Overcoming HPV Vaccine Hesitancy in Japan: A Narrative Review of Safety Evidence, Risk Communication, and Policy Approaches

Abstract

Human papillomavirus (HPV) infection remains a principal cause of cervical cancer worldwide. Although large-scale vaccination efforts have substantially lowered HPV infection rates and precancerous lesions, not all regions have achieved high coverage. In Japan, proactive HPV vaccine recommendations were suspended from 2013 to 2022 due to concerns over alleged adverse events, causing vaccination rates to drop from over 70% to below 1%. This narrative review synthesized research published from 2014 to 2025 in PubMed, Cochrane Library, and Google Scholar, focusing on English-language studies. Inclusion criteria encompassed analyses of HPV vaccine efficacy or safety, policies related to vaccination in Japan or other countries, and investigations into vaccine hesitancy or media influences. Data were categorized into five thematic areas: historical and policy contexts, evidence of vaccine safety and efficacy, societal drivers of hesitancy, communication strategies, and administrative or clinical interventions. Evidence robustly confirms the HPV vaccine's favorable safety profile, with severe adverse events appearing exceedingly rare. Nonetheless, media sensationalism and limited risk communication in Japan perpetuated mistrust, impeding vaccination uptake. Comparisons with Denmark and Ireland indicate that transparent, interactive risk communication can restore coverage to near-pre-suspension levels. Japan's recent policy reforms, including reinstating proactive recommendations and catch-up initiatives, have begun to reverse vaccination hesitancy. Sustained policy support, evidence-based messaging, and empathetic engagement with communities are central to rebuilding trust in the HPV vaccine. Lessons from best international practices emphasize the importance of multifaceted interventions, collaborative stakeholder engagement, and transparent risk communication to reduce the burden of HPV-related malignancies.

Keywords: Japan; cervical cancer; human papillomavirus; policy approaches; risk communication; safety evidence; vaccine hesitancy.