Health and Global Policy Institute (HGPI) has released the results of its cultural anthropological study on vaccine hesitancy. Based on an anthropological investigation into the realities of vaccine hesitancy in Japan, HGPI identified key issues and compiled perspectives aimed at informing policy recommendations. It is our hope that these recommendations will be reflected in future immunization and vaccine policies, advancing truly evidence-based policymaking.

■ Executive Summary

In contemporary Japan, public trust in vaccine safety remains among the lowest in the world, at just 30 to 39 percent, and reluctance toward vaccination against vaccine-preventable diseases (VPDs) poses a significant challenge. To understand the root causes of this resistance, the study conducted expert interviews, a Market Research Online Community (MROC), and in-depth interviews. The findings revealed that commonly held assumptions — such as the existence of a uniquely Japanese culture of vaccine hesitancy or distinctive patterns of vaccine avoidance among older adults — diverge significantly from the actual situation on the ground. Drawing on these results, five key issues and four perspectives for policy implementation are presented below.

■ Discussion Points

Discussion point 1: While leaving behind superficial hypotheses on the causes of vaccine hesitancy, steps must be taken to establish immunization and vaccination policies that are compatible with current circumstances in Japan.
While some have hypothesized that vaccination programs are hindered by inconvenient access to vaccination sites in rural areas, this hypothesis might not reflect real-world circumstances. In addition, some have also shared the hypothesis that vaccine hesitancy may be more prevalent among older age groups in Japan, but this, too, does not match actual circumstances. There are no issues related to vaccine literacy among the public or to media influence that are unique to Japan.

Discussion point 2: There is less vaccine hesitancy among elderly people compared to members of other age groups, but they are unaware of the existence of vaccines for older adults.
Owing in part to past practices in which mass vaccinations were conducted at elementary schools, the prevailing view of vaccines is that they are a health measure for children. As a result, few people recognize vaccines as a tool that can also be used to improve health for older adults. The fact that older people do not know that there are vaccines for their age group is highly likely to be an issue. Awareness-building activities must be implemented to convey the fact that there are many vaccines available for this age group and that they are effective tools for improving healthy life expectancies for older adults.

Discussion point 3: Although there is data showing that the chances of adverse reactions among those who vaccinate are extremely low, for people who are afraid of the risks of adverse reactions, exposure to such information tends not to relieve their concerns.
Despite the fact that numerical data on the low probability of adverse reactions due to vaccines has been disseminated, the fact that such chances are low may not have fully taken root among the public. Expectations are high for measures that focus on and emphasize the low probability of adverse reactions to convey this information in an effective manner, such as by comparing them to traffic accidents or by using other examples of probability.

Discussion point 4: Even when information on vaccine-preventable diseases (VPDs) is available, exposure to such information tends not to result in changes in vaccine-related behaviors.
While information on VPDs has been disseminated to a certain extent, it has not encouraged people to change their attitudes and begin to want to prevent or avoid those diseases, and may not be leading to changes in vaccine-related behaviors. It will be necessary to clearly convey information regarding VPDs and the dangers and risks they pose to life and health in a manner that encompasses perspectives on the serious risks VPDs pose to individual health in addition to a public health perspective.

Discussion point 5: Accurate information on vaccines must be provided by family doctors and other health professionals who are near and familiar to patients.
Rather than general information from sources like the media, people tend to rely on information from networks that are close to them and that they can trust. Because Japan’s healthcare system has yet to fully implement the functions that are fulfilled by family doctors, there are disparities among individuals in terms of who has a family doctor that they feel close to and can trust. Expectations are high for steps to be taken to expand the functions of family doctors, to deepen the family doctor specialty as well as to build a vaccine provision system that relies on family doctors to provide vaccines and correct information.

Based on the issues outlined above, and with the aim of exploring possibilities for concrete policy implementation, a roundtable was held with healthcare policy officials from Kanagawa Prefecture — one of the prefectures adjacent to Tokyo — to exchange views on the research findings and the issues identified through this study. Drawing on the insights gained from that discussion, four perspectives for policy implementation are presented below.

1. Perspective for policy implementation 1 (regarding discussion point 2): The need to disseminate easy-to-understand information among older adults
   This survey found that older adults are unaware of the existence of vaccines for their age group, which is a finding that is consistent with the administration’s awareness of the situation. While people need easy-to-understand information on such vaccines, it is difficult for the administration to disseminate information using methods that emphasize ease of understanding. Reference materials from the administration tend to become complicated because the information contained must be accurate and scientifically correct, particularly when those materials include information on adverse reactions. It may be easier to utilize pamphlets and other reference materials that are created by parties like private companies, academic societies, and business groups and that have been designed with ease of understanding in mind. However, it can be difficult to distribute materials prepared by individual companies at public consultation offices or through similar channels. It may be possible to provide easy-to-understand reference materials more easily if they are created jointly with relevant companies and with cooperation from academic societies and similar parties. In addition, when attempting to reach older adults, paper-based reference materials are effective.
   
   
2. Perspective for policy implementation 2 (regarding discussion point 3): The need to improve methods for transmitting information regarding adverse reactions
   Even though information regarding the low chances of vaccines causing adverse reactions is being provided in numerical terms, there is not broad awareness toward those probabilities among citizens. This finding is consistent with the administration’s recognition of this issue. However, it is difficult for the administration to disseminate information in a manner that is based on probability theory and that focuses on the low chances that certain incidents will occur, such as when discussing traffic accidents. To address this, expectations are high for initiatives from the private sector and academic societies, just as in Perspective 1. The administration can help by providing specific instructions regarding what measures people should take in the event an adverse reaction does occur. It is desirable for such information regarding relief systems for adverse actions to also be provided alongside information disseminated during initiatives from the private sector or from academic societies. If the information in question is related to relief systems for adverse reactions, the administration can also utilize social networks to disseminate it, so such methods could be considered in the future.
   
   
3. Perspective for policy implementation 3 (regarding discussion point 4): The need for methods to approach uninterested people
   Many vaccines for older adults are categorized as voluntary and target people who are in good health. As a result, in many cases, citizens tend to be passive toward or are uninterested in these vaccines. This finding is consistent with the administration’s awareness of these circumstances. In particular, the lack of methods for approaching uninterested people and providing them with information related to health and vaccines is considered to be an issue. To reach people who do not possess very high levels of health or information literacy, information must be transmitted in a manner that is extremely easy to understand. Just as in Perspective 1, expectations are high for collaboration among the administration, the private sector, and academic societies to advance efforts to disseminate information.
   
   
4. Perspective for policy implementation 4 (regarding discussion point 5): The need to collaborate with family doctors
   Our findings on collaboration among family doctors and the administration as well as the effectiveness of family doctors when providing vaccination-related information are consistent with the administration’s awareness toward these items. Measures to expand the roles of family doctors are currently advancing in Japan. When holding discussions on those measures, expectations are high for the Government and each prefecture to seek to ensure family doctors can help provide appropriate information regarding vaccines for elderly people. However, on the administrative side, the departments and divisions responsible for examining the expansion of family doctor services are different from those that handle vaccination programs. Furthermore, municipal governments are responsible for vaccination programs rather than prefectural governments, so the hierarchy among administrative organizations is not properly aligned. This arrangement makes it difficult to reflect measures related to vaccination programs for older adults in measures for expanding the roles of family doctors. Expectations are high for various organizations including private companies, academic societies, and think tanks to continue to advocate for the need for cross-cutting initiatives that span administrative organizations.