How Japan fell behind in fight against cervical cancer

Gary Finnegan

Gary Finnegan

June 17th, 2022

Gary Finnegan

‘Nine years after a disastrous decision to cease recommending HPV vaccination ‒ a move expected to result in more than 5,000 preventable deaths ‒ Japanese authorities have changed course. There’s a lot of catching up to do.’

For Japan, it is a grim prospect: in the decades to come, developed countries that introduced human papilloma virus (HPV) vaccination as many as 15 years ago will record sharp declines in cervical cancer rates. Japanese women will continue to die in their thousands.

Key points

  • Authorities in Japan have reinstated their recommendation for HPV vaccines
  • Government dropped its support in 2013 in response to ‘anti-vaccine pressure’
  • The decision may cost ~25,000 cervical cancer cases and up to 5,700 deaths
  • A catch-up campaign has been launched to limit the damage
  • Policy shift follows positive response to COVID-19 vaccination in Japan

HPV causes several types of cancer, including cancer of the cervix. The first HPV vaccine became available in 2006, opening new possibilities for cancer prevention. The vaccine is usually offered in early adolescence and dramatically reduces the number of ‘pre-cancers’ which might otherwise develop into cervical cancers in adulthood. The benefits are already coming into view but the full impact will be seen in the years to come.

Australia, an early adopter that introduced a HPV vaccination programme, expects to be the first to eliminate cervical cancer. In Europe, a concerted effort to beat the disease through vaccination, screening and testing will see millions of girls and boys protected against HPV over the coming decade.

Meanwhile, in Japan, the legacy of a decision to withdraw an explicit recommendation for the vaccine in 2013 ‒ in response to ill-founded concerns over vaccine safety ‒ may continue to haunt one of the most advanced societies in the world.

Japan is not the only country to face a crisis of confidence in HPV vaccines. Denmark and Ireland also saw sharp declines in uptake, fuelled by unfounded online rumours. Both countries invested time and resources in campaigns to rebuild vaccination rates over several years. 

Japan took another course: abruptly suspending its proactive support for the vaccine (although the vaccine remained available) and ignoring years of expert pleading to restore the recommendation.

A Japanese city square full of people at night

Counting the cost

When the government withdrew its recommendation for the vaccine, uptake sank and the rate of HPV infection in Japan has risen sharply as a result. In 2013, 70% of adolescent girls had the vaccine. By 2019, it was just 1%.

A modelling study estimated that 25,000 cases of cervical cancer and up to 5,700 deaths would be recorded among women who missed out on vaccination between 2013 and 2019.

One way to mitigate the negative impact is to run a rapid catch-up campaign. This is now part of the Japanese government’s plan to contain the damage of a misguided policy, but experts say that this would prevent just 60% of cases because many unvaccinated women have been infected with HPV in the meantime. 

There is another problem: awareness of the vaccine is now extremely low. Vaccine confidence expert, Prof Heidi Larson, has said ‘reigniting positive public awareness of the value of the HPV vaccine’ will be a challenge.