Each year in Japan, over 11,000 cervical cancer cases are recorded, from which around 3000 women die – unnecessarily. The tools to prevent cervical cancer, HPV vaccination and cervical screening, are not being optimally used. Currently, less than 0.1% of eligible Japanese women get vaccinated against HPV,¹ and cervical cancer screening coverage is around 40%.² Why are the stats so low?

The situation was not always this alarming. The bivalent HPV vaccine was first licensed in Japan in October 2009. Backed by public funding, acceptance of the HPV vaccine rose to over 70%, and the introduction of HPV vaccine in Japan was successful. However, over the next several years, unfounded adverse reports about the HPV vaccine emerged in the Japanese media. Sensational misinformation spread widely, damaging public opinion about the vaccine.

The setback was enormous. In June 2013, the Japanese Ministry of Health, Labour, and Welfare (MHLW) suspended proactive recommendations for the HPV vaccine (just two months after it had been introduced into the Japanese National Immunization Program) and within the next 3 years, HPV vaccination dropped nationally from 74% to 0.7% (Figure 1).^2,3

Today, eight years on, although the MHLW agrees that there is ample evidence that the vaccine is safe and effective,^4-6 it continues to withhold proactive recommendation of the vaccine, calling for an improvement in public understanding and confidence about the HPV vaccine to precede the reintroduction of proactive recommendation from the government.

Vaccine scares wreaking havoc on vaccination programs are not unique to Japan. Similar setbacks have occurred in Colombia, Denmark, and France. Yet HPV vaccine hesitancy in Japan seems to be exceptionally challenging to reverse, despite concerted efforts from HPV professionals like Prof. Ryo Konno, Dr. Sharon Hanley, and many others. Why is that?

One theory behind Japanese government hesitation to proactively recommend a safe and effective vaccine has to do with the cultural importance of consensus in decision-making. Japanese culture yearns for unanimity behind important decisions before they are made. Public understanding and confidence in the HPV vaccine may need to noticeably improve before the government acts.

Dr. Nagayasu Egawa is a Research Associate in the Pathology Dept of the University of Cambridge. With fifteen years of HPV basic research to his credit, Nagayasu appreciates working in a field that has a positive impact on society. However, it is the memory of faces of women who suffered from cervical cancer and died that have motivated him to use his expertise to try to help address this preventable problem in his home country.

Last July, Nagayasu joined the International Papillomavirus Society (IPVS) Advocacy Campaign Committee, the engine behind the annual International HPV Awareness Day (IHAD) campaign. As he says himself, “IPVS provided me with a clear goal and I simply took it.”

What can one HPV basic researcher in the UK do to help women in Japan avoid developing cervical cancer?

These have been my activities over the last six months to raise public awareness and understanding of HPV in Japan:
Tailoring HPV campaign materials to be locally effective. Each year IPVS creates materials to raise awareness about HPV in various languages and cultural backgrounds. It’s important to make these materials effective in the context of Japanese society.
Finding partners who share the same goal. Finding dedicated local partners with whom you can discuss your ideas and stimulate each other to move forward is essential. Last year a friend started a non-profit organization called “Minpapi”, which stands for “let’s know about HPV”. Minpapi edits videos to include Japanese dubbing and subtitles and translates patient information leaflets into Japanese.
Start talking to (influential) people. Using the Japanese approach (lots of bilateral conversations before the meeting) and backed by IPVS, we pulled together a small webinar to introduce the HPV Awareness campaign 2021 to public policymakers and others. Minpapi’s connections helped get influential people on board. We continue to reach out to MHWL and we are organising a press conference in Japan and several events on social networking sites (YouTube live, Clubhouse) for March 4th. NHK, the BBC of Japan, is planning a television broadcast about IHAD on March 4th, providing national publicity!

What are you hoping to achieve?

The long-term goal of the awareness campaign is to eliminate cervical cancer in Japan. Right now, we must increase basic awareness of HPV in Japanese society, to stimulate more screening and higher vaccination rates. HPV is a serious health issue with solutions. Nobody wants to see a woman in their lives die of cervical cancer if it can be avoided. We must shift public opinion far enough to get the MHLW to proactively recommend the HPV vaccine. What kids learn in school about infectious disease and cancer must also improve. Information about HPV and cervical cancer is just one of several infectious disease and cancer connections missing from the curriculum. It’s nonsense.

How does IPVS help?

Aside from developing materials to use to catch public attention, just the fact that IPVS is interested in helping eliminate cervical cancer in Japan and cares about solving this problem is encouraging to local advocates. IPVS involvement lends credibility to our messages in the eyes of stakeholders and it motivates us to continue the uphill battle we face for changing perception of HPV vaccine in Japan.

Do you have any advice for other HPV professionals who may be contemplating doing more to raise awareness about HPV?

The main thing I am doing is to connect people and ideas and ‘stir the pot’ at frequent intervals to keep the energy level high and the campaign active. Just find something to do and do it. Otherwise, it won’t happen. It’s more fun to work together with others than if you try to do everything yourself. By building on all our small efforts, we can beat HPV.

References

1.Ministry of Health, labour and Welfare, Government of Japan. Routine Vaccination Coverage. Last accessed: 22 February 2021 Available from: https://www.mhlw.go.jp/topics/bcg/other/5.html?fbclid=IwAR0Wi4vXgFjPln13xavYJ6QRE098kAwdIFPYbWOb9WI_LWghNuzNI_QpN6U

2. Konno R, Albero G, Bruni L. Japan, Fact Sheet. HPV World 2019:90. Available from: https://www.hpvworld.com/media/29/media_section/4/2/1642/hpvworld-090.pdf

3. Hanley SJ, Yoshioka E, Ito Y, Kishi R. HPV vaccination crisis in Japan. Lancet. 2015 Jun 27;385(9987):2571. Available from: https://pubmed.ncbi.nlm.nih.gov/26122153/

4. Konno R, Konishi H, Sauvaget C et al. Effectiveness of HPV vaccination against high-grade cervical lesions in Japan. Vaccine. 2018 Dec References: 18;36(52):7913-7915. Available from: https://pubmed.ncbi.nlm.nih.gov/29778520/

5. Garland SM, Pitisuttithum P, Ngan HYS et al. Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries. J Infect Dis. 2018 Jun 5;218(1):95-108. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989602/

6. Murata S, Shirakawa M, Sugawara Y et al. Post-hoc analysis of injection-site reactions following vaccination with quadrivalent human papillomavirus vaccine in Japanese female clinical trial participants. Papillomavirus Res. 2020 Dec;10:100205. Available from: https://pubmed.ncbi.nlm.nih.gov/32827835/

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