo, with representatives of advocacy groups from Spain, the United Kingdom, Ireland, and Colombia participating alongside Japanese plaintiffs' groups.^[81] 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.^[82] In Ireland, cervical cancer patient and advocate Laura Brennan publicly promoted HPV vaccination during efforts to restore confidence in the vaccine following a decline in uptake. Her advocacy received widespread media attention and formed part of broader public health communication campaigns associated with subsequent recovery in vaccination coverage.^[83][84]

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.^[85] 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, it was longer than in previous cases and was associated with markedly reduced vaccination coverage and projected shortfalls relative to World Health Organization targets.^[33] In interviews published in 2019 and 2026, former MHLW official Tokumasa Shoubayashi (正林督章) stated that the prolonged suspension was primarily driven by media coverage rather than scientific evidence alone. He recalled that officials had initially expected proactive recommendation to resume within about six months while additional safety data were gathered, but that the first meeting of the Adverse Reactions Review Committee was disrupted by heckling from the public gallery, preventing it from reaching a conclusion, and that even academic societies opposed the vaccine at the time. He also stated that several MHLW medical officers assigned to the issue suffered mental health breakdowns after being subjected to hostile telephone calls from opponents of the vaccine.^[86] He attributed the decline in public trust to Japan's prevailing "zero-risk" mindset, said that public opinion failed to shift despite accumulating evidence supporting the vaccine's safety and effectiveness, and suggested that without a change in public opinion, resuming proactive recommendation would be difficult to justify.^[87]

Junko Mihara (三原じゅん子), a member of the House of Councillors and a cervical cancer survivor, advocated for the resumption of proactive HPV vaccination. Drawing on her personal experience, she called for stronger government support and, in parliamentary questioning, raised concerns about delays in resuming recommendations and approving the nine-valent vaccine, asking why it had not been resumed and “what factors were influencing the delay.” She also argued that the term “HPV vaccine” should be used instead of “cervical cancer vaccine” to reflect its broader protective effects, including for males.^{[88][89][90][91]} At a January 2020 study session organized by the "Society for Considering the Future of Japanese Medicine," Fumimaro Takaku (髙久史麿), chairman of the Community Health Care Organization and former president of the Japan Medical Association, warned that if proactive HPV vaccination recommendations continued to be withheld, Japan would within a decade become the only developed country with a high rate of cervical cancer. He attributed primary responsibility to the Ministry of Health, Labour and Welfare, noting that when he had personally visited the ministry to raise concerns, the official response was that they would wait for the results of a nationwide survey before making any decision — a reply he described as evasive. Kunio Kitamura (北村邦夫), chairman of the Japan Family Planning Association, expressed puzzlement that meaningful progress remained elusive even with a parliamentary league of influential lawmakers behind the initiative, questioning whether the greater fault lay in acting and failing, or in failing to act at all.^[92]

Ministry directive restricting individual notification (2013-2020)

On June 14, 2013, concurrent with the suspension of proactive recommendation, the MHLW issued a directive to prefectural governors pursuant to Article 245-4, Paragraph 1 of the Local Autonomy Act, stating that municipal notifications to eligible persons "should not include individual notification."^[70][93] This restriction remained in effect until October 9, 2020, following the transition from the Shinzo Abe administration to the Yoshihide Suga administration on September 16, 2020.^[94] The MHLW revised the 2013 notice by deleting this provision and instead encouraging municipalities to send individual notifications to eligible persons, communicating the revision to prefectural governors with instructions to inform municipalities and related organizations.^[95][96] On the same day, the MHLW also requested cooperation from the Japan Medical Association in disseminating updated informational materials on HPV vaccination, which was subsequently forwarded to member organizations.^[97]

Gender disparities and policy response

In Japan, the HPV vaccine was commonly referred to as the "cervical cancer vaccine".^[111] Hanako Jimi (自見英子), 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."^[112] Kanako Inaba (稲葉加奈子), an obstetrician-gynecologist and representative of the advocacy group "Minpapi!"(“Let’s Learn About HPV Together” Project), 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?"^[113]

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.^[114][c]

Controversy

Some clinicians and professional organizations noted early in the controversy that HPV vaccination differed from most routinely administered vaccines in Japan because it was given intramuscularly. In Japan, routine vaccination had historically relied heavily on subcutaneous injection, partly because intramuscular injections had long been avoided following quadriceps contracture cases associated with intramuscular administration of certain drugs in the 1970s.^{[116][117][118]} In June 2026, the Public Health Committee of the Japan Pediatric Association released an educational video to promote the understanding and practice of intramuscular vaccination among healthcare professionals.^[119]

On September 12, 2013, the Japan Society of Obstetrics and Gynecology, the Japan Association of Obstetricians and Gynecologists, and the Japan Society of Gynecologic Oncology jointly submitted a petition to Norihisa Tamura, Minister of Health, Labour and Welfare, requesting the resumption of deliberations on the reinstatement of recommendations for cervical cancer vaccination, and calling for the early resumption of deliberations on active recommendations.^[120]

At “The Public Hearing on Adverse Events following HPV Vaccination in Japan,” held on February 26, 2014, Dr. Sin Hang Lee and others expressed concerns regarding the vaccine’s adjuvant.^[121]

In March 2016, a research team led by Dr. Shuichi Ikeda (池田修一) reported that 80% of patients with neurological symptoms shared the HLA-DPB1*0501 gene type.^[122] Mouse experiments suggested autoantibody deposition in the hippocampus.^[123]According to the research team's presentation, experiments using NF-κB p50 knockout mice found that only the Cervarix-treated group showed IgG autoantibody deposition in the mouse hippocampus, binding of these antibodies to human hippocampal tissue, and peripheral neuropathy. The researchers stated that they planned to purify the antibodies to investigate the mechanism underlying the neurological disorder.^[124]

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.^{[125][126][127]} In June 2016, Shinshu University established an external investigation committee in response to a whistleblower report alleging research misconduct. 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 integrity of the research. The Shinshu University investigation committee concluded by stating that "a serious reflection is required for having caused public confusion."^[128]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."^[129]

In a separate line of research, a study published in Scientific Reports in 2016 suggested that combined administration of an HPV vaccine and pertussis toxin caused neurological damage in mice.^[130] 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.^[131] In May 2018, Scientific Reports formally retracted the article, citing methodological flaws.^[132]

Dr. Ikeda filed a defamation lawsuit against journalist Riko Muranaka (村中璃子) and the magazine Wedge, alleging that her reporting on his research constituted libel. The court ruled in favor of Ikeda. Nobel laureate Tasuku Honjo (本庶佑) submitted an expert opinion criticizing the scientific basis of the study.^{[133][134][135]} He publicly addressed the HPV vaccine issue during a press conference in Stockholm, calling the situation in Japan "outrageous and serious."^[136] He also met with the Minister of Health to urge the resumption of proactive HPV vaccine recommendation.^[137] Honjo later stated that although he explained the issue to journalists, his comments were repeatedly rejected by editorial desks.^[138] 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^[139] 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.^[140]

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.^[141][142] The Supreme Court dismissed her claim on the grounds that it served no purpose, as the publisher had already paid the full amount of damages.^[143] International commentators noted that Japan's suspension had broader implications. Okita (2020) analyzed the suspension as a case study at the intersection of science, ethics, and policy, concluding that political decisions departed significantly from scientific consensus.^[144]

Evidence and expert responses

Expert statements

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, and warned that young women were being left vulnerable to HPV-related cancers that otherwise could be prevented. GACVS further stated: "Policy decisions based on weak evidence, leading to lack of use of safe and effective vaccines, can result in real harm."^[150] Japan was the only country named in the statement, marking an unusually direct rebuke from an international health authority.^[151][152] The Lancet also described the situation as an "HPV vaccination crisis in Japan".^[153] 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.^[154]

At the 19th Joint Meeting of the Subcommittee on Adverse Reactions held on 23 May 2016, both the GACVS statement and the joint declaration of the 17 academic societies were distributed merely as reference materials rather than formal agenda items. Committee member Nobuhiko Okabe, director of Kawasaki City Institute for Public Health and himself a GACVS member, intervened after the committee had already reached a provisional conclusion of no policy change, requesting that the reference materials be explained, and subsequently introduced both documents to the committee himself. The committee nonetheless concluded that no change to the current policy was necessary.^[155][156]

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."^[157][158]

Epidemiological study by Sofue Group

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. Tomotaka Sofue (祖父江友孝) 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. ^[159]

Professional response to scientific evidence

A 2017 survey of physicians who had trained at Osaka University Hospital's Department of Obstetrics and Gynecology or its affiliated institutions revealed significant awareness of international scientific evidence. Among the 259 respondents, 66.5% were aware of the World Health Organization's (WHO's) 2015 statement affirming HPV vaccine safety, and 71.5% were aware of the Sofue epidemiological study commissioned by the Ministry of Health. Furthermore, 72.7% agreed with findings supporting the vaccine's safety, and 84.3% agreed with its efficacy.^[160]

Case reports and clinical observations

In a 2017 study, Takahashi Yukitoshi and colleagues at the National Hospital Organization Shizuoka Institute of Epilepsy and Neurological Disorders analyzed cases that exhibited prolonged neurological symptoms after HPV vaccination and reported elevated levels of IL-17, IL-8, and MCP-1 in the cerebrospinal fluid, suggesting possible involvement in central sensitization and hyperalgesia.^[161]

A research group led by Professor Noriomi Matsumura (松村謙臣) and Professor Ikuo Tsunoda (角田郁) at the Faculty of Medicine, Kindai University conducted a computational analysis of the “molecular mimicry hypothesis,” which has been cited as a basis for claims that HPV vaccination causes neurological symptoms and autoimmune reactions, and found no supporting evidence. The study demonstrated that no molecular mimicry exists between HPV vaccine antigens and human proteins that could trigger autoimmune responses. The findings were published in January 2026 in the peer-reviewed journal International Journal of Clinical Oncology.^[162]

Following the 2016 controversy, the Ministry of Health, Labour and Welfare continued to support grant-funded research on HPV vaccine safety and on patients reporting symptoms after HPV vaccination through multiple research projects, including projects led by Nobuhiko Okabe and Shuichi Ikeda.^[163][164]

Adverse event litigation

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.^[165][166] 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.^[167]

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.^[168] All authors are members of Medwatcher Japan (薬害オンブズパースン会議), a pharmaceutical watchdog NGO whose secretary-general serves as co-representative of the national legal team in HPV vaccine-related lawsuits.^[169]

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. ^[170]

Catch-up program

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.^[180] 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.^[181]

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.^[182] Proactive recommendation resumed in April 2022. That year, 540,681 individuals received their first dose.^[183] In fiscal year 2024, total first-dose recipients rose to 1,513,862, including 429,652 routine and 1,084,210 catch-up recipients.^[184] 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.^[185]

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, having risen since the 1980s while other high-income countries sharply reduced their rates through screening, and emphasized the effectiveness and safety of HPV vaccination and screening. The Center recommended both measures as essential components of prevention. At the press conference, Kota Katanoda（片野田耕太）, head of the Center's Division of Data Science, described Japan's cervical cancer situation as miserable compared with other developed countries and said the Center itself had failed to provide the scientific information it should have during the suspension period, characterizing the fact sheet as an attempt to reset the discussion on an evidence-based footing.^[173][186]

Controversy over MEXT's Educational Guidance

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.^[187][188] 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.^[189]

Supply management during demand recovery

In 2020, shipment adjustments occurred amid increased demand for HPV vaccines.^[190] 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.^[100]

Media coverage of alleged HPV vaccine adverse reaction cases

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 (石渡 勇), 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.^[191] 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.^[192][193] A 2014 report by the Center for Strategic and International Studies (CSIS) concluded that the local government's recognition of adverse cases in Suginami Ward, combined with sensational newspaper, television, and online coverage, contributed to the national halt of promotion.^[194] Journalist and physician Riko Muranaka (村中璃子) argued in Wedge Online in 2015 that the gap between scientific evidence and media portrayal left affected families in distress and reinforced public distrust.^[195]

Media silence and gradual recovery

During the years following the suspension of proactive HPV vaccine recommendations in Japan, mainstream media provided limited sustained coverage. Commentators have described this prolonged silence as a distinctive feature of the Japanese case.^[196] 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.^[197]

Japan’s kisha club (press club) system is an exclusive network of reporters affiliated with government ministries and agencies. It has been criticized for promoting uniform, press-release-based reporting and for discouraging independent or investigative journalism and is often cited as a structural factor limiting press freedom in Japan.^[198][199].Masami Kojima, a journalist and former Mainichi Shimbun reporter, said that when he wanted to write about Riko Muranaka's 2017 John Maddox Prize, his editor at the time blocked the piece, citing fear of protests from citizen advocacy groups. He noted that around that time, after the Sankei Shimbun published an article on the HPV vaccine's effectiveness, a protest letter was posted at the MHLW press club.^[108]

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.^[200]

Social media and public discourse

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.^[201] A preliminary 2026 study of posts on the platform, based on a limited sample and short observation period, reported a “praise movement” characterized by predominantly positive sentiment.^[202]

Journalist Eito Suzuki (鈴木エイト) 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.^[203]

Media coverage and civic perspectives

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.^[204] 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.^[205] 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.^[206]

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.^[207] 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.^[208] In a 2025 narrative review published in Vaccine, 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.^[55] A 2021 study published in Vaccine by researchers including Takahiro Kinoshita (木下喬弘) and Michael R. Reich of the Harvard T.H. Chan School of Public Health 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.^[209]

In a 2025 survey conducted by the Japan Cancer Society with 5,788 respondents, HPV vaccination experience increased across all age groups compared to the previous year’s survey. Regarding the reasons for receiving the HPV vaccine, the most common response overall was “because information about the HPV vaccine was provided by the national or local government,” cited by 38.8% of respondents. Whereas negative opinions were more prevalent in the previous survey, positive opinions ranked highest in this survey. As for consultation behavior, the largest proportion of respondents reported that they had not consulted anyone, followed by 36.7% who consulted their mothers.^[210]

Public health communication and education

Following the resumption of proactive recommendations, researchers have focused on developing evidence-based educational interventions to improve parental decision-making regarding HPV vaccination. A 2024 research project at Ishikawa Prefectural Nursing University is developing two types of educational content for parents: knowledge-based materials centered on medical and statistical information, and narrative-based materials featuring testimonies from cancer survivors and their families.^[211]