The World Health Organization (WHO) states that vaccination is the most cost-effective public health intervention when considering health, social, economic, and educational impacts. Nevertheless, 1.5 million people worldwide are affected by vaccine-preventable diseases (VPD) each year due to lack of or inability to vaccinate. In Japan, society has reacted strongly to health hazards related to vaccination, and there have been cases where immunization policies have had to be reconsidered due to media reports and lawsuits. There is also a phenomenon known as vaccine hesitancy, where people hesitate or refuse to vaccinate themselves or their children. This has led to a situation where routine immunizations cannot be provided to the public on schedule. In addition, VPDs are still being reported in Japan due to changes in the system.
In recent years, in light of advances in science and technology and the diversification of lifestyles, international organizations and immunization policies in other countries have increasingly emphasized the importance of the life-course approach to immunization, with immunizations taking place not only during childhood, but throughout adolescence, middle age, and old age. In addition, in order to respond to the trend of vaccine hesitancy, Japan has been implementing various initiatives, such as disseminating scientific evidence on the efficacy, safety, and necessity of vaccinations in an easy-to-understand manner and introducing a catch-up system for the unvaccinated. In Japan, the life-course approach has not always been sufficiently implemented because of the design of the immunization system, the perception of the government, and the perception of health care providers.
As of early May 2021, a novel coronavirus infection (COVID-19: Coronavirus Disease 2019) has claimed the lives of approximately 3 million people and caused global economic and social disruption. As some countries move toward the end of the pandemic, expectations for effective and safe vaccines as well as the establishment of treatment methods are increasing worldwide. In Japan, along with a growing sense of urgency regarding infectious diseases, there is a growing interest among all generations in the domestic situation surrounding immunization and vaccination.
As described above, as society’s interest in immunization and vaccination policy grows, it is important that each citizen deepens their understanding of the value that immunization brings to individuals and society throughout one’s life course, across all generations. Japan is expected to implement policies for life-course-based immunization and vaccinate the unimmunized generation.
Thoughts and challenges relating to immunization policy in Japan
In the “Basic Plan for Immunization” established by the Ministry of Health, Labour and Welfare (MHLW), it is clearly stated that since the enactment of the Immunization Law in 1948, vaccines have been remarkably effective in improving the level of public health and maintaining the health of the people, and have made significant contributions to humanity, such as the control of smallpox, which was once a threat to humanity, and the eradication of polio in the Western Pacific region. On the other hand, it is also mentioned that the public’s concerns about adverse effects of immunization have not been dispelled for a long time, and that the number of publicly administered vaccines is low compared to other developed countries (vaccine gap).
(From “Basic Plan on Immunization,” Ministry of Health, Labour and Welfare website)
What does immunization and vaccination mean?
The Tokyo Metropolitan Medical Association’s website, What is immunization?, explains that “Immunization is the process of making a person less susceptible to a disease by administering a less virulent pathogen (virus or bacteria) or toxin in advance. The term ‘vaccination’ is used to describe the administration of a vaccine or toxoid.”
(From “What is vaccination?”, Tokyo Metropolitan Medical Association website)
In other words, “immunization” refers to the “act” and “vaccine” refers to the “thing” used for immunization. There are three main types of vaccines: live-attenuated vaccines, inactivated vaccines, and toxoids. That being said, technological progress has been remarkable in recent years, as evidenced by the response to COVID-19.
Routine and Voluntary Immunization
In addition, the Immunization Law, which is enforced for the purpose of preventing the outbreak and spread of potentially contagious diseases, creates two categories of immunization: “routine” and “voluntary.” The measures have been changed based on the idea that there are two types of diseases: Class A diseases, which focus on group prevention and prevention of serious diseases, and for which the government actively recommends and the individual (guardian) is obliged to make efforts, and Class B diseases, which focus on individual prevention and for which the individual (guardian) is not obliged to make efforts. Therefore, the immunization process varies greatly depending on whether the vaccine is classified as routine or voluntary.
|Routine Vaccinations||Objective to Protect Public Health (Category I)||Hib Vaccine||Hib (Bacterial meningitis, epiglottitis)|
|Pediatric Pneumococcal Vaccine||Pediatric Pneumococcal (Bacterial Meningitis, Sepsis, Pneumonia)|
|Hepatitis B Vaccine||Hepatitis B|
|Rotavirus Vaccine||Infectious Gastroenteritis
|DPT/IPV||Diphtheria, Pertussis, Tetanus, Polio|
|MR (Measles, Rubella) Vaccine||Measles, Rubella|
|Chicken Pox Vaccine||Chicken Pox|
|Japanese Encephalitis Vaccine||Japanese Encephalitis|
|HPV (Human Papillomavirus) Vaccine||Human Papillomavirus (Cervical Cancer)|
|Objective to Protect Individual's Health (Category II)||Influenza Vaccine (For the Elderly)||Influenza|
|Adult Pneumococcal Vaccine (For the Elderly)||Adult Pneumococcal Disease|
|Voluntary Vaccinations||Mumps Vaccine||Mumps (Epidemic Parotitis)|
|DPT||Diphtheria, Pertussis, Tetanus|
|Hepatitis A Vaccine||Hepatitis A|
|Live-attenuated Vaccines||Inactivated Vaccines||Toxoid Vaccines|
|Measles||Pertussis (DPT-PIV: Diphtheria, Pertussis, Tetanus, Inactivated Poliovirus Vaccine)||Diphtheria & Tetanus|
|Rubella||Japanese Encephalitis||DT Toxoid|
|Mumps||Type A Pneumonia||Adult Diphtheria|
|Yellow Fever||Type B Pneumonia||Tetanus|
|BCG||Haemophilus Influenzae Type B (Hib)|
|Rotavirus||13-valent Pneumococcal Conjugate|
|23-valent Pneumococcal Polysaccharide|
|Human Papillomavirus (HPV)|
|Inactivated Poliovirus Vaccine|
(From “What is immunization?” Tokyo Metropolitan Medical Association website)
Challenges with Japan’s immunization and vaccination policy
In Japan, vaccination rates in infancy are extremely high, but vaccine hesitancy, or the failure of public awareness campaigns to raise vaccination rates, tends to prevent vaccination rates from rising as much as expected, especially among adolescents and those who have reached an age when they can make their own decisions. Major examples include the human papillomavirus (HPV) vaccine and the influenza and pneumococcal vaccines in the elderly.
As for the HPV vaccine, the vaccination rate in Japan is extremely low compared to other countries. According to WHO estimates for 2019, the percentage of women aged 15 who have been vaccinated is 0.3% in Japan, compared to 55% in the US and 80% in Australia. It is believed that one of the reasons for the significant decline in vaccination rates in Japan is the discontinuation of “positive recommendations” by the Ministry of Health, Labour and Welfare, along with reports of various adverse reactions. This was a decision made at the time due to reports of serious adverse reactions that could not be attributed to HPV vaccination. At present (May 2021), there is an increasing number of calls for the “MHLW’s suspension of active recommendations” to be reversed and recommendations to be resumed.
Vaccination coverage among the elderly in Japan is also lower than in other countries, despite the availability of free and reduced copayment support. The influenza vaccine coverage rate is 50.2%, about half of all elderly, and the pneumococcal vaccine coverage rate is even lower at 37.8%.
One of the reasons why the vaccination rate has not increased, despite the measures taken by local governments and the national government, is due in part to adverse reactions, but also to a lack of communication with the target population, leaving lots of room for improvement. The tendency for people to avoid vaccines mainly stems from concerns about side effects, but in order to gain understanding of vaccines, careful dialogue is required, based on acceptance and respect for their concerns and intentions, rather than one-sidedly conveying their efficacy and forcing vaccination.
The following is a summary of the 17 key findings that the Institute for Public Relations (IPR) recommends to guide communication relating to the COVID-19 vaccine. Although this summary relates to the COVID-19 vaccine, some statements are applicable to all vaccine measures.