A research team led by Hana Tomoi of Nagasaki University School of Tropical Medicine and Global Health and the London School of Hygiene & Tropical Medicine (UK) conducted a scoping review to systematically identify determinants influencing decision-making about human papillomavirus (HPV) vaccination in Japan.
The study was published in the journal Vaccine on December 17, 2025.

This study is the first scoping review to systematically organize the determinants influencing HPV vaccination decision-making among parents and adolescent girls in Japan. It also explores three key research gaps that have not been sufficiently addressed in previous studies: 1) the historical and social context surrounding HPV vaccination, 2) the social group environments of parents and adolescent girls, and 3) perspectives and experiences unique to adolescent girls. By moving beyond a narrow focus on individual knowledge or information deficits, this study reexamines Japan’s long-standing low HPV vaccination rates through the lens of broader vaccine-related contexts and decision-making processes specific to adolescence.

Abstract

Background

Human papillomavirus (HPV) vaccination coverage in Japan was initially over 70 %, but it dramatically declined following 2013 media reports of adverse events, leading to public fear and suspension of proactive government recommendations for the HPV vaccine. Despite the resumption of the recommendations in 2022, public trust remains low, with 40.9 % of girls and mothers still undecided about HPV vaccination. This review synthesizes evidence on the determinants of HPV vaccination decision-making among caregivers and adolescent girls in Japan and identifies research gaps to guide future research.

Methods

A literature search was conducted in three databases, Medline, Embase and Scopus. The search timeframe was between January 2009 and July 2025. Studies were selected, focusing on research that examined influences on HPV vaccination decision-making in Japan. Identified influences were categorized using the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunisation vaccine hesitancy matrix.

Results

This review identified a wide range of determinants influencing HPV vaccination decision-making, including contextual, individual and group, and vaccine-specific factors. Contextual influences, such as government recommendations and negative media coverage, played a significant role in shaping public attitudes. Individual and group factors, including knowledge, healthcare provider recommendations, and peer norms, were also critical. Vaccine-specific issues, such as concerns about safety and cultural barriers further complicated decision-making.

Three key research gaps were also identified: (1) insufficient exploration of contextual influences, including Japan’s unique socio-cultural landscape and historical mistrust; (2) limited understanding of how adolescents navigate social group influences and integrate conflicting information into their decisions; and (3) a lack of focus on the specific perceptions of adolescent girls.

Conclusions

Addressing these gaps requires interdisciplinary research that incorporates socio-cultural, behavioral and systemic perspectives. Further research and tailored interventions are essential to rebuild public trust and increase HPV vaccine uptake in Japan.

Journal Information

Journal: Vaccine (2026) Volume 72
Title: Determinants of human papillomavirus vaccination decision-making in Japan: a scoping review exploring contextual, social, and adolescent-specific influences
Authors: Hana Tomoi, Sharon J. B. Hanley, Heidi J. Larson, Hiroaki Tomoi, Ken Masuda
Publication Date: December 17, 2025
DOI: 10.1016/j.vaccine.2025.128111

For more details, please refer to the full article published in Vaccine.