Understanding confidence in the human papillomavirus vaccine in Japan: a web-based survey of mothers, female adolescents, and healthcare professionals

Michiko Shuto,Youngju Kim,Kotoba Okuyama,Kazunobu Ouchi,Hideo Ueichi,Chimeremma Nnadi,Heidi J Larson,Gonzalo Perez,Shin Sasaki

doi:10.1080/21645515.2021.1918042

Abstract

ABSTRACT Vaccine confidence reflects social, individual, and political factors indicating confidence in vaccines and associated health systems. In Japan, the government ceased proactive recommendation of the human papillomavirus (HPV) vaccine in June 2013, only several months after the recommendation had begun. Seven years later, as of October 2020, the suspension persists and vaccine coverage has precipitously declined, resulting in many young women being continually exposed to the risk of preventable HPV-related diseases. Accordingly, understanding stakeholder opinions on HPV vaccination issues is critical for informing strategies to improve HPV vaccine confidence and acceptance. In October 2019, we performed a nationwide, web-based survey of 1646 mothers of HPV-vaccination–eligible girls, 562 female adolescents aged 15–19 years, and 919 healthcare professionals (HCPs) in Japan. This survey captured key elements of vaccine confidence (i.e., importance, effectiveness, and safety of the HPV vaccine), awareness, and the willingness to receive (in HPV-vaccination–eligible girls) or recommend (in HCPs) the HPV vaccine, and the factors responsible for these decisions. HPV vaccine confidence was generally higher among HCPs than among mothers or female adolescents. Nearly half of all stakeholders were neutral regarding their willingness to receive/recommend the HPV vaccine. The seriousness of cervical cancer and the HPV vaccine’s effectiveness or safety were important deciding factors for receiving/recommending the HPV vaccine. Besides these factors, sufficient information and free vaccination were crucial. Our results suggest several factors that could help shape public policy and communication strategies to improve HPV vaccine confidence and acceptance in Japan.

Highlights

In Japan, in 2018, cervical cancer was the second most com mon cancer among women aged 15–44 years.[1]
Media reports about the occur rence of diverse symptoms in some human papillomavirus (HPV) vaccine recipients in 2013 led the Ministry of Health, Labour and Welfare (MHLW) in Japan to suspend their proactive recommendation for rou tine use of the HPV vaccine in the national immunization program (NIP) just a few months after their recommendation began
Awareness, and willingness to receive/recommend the HPV vaccine among 1591 mothers with daughters unvaccinated

Summary

Introduction

In Japan, in 2018, cervical cancer was the second most com mon cancer among women aged 15–44 years.[1] Human papil lomaviruses (HPVs) cause almost all cases of cervical cancer and are implicated in various other cancers.[1] Many countries have invested significant resources in HPV vaccination and other measures to promote cervical cancer elimination.[2] In Japan, HPV vaccines have been commercially available since late 2009 and were introduced into the national immunization program (NIP) in April 2013. HPV vaccine coverage has sharply declined from approximately 70% to less than 1%.8. Among Japanese women born between 1994 and 2007, an excess of 24,600–27,300 preventable cervical cancer cases and 5000–5700 cervical cancer deaths are projected to occur over their lifetime owing to the precipitous decline in HPV vaccination coverage recorded between 2013 and 2019.9. We conducted a survey focused on understanding HPV vaccine confidence and the willingness to receive the HPV vaccine among Japanese mothers and female adolescents, and among healthcare profes sionals (HCPs) to recommend the HPV vaccine

Study design

Ethics approval

Results

Discussion

Disclosure of potential conflicts of interest