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HPV Vaccine Hesitancy

Many deaths could still be prevented if vaccination coverage is restored
14 Feb 2020
Epidemiology/Etiology/Cancer Prevention;  Gynaecologic malignancies

Although the human papillomavirus (HPV) vaccine is still included in the Japanese national immunisation programme and is provided free of charge for girls aged 12–16 years, the Japanese Government suspended proactive recommendations for the vaccine in June 2013, after unconfirmed reports of adverse events following immunisation appeared in the media. Vaccine coverage declined rapidly from more than 70% to less than 1%. It is estimated that the HPV vaccine crisis result to date in around 5000 deaths from cervical cancer in Japan. Many of these deaths could still be prevented if vaccination coverage with extended catch-up can be rapidly restored according to an article published on 10 February 2020 in the Lancet Public Health.

HPV causes cervical cancer and cancers at other anogenital and oropharyngeal sites in both women and men, resulting in an estimated total of 630 000 HPV-related cancers globally in 2012. Globally, cervical cancer represents the largest burden of HPV-related cancer. HPV vaccination of girls and young adolescent females prevents infections with vaccine-targeted types and the development of cervical precancerous abnormalities.

Funding for HPV vaccination in Japan began in 2010 for girls aged 12–16 years, with three-dose coverage initially reaching more than 70%. The Japanese Government suspended proactive recommendations for the vaccine in June 2013. Despite a large amount of evidence supporting the safety of HPV vaccination, the suspension of proactive recommendation has now continued for more than 6 years, and has not only negatively impacted vaccine confidence within Japan, but might also have influenced the perception of the vaccine in other countries, such as Denmark, Ireland, and Colombia. 

In January 2019, the World Health Organization listed vaccine hesitancy as one of the top ten threats to global health.

By using a well validated modelling platform, the study team found that the vaccine crisis from 2013 to 2019 is predicted to result in an additional 24600–27300 cases and 5000–5700 deaths over the lifetime of cohorts born between 1994 and 2007, compared with if coverage had remained at around 70% since 2013.

However, restoration of coverage in 2020, including catch-up vaccination for missed cohorts, could prevent 14800–16200 of these cases and 3000–3400 of these deaths.

If coverage is not restored in 2020, an additional 3400–3800 cases and 700–800 deaths will occur over the lifetime of individuals who are 12 years old in 2020 alone. If the crisis continues, 9300–10800 preventable deaths due to cervical cancer will occur in the next 50 years (2020–2069).

The authors interpreted that results by stating that the vaccine crisis in Japan to date will result in around 5000 deaths due to cervical cancer alone, and this number will increase by around 700–800 for each year that the crisis continues. Most of the additional cervical cancers and deaths are still preventable if vaccination coverage is quickly restored. However, even if vaccination coverage is restored, cervical screening initiatives should also be prioritised, especially for women in cohorts who missed vaccination due to the crisis, and for older unvaccinated women.

The study was funded by the National Health and Medical Research Council Australia Centre of Research Excellence in Cervical Cancer Control and Japan Society for the Promotion of Science.


Simms KT, Hanley SJB, Smith MA, et al. Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health; Published online 10 February 2020. DOI: https://doi.org/10.1016/S2468-2667(20)30010-4.

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