HPV vaccination in Japan refers to the routine immunization programme, mandated under national law but funded and administered by municipal governments, to prevent cervical cancer and other HPV-related diseases. The programme has been marked by the introduction of routine immunization in 2013, an eight-year suspension of proactive recommendations (2013–2021) amid safety concerns, and subsequent recovery. It is routinely offered to girls from the equivalent of sixth grade of elementary school through the first year of high school, with vaccination provided free of charge under the national immunization programme through municipalities. Those who begin vaccination before age 15 generally receive two doses, while those who begin at age 15 or older receive three doses. Since April 2026, the 9-valent vaccine Gardasil 9 has been the only HPV vaccine used in the routine programme in Japan. The suspension contributed to a sharp decline in vaccination and drew international attention, as Japan became the only high-income country to halt routine vaccine recommendations for an extended period. The resulting reduction is projected to lead to thousands of additional cervical cancer cases and deaths if vaccination coverage does not recover to pre-suspension levels. Evidence found no association between HPV vaccination and the prior side effects that were a concern in Japan. International health organizations, including the World Health Organization, affirmed the vaccine's safety profile and called for Japan to resume proactive recommendations. Cervical cancer remained a major public health issue in Japan,where new cases and mortality had remained largely unchanged for decades, unlike declines seen in many other developed countries. Following the resumption of proactive government recommendations in April 2022, vaccination coverage has gradually recovered through both routine immunization and catch-up vaccination for those who missed vaccination during the suspension. As of 2024, first-dose coverage exceeded 70% in some prefectures, although substantial regional disparities remain.
Background 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. In 2021, there were 10,690 diagnosed cases of cervical cancer in Japan, and in 2024, the number of deaths from the disease was 2,751. 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. Some researchers argue that Japan’s vaccine environment has a distinctive pattern. According to Andrew Gordon and Michael R. Reich, Japan is not historically a “vaccine‑hesitant country,” and routine childhood vaccines are widely accepted. However, repeated social movements over alleged vaccine injuries made both the government and the public more cautious toward newly introduced vaccines. Gordon and Reich referred to this dynamic as a “puzzle of vaccine hesitancy.”
Vaccination programme HPV vaccination in Japan targets girls in the sixth grade of elementary school through the first year of high school (approximately ages 12–16). Depending on the age at which vaccination begins, two or three doses are administered at specified intervals, and completing the required doses within one year is recommended. As of 2025, the only vaccine used in the routine, publicly funded programme is the 9-valent Gardasil 9 (シルガード9), which protects against seven high-risk HPV types (16, 18, 31, 33, 45, 52, and 58), preventing an estimated 80–90% of cervical cancers caused by HPV. The bivalent (Cervarix) and quadrivalent (Gardasil) vaccines were also part of the routine programme through fiscal year 2025. Vaccination is provided free of charge to eligible individuals through designated municipal medical institutions during the routine eligibility period. HPV vaccination in males can help prevent HPV-related diseases, including anal cancer, penile cancer, oropharyngeal cancer, and genital warts, and may also reduce HPV transmission. In Japan, male vaccination is approved but is not included in the routine immunization programme. Cost-effectiveness evaluation and the expansion of public vaccination coverage remain policy considerations. International and domestic epidemiological research has found that countries with early national HPV vaccination programs, including Australia, the United Kingdom, and the United States, have seen significant reductions in HPV infection and precancerous lesions, including herd immunity effects among unvaccinated individuals of the same generation. Since 2020, Sweden, England, and Denmark have each published real-world evidence of reduced invasive cervical cancer among vaccinated cohorts. Domestic Japanese studies, including research conducted in Niigata, Akita, Miyagi, and Matsuyama, have similarly found reduced rates of HPV infection and precancerous lesions among vaccinated individuals compared with unvaccinated individuals of the same age.
Legal framework Japan's immunization system is implemented under the Immunization Act, enacted in 1948. At the time of its enactment, routine vaccination programs were classified as delegated state administrative functions. Following the implementation of the Omnibus Decentralization Law in April 2000, they became autonomous functions of local governments. Under Article 5 of Japan's Immunization Act, the responsibility for implementing routine vaccinations lies with local governments, such as cities, towns, and villages. 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. 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.
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. 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. 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. 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. 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.”
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. 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. For vaccinations falling outside the routine immunization schedule, it is possible to receive Silgard 9 at one's own expense. However, unlike routine vaccinations, the relief system applicable in the event of a health impairment is not the "Relief System for Health Damage Associated with Vaccination" based on the Preventive Vaccination Law, but rather the "Relief System for Adverse Drug Reactions" based on the Pharmaceuticals and Medical Devices Agency (PMDA) Law.
Current status In Japan, HPV vaccination data has traditionally been reported as an "implementation rate" (実施率) based on vaccinations administered to girls within the standard vaccination age range. Because catch-up vaccinations may be included in the annual totals, the reported implementation rate can exceed 100%. Vaccination coverage estimates by birth cohort were introduced later and are also used in epidemiological analyses.
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. The schedule was revised in April 2023, coinciding with the introduction of the 9-valent HPV vaccine, reducing the routine vaccination from three doses to two doses for those under 15 years of age.
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.
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%. 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. 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).
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. 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.
By prefecture in 2024 In fiscal year 2024, annual (non-cumulative) routine HPV vaccination rates were highest in Miyazaki Prefecture at 20.8%, followed by Yamagata Prefecture at 19.8%, while Okinawa Prefecture had the lowest rate at 7.4%. 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 placing posters in stores and other locations Okinawa Prefecture has recognized low HPV vaccination coverage as a public health challenge. According to an Okinawa Prefectural Assembly statement, the prefecture's routine HPV vaccination coverage was 4.1% in fiscal year 2022, 5.3% in fiscal year 2023, and 7.4% in fiscal year 2024. Catch-up vaccination coverage was 2.1%, 2.4%, and 8.8%, respectively. The prefecture reported that both routine and catch-up vaccination coverage remained the lowest among Japanese prefectures and identified improving vaccination uptake as an important policy issue. Local medical organizations have also expressed concern regarding low vaccination coverage in Okinawa. The Okinawa Prefecture Medical Association and regional medical groups have promoted measures to increase vaccination opportunities, including public information campaigns and group vaccination programs.
Professional society recommendations On 7 August 2026, the Japan Society of Obstetrics and Gynecology (JSOG) issued a statement urging healthcare professionals across all specialties to actively support HPV vaccination. Citing the WHO's goal of achieving 90% HPV vaccination coverage among girls by age 15 by 2030, the society noted that uptake in Japan had recovered only to around 50% following the resumption of proactive recommendations in 2022. It emphasized that cervical cancer remains a preventable disease and encouraged physicians to discuss HPV vaccination with eligible patients and their families and to strengthen vaccination services in clinical practice.
International context
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 vaccination coverage exceeding 80% through school-based delivery, while the United Kingdom has consistently achieved coverage above 70% through its national programme. According to the ECDC, Iceland, Portugal, and Norway reached the 2024 target of 90% HPV vaccination coverage among girls by age 15, and declining cervical cancer incidence has been reported among vaccinated cohorts across Europe. 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.
History of vaccination policy
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. Cervarix (GlaxoSmithKline) was approved in October 2009 and released in December. In November 2010, the “Emergency Program to Promote Vaccination Against Cervical Cancer and Other Diseases” was launched, and the HPV vaccine became publicly subsidized. Gardasil (Merck & Co.) was approved in July 2011 and released in August. 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)". Proactive recommendations were suspended just two months later, in June 2013(see §International context),leading to a sharp and prolonged decline in coverage(see §International comparison)
Political and social factors
In a 2013 session of the National Diet, Upper House member Michiko Ueno (上野通子）expressed concern regarding HPV vaccine promotion, stating that the government may not have given sufficient consideration to sexual education in relation to administering the vaccine to girls in their early teens. Fellow councillor Eriko Yamatani (山谷えり子) 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. 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 educational purity as a doctrinal priority, HPV vaccination was seen as incompatible with its moral teachings.
suspended its proactive recommendation for the HPV vaccine
Initial suspension and response
In March 2013, parents of girls who reported serious symptoms following HPV vaccination established the National Liaison Association of Cervical Cancer Vaccine Victims and called for the suspension of HPV vaccination. The association subsequently called for the vaccination programme itself to be suspended, including in a meeting with the health minister in August 2013. 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. 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. 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. In the United Kingdom, the United States, Ireland, and Colombia 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. 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. 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. 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. 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. In interviews published in 2019 and 2026, former MHLW officialTokumasa 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. 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.
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. 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.
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." 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. 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. 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.
Municipal implementation surveys In a 2018 survey of local governments, the Ministry of Health, Labour and Welfare asked about the use of HPV vaccine leaflets. The results showed that of the 1,741 municipalities surveyed, 70.9% (1,235 municipalities) had neither posted the leaflets online nor distributed them in person. Further, only 79 municipalities were sending or distributing leaflets or their own informational materials directly to eligible individuals. In a survey of citizens, some respondents expressed concern about the phrasing “We are temporarily suspending our active recommendation of the HPV vaccine” and noted that the information provided seemed to focus heavily on side effects. The MHLW conducted surveys to monitor municipal implementation of information provision policies. A March 2021 survey of 1,714 municipalities (with a 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. 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 reason recorded in the survey was "considering past adverse reactions, we are proceeding cautiously with recommendations."
Responses by local governments 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 a 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. As HPV vaccination rates fell sharply, Okayama Governor Ryuta Ibaragi (伊原木隆太) launched an independent public awareness campaign. He issued a leaflet under his own name promoting HPV vaccination. Motivated by concerns about cervical cancer deaths among women in their 30s and 40s, he continued these efforts despite receiving little support from other governors or municipalities. He remarked that, regardless of how strongly the WHO Director-General promoted HPV vaccination, municipalities followed the guidance of Japan's Ministry of Health, Labour and Welfare rather than that of the WHO. Tomonori Kiyoyama清山知憲, 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.
Media amplification and public anxiety A physician-led study of Japan’s five largest newspapers concluded that media coverage of HPV vaccination became increasingly negative after Asahi Shimbun's widely publicized report on the Suginami Ward case described above, which described a student alleging adverse symptoms following vaccination. The study further suggested that the Japanese government’s reluctance to issue explicit safety assurances—partly influenced by past vaccine-related lawsuits such as those involving the MMR vaccine—contributed to prolonged negative reporting and the continued suspension of proactive HPV vaccine recommendations. The HPV vaccine debate occurred during a broader period of opposition to comprehensive sex education in Japan, which some researchers have characterized as "sex education backlash" (性教育バッシング). Obstetrician-gynecologist Song Mi-hyun(宋美玄), According to Song, this climate subjected medical professionals and journalists who supported HPV vaccination to public criticism and organizational pressure. Journalist Naoko Iwanaga (岩永直子), then editor-in-chief of yomiDr., a medical information website run by the Yomiuri Shimbun, launched a feature on HPV vaccine safety and efficacy in 2017. After the series drew numerous complaints, she was repeatedly summoned by supervisors, removed as editor-in-chief, and transferred to a regional bureau, which she described as effectively ending her medical journalism career at the newspaper. She later joined BuzzFeed Japan, where she continued reporting on HPV vaccination and received the 2020 Internet Media Award. The Nagoya Study, discussed in detail below, was conducted at the mayor's direction in response to citizens alleging vaccine injury; however, because it found no differences between vaccinated and unvaccinated individuals, the results were removed from the city's website three days after publication. As of 2026, Japan’s Ministry of Education curriculum guidelines continue to maintain provisions that prohibit teaching about sexual intercourse and contraception in schools.
Gender disparities and policy response In Japan, the HPV vaccine was commonly referred to as the "cervical cancer vaccine". 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." 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?" 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.
The Controversy Over HPV Vaccine Safety
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. 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. 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. 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. 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. Mouse experiments suggested autoantibody deposition in the hippocampus. 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. 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. 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." 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." 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. 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. In May 2018, Scientific Reports formally retracted the article, citing methodological flaws.
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. He publicly addressed the HPV vaccine issue during a press conference in Stockholm, calling the situation in Japan "outrageous and serious." He also met with the Minister of Health to urge the resumption of proactive HPV vaccine recommendation. Honjo later stated that although he explained the issue to journalists, his comments were repeatedly rejected by editorial desks. 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 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. 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. 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. 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.
Evidence and expert responses
Scientific review: Nagoya City study Following concerns over repo