The State of Vaccine Confidence

The State of Vaccine Confidence

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Confidence Commentary: The VCP Blog Blog archive

Japan’s Wakefield Moment?

Heidi Larson | April 30, 2015

A commentary by Heidi Larson and J. Stephen Morrison: 

On the occasion of Japanese Prime Minister Abe’s state visit to Washington DC, we want to register our unequivocal support for the many Japanese medical and health professionals who are advocating for the reinstatement of a proactive recommendation of the HPV vaccination which was suspended in Japan in June 2013. We wholeheartedly endorse their timely efforts, and especially want to bring public attention to their calls for high-level political action.

It is time to act.

It is disturbing that important appeals are not being heard or reported on in the Japanese media: these include the petition to reinstate Japan’s HPV vaccine recommendation, signed in March 2015 by over 200 Japanese pediatricians and gynecologists; the statement by the head of the Japanese Medical Association that he would vaccinate his own daughter; and multiple other individuals eager to see high-level political support for HPV vaccination in Japan. Instead, negative media stories are heavily favored, despite scientific investigations determining no causal link between the HPV vaccine and the reported adverse events following vaccination in Japan.

We are not unsympathetic to what was deemed to be psychosomatic responses to vaccination by a number of young girls and understand the anxiety caused. But there are thousands of girls in Japan who are being deprived of a life-saving vaccine that safely and effectively prevents cervical cancer because their families and doctors are inhibited by the lack of high-level political support for this important vaccination.

Two years ago, the Japan Medical Association (JMA) mobilized over 1,600,000 citizen signatures and submitted a demand to the Minister of Health, Labour and Welfare appealing for what successfully became the amended Preventive Vaccination Act, enacted on April 1, 2013, through which Hib, pediatric pneumococcus, and human papilloma virus (HPV) vaccines were included as part of Japan’s routine vaccination schedule.

The early enthusiasm for the HPV vaccine was overwhelming, with nearly 80 percent vaccination uptake. Since then the suspension of proactive recommendation of the vaccine has led to the dramatic decline in HPV vaccination to under five percent.

The public reaction in Japan, demonstrated by the volatile shifts in uptake of the HPV vaccine, speaks both to the power of the Japanese government’s voice – and how powerful the absence of its voice can be. The current dominant anti-vaccine voices in Japan are not representative of the silent majority who are starting to self-organize.

The situation in Japan is worsening. It is not a scientific or medical problem. It is an exceptional political problem that can only be resolved through determined high-level political action that sets the record straight and restores public confidence and trust. Left unresolved, the situation more and more resembles the crisis created by the British researcher Andrew Wakefield who in 1998 advanced the spurious claim that his research proved a causal link between childhood vaccines and autism. It took more than a decade to repair the damage to public trust Wakefield caused, and anxieties still linger in some settings. Japan is risking a similar long-term local and global quagmire with long-term negative public health consequences and serious reputational damage. The HPV vaccine is a safe and effective means to prevent cancer among young girls and boys. Over 180 million doses have been delivered worldwide since the vaccine first became available in 2006. Japan cannot afford a Wakefield moment.


Dr. J. Stephen Morrison
Senior Vice President and Director of the Global Health Policy Center, Center for Strategic and International Studies (CSIS)          

Dr. Heidi Larson
Senior Lecturer, London School of Medicine & Tropical Hygiene and Clinical Associate Professor, Global Health, University of Washington


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