• Keiko Kunitoki MD, MPH
• Masafumi Funato MD, MPH
• Makiko Mitsunami MD
• Takahiro Kinoshita MD, MPH
• Michael R. Reich PhD

• Sawako Shirahase TCJS Director

Vaccine hesitancy is a growing concern in global public health, and illustrates serious problems arising from lack of social trust. We analyzed Japan’s human papillomavirus (HPV) vaccine crisis, which started with a rapid decline in the vaccination rate from approximately 70% to less than 1% and lasting until now, using a framework for examining barriers to access and use of health technologies according to four categories: architecture, availability, affordability, and adoption. Significant problems were identified in the architecture of the policy-making process, public information availability, adoption of evidence in decision-making body, knowledge and confidence among providers, and social trust from end-users. We propose a series of actions for key stakeholders (national government, municipalities, professional associations, politicians, civil society, and mass media). Through this case, we discuss how to build mutual trust, which is required to increase social trust in the vaccine and thereby regain vaccine confidence and reduce preventable deaths.

Keiko Kunitoki, MD, MPH

Is a current research fellow of Psychiatry at Massachusetts General Hospital/Harvard Medical School (HMS) and a graduate of Harvard T.H. Chan School of Public Health (HSPH). Her interest in preventive medicine has brought her to the main field investigating the gene-environment interaction on neurodevelopment, and also research activity on vaccine confidence launched as HPV-J (Harvard society for Promoting Vaccination in Japan).

Masafumi Funato, MD, MPH

is a family physician specializing in global health. Prior to Harvard, he worked as a health program manager at one of the national public donor agencies in Japan and managed implementation projects using a public-private partnership structure in Hanoi, Vietnam. Dr. Funato holds an MPH in Global Health from Harvard T.H. Chan School of Public Health.

Makiko Mitsunami, MD

is a Japanese obstetrician and gynecologist and a 2nd-year MMSc student at HMS, researching impacts of diet on fertility with Dr.Jorge E. Chavarro at the nutritional and environmental epidemiology department at HSPH. She is a co-founder of the HPV vaccine promotion group (Minpapi Association).

Takahiro Kinoshita, MD, MPH

is an emergency physician from Osaka, Japan. He has been engaged in social marketing/healthcare promotion using a verified account on Twitter. He is a co-founder of the two vaccine promotion groups: HPV vaccine (Minpapi Association) and COVID vaccine (CoV-Navi).

Michael R. Reich, PhD

is Taro Takemi Research Professor of International Health Policy at Harvard T.H. Chan School of Public Health. He has many publications on health system strengthening and reform, access to medicines and pharmaceutical policy, and the political economy of policy-making processes, and has been engaged with health policy issues in Japan for five decades. For more information see:
https://www.hsph.harvard.edu/michael-reich/