HPV vaccination in Japan refers to the routine immunization programme, mandated under national law but funded and administered by municipal governments, to prevent cervical cancer and other HPV-related diseases. The programme has been marked by the introduction of routine immunization in 2013, an eight-year suspension of proactive recommendations (2013–2021) amid safety concerns, and subsequent recovery. It is routinely offered to girls from the equivalent of sixth grade of elementary school through the first year of high school, with vaccination provided free of charge under the national immunization programme through municipalities. Those who begin vaccination before age 15 generally receive two doses, while those who begin at age 15 or older receive three doses. Since April 2026, the 9-valent vaccine Gardasil 9 has been the only HPV vaccine used in the routine programme in Japan.
The suspension contributed to a sharp decline in vaccination and drew international attention, as Japan became the only high-income country to halt routine vaccine recommendations for an extended period. The resulting reduction is projected to lead to thousands of additional cervical cancer cases and deaths if vaccination coverage does not recover to pre-suspension levels.
A large-scale epidemiological study in Nagoya, Japan, found no significant association between HPV vaccination and 24 reported post-vaccination symptoms. International health organizations, including the World Health Organization, affirmed the vaccine's safety profile and called for Japan to resume proactive recommendations. Cervical cancer remained a major public health issue in Japan, where new cases and mortality had remained largely unchanged for decades, unlike declines seen in many other developed countries.
Following the resumption of proactive government recommendations in April 2022, vaccination coverage has gradually recovered through both routine immunization and catch-up vaccination for those who missed vaccination during the suspension. As of 2024, first-dose coverage exceeded 70% in some prefectures, although substantial regional disparities remain.
Background Cervical cancer is one of the most common cancers affecting young women in Japan. Each year, more than 10,000 women are diagnosed with cervical cancer, and approximately 3,000 die from the disease. In addition, about 1,000 women under the age of 40 lose their fertility each year due to cervical cancer treatment. In 2021, there were 10,690 diagnosed cases of cervical cancer in Japan, and in 2024, the number of deaths from the disease was 2,751.
These figures have remained largely unchanged for the past 30 years, in contrast to declining trends observed in other developed countries such as the United States, the United Kingdom, European nations, and Australia. One of the main contributing factors is the low uptake of cervical cancer screening by cytology and the absence of an organized screening system. Many women undergo irregular, ad hoc screenings, and the self-reported screening rate within two years among women aged 20 to 65 is approximately 40%. Under these circumstances, widespread use of the HPV vaccine is expected to play a major role in reducing the burden of cervical cancer in Japan.
Some researchers argue that Japan’s vaccine environment has a distinctive pattern. According to Andrew Gordon and Michael R. Reich, Japan is not historically a “vaccine‑hesitant country,” and routine childhood vaccines are widely accepted. However, repeated social movements over alleged vaccine injuries made both the government and the public more cautious toward newly introduced vaccines. Gordon and Reich referred to this dynamic as a “puzzle of vaccine hesitancy.”
Vaccination programme HPV vaccination in Japan targets girls in the sixth grade of elementary school through the first year of high school (approximately ages 12–16). Depending on the age at which vaccination begins, two or three doses are administered at specified intervals, and completing the required doses within one year is recommended. As of 2026, the only vaccine used in the routine, publicly funded programme is the 9-valent Gardasil 9 (シルガード9), which protects against seven high-risk HPV types (16, 18, 31, 33, 45, 52, and 58), preventing an estimated 80–90% of cervical cancers caused by HPV. The bivalent (Cervarix) and quadrivalent (Gardasil) vaccines were also part of the routine programme through fiscal year 2025.
Vaccination is provided free of charge to eligible individuals through designated municipal medical institutions during the routine eligibility period.
HPV vaccination in males can help prevent HPV-related diseases, including anal cancer, penile cancer, oropharyngeal cancer, and genital warts, and may also reduce HPV transmission. In Japan, male vaccination is approved but is not included in the routine immunization programme. Cost-effectiveness evaluation and the expansion of public vaccination coverage remain policy considerations.
International and domestic epidemiological research has found that countries with early national HPV vaccination programs, including Australia, the United Kingdom, and the United States, have seen significant reductions in HPV infection and precancerous lesions, including herd immunity effects among unvaccinated individuals of the same generation. Since 2020, Sweden, England, and Denmark have each published real-world evidence of reduced invasive cervical cancer among vaccinated cohorts. Domestic Japanese studies, including research conducted in Niigata, Akita, Miyagi, and Matsuyama, have similarly found reduced rates of HPV infection and precancerous lesions among vaccinated individuals compared with unvaccinated individuals of the same age.
Legal framework Japan's immunization system is implemented under the Immunization Act, enacted in 1948. At the time of its enactment, routine vaccination programs were classified as delegated state administrative functions. Following the implementation of the Omnibus Decentralization Law in April 2000, they became autonomous functions of local governments.
Under Article 5 of Japan's Immunization Act, the responsibility for implementing routine vaccinations lies with local governments, such as cities, towns, and villages. For diseases classified as Category A under the Immunization Act (Japan), municipalities are legally obligated to promote vaccination among eligible individuals and their guardians. "Proactive recommendation" refers to targeted outreach efforts such as sending postcards or screening forms directly to households prior to the standard vaccination period, encouraging timely uptake of the vaccine.
The Vaccination and Vaccine Subcommittee is an advisory body that makes recommendations to the Minister of Health, Labour and Welfare; formal policy decisions are made and implemented by the Ministry.
Although municipalities are responsible for implementing routine vaccinations and covering the associated costs, 90 percent of these costs is financed through local allocation tax grants from the national government.
Procurement and distribution of vaccines In low-income countries, vaccines are procured at low prices with the support of the GAVI Alliance, a global partnership organization launched at the Annual Meeting of the World Economic Forum (Davos) in 2000. Japan is one of the donor countries. A 2018 study on HPV vaccine pricing in European tender-based settings concluded that, since HPV vaccines are widely procured across Europe, the average tender price decreased to one-quarter of the list price. The study suggested that tendering is an effective cost-containment strategy and may expand cost-effective HPV vaccination to previously excluded target groups. A 2024 study found that the lowest price was the predominant criterion in national tenders for HPV vaccine suppliers in EU member states, indicating that competitive tendering was used to obtain vaccines at the lowest available price.
On the other hand, in Japan, because responsibility for routine immunization rests with local governments, vaccines are purchased by individual medical institutions through wholesalers from vaccine manufacturers. The national government does not engage in price negotiations with manufacturers, and vaccine procurement is carried out by medical institutions or, in some cases, by municipalities. As a result, “for vaccines designated as routine immunizations, municipalities must purchase them at any price, creating a price formation mechanism favorable to sellers.”
Vaccine side effect reports Japan's adverse-reaction reporting system operates through multiple channels: physicians are required under Article 12 of the Immunization Act to report suspected reactions upon becoming aware of them; vaccine manufacturers separately report cases under the Pharmaceuticals and Medical Devices Act; and vaccine recipients or their guardians may also report suspected harm directly to their municipality. According to the Pharmaceuticals and Medical Devices Agency (PMDA), a report may be accepted "even where a causal relationship between the reported symptom and vaccination is not necessarily clear," if reporting is judged necessary from the standpoint of preventing harm to public health. Common side effects include pain, swelling, and redness at the injection site. Rare adverse reactions, occurring at an undetermined frequency, include anaphylaxis, Guillain–Barré syndrome, acute disseminated encephalomyelitis (ADEM), and immune thrombocytopenia. Vaccination is contraindicated for individuals with known hypersensitivity to vaccine components, and requires medical consultation for those with certain underlying conditions, prior severe allergic reactions to vaccination, seizure history, immunodeficiency, or pregnancy. For vaccinations falling outside the routine immunization schedule, it is possible to receive Silgard 9 at one's own expense. However, unlike routine vaccinations, the relief system applicable in the event of a health impairment is not the "Relief System for Health Damage Associated with Vaccination" based on the Preventive Vaccination Law, but rather the "Relief System for Adverse Drug Reactions" based on the Pharmaceuticals and Medical Devices Agency (PMDA) Law.
For routine vaccination under the Immunization Act, Japan's vaccine injury compensation system provides benefits to people who suffer health problems following vaccination. Applications are reviewed individually by the Health Damage Review Committee, which considers the medical plausibility of the symptoms, their temporal relationship to vaccination, and whether another cause is reasonably more likely. The Ministry of Health, Labour and Welfare states that strict medical proof of causation is not required for compensation; cases may be eligible when a causal relationship with vaccination cannot be ruled out.
Current status In Japan, HPV vaccination data has traditionally been reported as an "implementation rate" (実施率) based on vaccinations administered to girls within the standard vaccination age range. Because catch-up vaccinations may be included in the annual totals, the reported implementation rate can exceed 100%. Vaccination coverage estimates by birth cohort were introduced later and are also used in epidemiological analyses.
HPV vaccination in Japan initially achieved high uptake, with over 70% coverage among eligible girls in some regions. In recent years, following the resumption of proactive recommendation in 2022, catch-up programs and advocacy efforts have gradually increased awareness and access, though disparities persist. The following section presents historical vaccination numbers and cohort-specific coverage. The schedule was revised in April 2023, coinciding with the introduction of the 9-valent HPV vaccine, reducing the routine vaccination from three doses to two doses for those under 15 years of age.
By birth cohort