Logan Reed
Japan and the US have different approaches to vaccination, with Japan ranking higher than the US in terms of overall health, despite having lower vaccination rates. Japanese parents may have different attitudes towards vaccination compared to American parents, and there are no federal vaccination laws in the US, whereas Japan has no domestic legislation for vaccination requirements for children entering school. Recommendations about vaccine intervals also vary, with the US allowing patients to return at any time for additional vaccinations, while Japan enforces waiting periods between vaccinations.
| Characteristics | Values |
|---|---|
| Vaccine preventable diseases | US: Higher rates of vaccination for hepatitis B, measles, mumps, rubella, and varicella |
| Japan: Lower rates of vaccination for the above diseases | |
| Legislation | US: No federal vaccination laws, but all 50 states require certain vaccinations for school entry |
| Japan: No domestic legislation for school entry, but some vaccines are "routine" and strongly recommended by the government | |
| Administration | US: Intramuscular route for many vaccines |
| Japan: Subcutaneous administration for most vaccines | |
| Intervals between vaccinations | US: No waiting period between vaccinations |
| Japan: Wait at least one week after an inactivated vaccine, and 28 days for live vaccines | |
| MMR vaccine | US: Legislators and health officials are trying to make the MMR vaccine compulsory |
| Japan: No MMR vaccine | |
| Infant mortality rate | US: Highest infant mortality rate of all industrialised countries |
| Japan: Second lowest infant mortality rate in the world |
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What You'll Learn
Japanese parents' attitudes to vaccination
Japan has a strong health record, but its incidence rates of vaccine-preventable diseases (VPDs) are higher than those of other developed countries. This discrepancy can be attributed to various factors, including historical and political issues that delayed the introduction of several important vaccines until recently. Vaccine hesitancy, influenced by societal attitudes and historical factors, is also prevalent in Japan.
Japanese parents' attitudes towards vaccination are shaped by cultural and historical influences, with some preferring traditional medicine or alternative remedies, leading them to question the need for vaccines. Research from Kinki University in 2018 indicated that around 20% of Japanese parents refused the MMR vaccine for their children due to their preference for traditional medicine. This resistance to modern medicine has been further exacerbated by internet misinformation, which has contributed to COVID-19 vaccine hesitancy among young Japanese people.
Additionally, Japan's history of vaccine hesitancy plays a role in shaping parental perspectives. In 2020, the Japan Pediatric Society found that 15% of surveyed parents felt judged if they expressed doubts about the MMR vaccine, highlighting the societal pressure and stigma associated with vaccine decisions. Furthermore, a survey by the Japan Medical Association in the same year revealed that approximately 20% of parents had doubts about vaccine safety, which can lead to lower vaccination rates and create conditions for disease outbreaks.
The Japanese government's actions have also influenced parents' trust in vaccinations. The suspension of proactive recommendations for certain vaccines, such as the human papillomavirus vaccine (HPVV), and concerns about vaccine safety raised by Japanese public media outlets have contributed to hesitancy among parents. Moreover, the government's previous mandatory MMR vaccination policy, which was revoked due to serious adverse reactions, may have left a lasting impression on parents' perceptions of vaccine safety.
While Japan's MMR vaccination rate of approximately 93% as of 2021 is competitive globally, it is lower than that of some countries, including the United States and Canada, which report rates of around 90% to 95%. This disparity can be attributed to various factors, including public health policies, awareness campaigns, and parental attitudes toward vaccination. To improve vaccine uptake, Japan can adopt strategies from successful campaigns in other countries, such as the United States and the United Kingdom.
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Vaccine laws in the US and Japan
While Japan has a strong health record, its incidence rates of vaccine-preventable diseases (VPDs) such as hepatitis B, measles, mumps, rubella, and varicella are higher than in other developed countries. Historical and political factors have delayed the introduction of several important vaccines in Japan until recently. Access has also been affected by the division of vaccines into government-funded "routine" vaccines and self-pay "voluntary" vaccines. Routine vaccines have higher rates of administration than voluntary vaccines.
In Japan, immunisation law was amended in 1994 to prohibit mandatory vaccinations. However, there is no domestic legislation to enforce vaccination for children entering school. In contrast, all 50 states in the US require certain vaccinations prior to the entry of children into public schools. While there is no federal vaccination law in the US, vaccination is required for immigrants and refugees applying for visas or permanent resident status. The specific vaccines required are listed in the Immigration and Nationality Act (INA) Section 212(a)(1)(A)(ii), and individuals must also receive any other vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP).
Recommendations about vaccine intervals vary between the US and Japan. In the US, patients can receive additional vaccinations at any time if needed. However, in Japan, patients must wait at least one week for the next vaccination after any inactivated vaccine and 28 days for live vaccines. Japanese law also requires the subcutaneous administration of most vaccines, while many countries, including the US, use the intramuscular route, which is associated with decreased pain, lower adverse effect rates, and improved efficacy.
Child vaccination rates against diphtheria, tetanus, whooping cough, and measles are higher in Japan than in the US, according to the Organisation for Economic Co-operation and Development. However, comparisons between Japan and the US infant vaccination programs regarding infant mortality rates are inaccurate. While Japan has a lower infant mortality rate than the US, there is no evidence linking this to infant vaccination programs.
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Administration routes of vaccines
The route of vaccine administration is critical to its effectiveness and safety. There are several routes of vaccine administration, each with its advantages and considerations. Here are some of the commonly used administration routes for vaccines:
Intramuscular Injection (IM)
Intramuscular injections are administered into the muscle through the skin and subcutaneous tissue. This route is often preferred for vaccine administration because it is easy to perform, generally well-tolerated, and has a low risk of adverse reactions at the injection site. The recommended site for injection is based on age, with the deltoid muscle being suitable for multiple intramuscular injections in older children and adults.
Subcutaneous Injection (Subcut)
Subcutaneous injections are administered into the fatty tissue found below the dermis and above the muscle tissue. This route has traditionally been used for vaccine administration. However, it has been associated with an unacceptable rate of injection site reactions when used with adjuvanted vaccines. Some vaccines, like MMRII and IPOL, can be administered by either the subcutaneous or intramuscular route.
Oral Route
The oral route involves administering the vaccine through drops into the mouth. The Rotavirus vaccine (RV1 and RV5) is the only routinely recommended vaccine administered orally. It is important to note that oral vaccines should never be injected.
Intranasal Route
Intranasal vaccines are administered into each nostril using a manufacturer-filled nasal sprayer. Live, attenuated influenza (LAIV or FluMist) is an example of a vaccine administered by the intranasal route. This route offers an alternative to injection, providing a non-invasive option for vaccine delivery.
Intradermal Injection (ID)
Intradermal injections are administered superficially between the epidermis and the hypodermis layers of the skin, typically on the inner side of the forearm. This route is less commonly used for vaccine administration but may be considered for specific vaccines or under certain circumstances, such as Emergency Use Authorization.
The development of new vaccine platforms, such as nanoparticle structures, has led to ongoing research and debates about the optimal route of administration. Factors such as immunogenicity, safety, patient comfort, and convenience are considered when determining the recommended route for each vaccine.
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HPV vaccination in Japan and the US
Human papillomavirus (HPV) infections are a leading cause of cervical cancer, and HPV vaccines have been in use in the United States since 2006. The CDC recommends two doses of the HPV vaccine for children aged 11–12, with the option to start the vaccination from the age of nine. The HPV vaccine is highly effective in preventing HPV infections and has led to an 81% drop in HPV-related cancers and genital warts among young adult women. Gardasil-9 (9vHPV) is the vaccine distributed in the United States.
In Japan, the HPV vaccine has been part of the national immunization program since April 2013 for girls aged 12–16. The bi-valent Cervarix and quadra-valent Gardasil vaccines have been the most commonly used in Japan, targeting HPV strains 16 and 18, which are the most prevalent in cervical cancer cases in the country. However, concerns about adverse events (AEs) related to the HPV vaccine gained traction in the Japanese media in 2013, leading to a suspension of the government's proactive recommendation of the vaccine. This significantly impacted vaccination rates, with a decline from over 70% to 0.3% in 2016.
The World Health Organization (WHO) and the Japanese government have since worked to address these concerns and provide accurate information to the public. Despite these efforts, the negative media coverage influenced Japanese mothers' intentions to vaccinate their adolescent daughters, and vaccination rates remained low. However, there has been a recent increase in the demand for HPV vaccines in Japan, with a significant rise in the number of doses delivered to healthcare facilities between 2016 and 2021.
While both Japan and the United States offer the HPV vaccine, the context and uptake of the vaccine differ between the two countries. In the US, the HPV vaccine is widely recommended and has led to significant reductions in HPV-related cancers. In Japan, the HPV vaccine faced challenges due to media reports of adverse events, which led to a decline in vaccination rates, particularly among mothers with adolescent daughters. However, efforts to provide accurate information and increasing demand for the vaccine suggest a positive shift in HPV vaccination trends in Japan.
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MMR vaccine in Japan and the US
Japan and the US differ in their approaches to the MMR vaccine, which protects against measles, mumps, and rubella. In the US, two MMR vaccines are available: M-M-R II and PRIORIX. Both are recommended for children between 12 months and 12 years of age, with two doses given at least 28 days apart. The US has seen a decline in measles cases due to high vaccination rates and effective communication with those who refuse vaccination.
On the other hand, Japan does not include the MMR vaccine in its national immunization programs due to concerns over a high incidence of aseptic meningitis following vaccination. In 1993, the Japanese government withdrew its recommendation for the MMR vaccine, and monovalent mumps vaccines became voluntary. This decision has been a significant social concern, with outbreaks of rubella occurring due to gaps in 'herd' immunization.
The US and Japan also differ in their recommendations for vaccine intervals. In the US, patients can receive additional vaccinations at any time if needed, while in Japan, patients must wait at least one week for the next vaccination after an inactivated vaccine and 28 days for live vaccines. These differences can impact the effectiveness of the vaccines and the risk of adverse events.
Additionally, Japanese law requires subcutaneous administration of most vaccines, while many countries, including the US, prefer the intramuscular route, which is associated with decreased pain and improved efficacy. Cultural differences in attitudes towards vaccination may also play a role, and providers should be prepared to address potential barriers with cultural sensitivity when dealing with Japanese nationals or their children.
While Japan has a strong health record, its incidence rates of vaccine-preventable diseases, including measles, mumps, and rubella, remain higher than other developed countries. This may be due to historical and political factors that delayed the introduction of important vaccines, as well as the division of vaccines into government-funded "routine" and self-pay "voluntary" groups, affecting access and administration rates.
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Frequently asked questions
No, Japan has fewer vaccines than America. However, Japan has a strong health record and is ranked as the healthiest country in the world.
There are a variety of factors that contribute to Japan having fewer vaccines than America. Firstly, historical and political factors have delayed the introduction of several important vaccines in Japan. Secondly, vaccine administration in Japan is divided into government-funded "routine" vaccines and self-pay "voluntary" vaccines, with routine vaccines having higher administration rates. Additionally, cultural differences and varying attitudes towards vaccination between Japanese and American parents may play a role.
Japan has no federal legislation mandating vaccinations for children entering school, whereas all 50 states in America require certain vaccinations prior to a child's entry into public schools. Japan also has a waiting period between vaccinations, with at least a one-week interval for inactivated vaccines and 28 days for live vaccines. In contrast, America does not have a standardized waiting period and allows patients to receive additional vaccinations at any time.
Yes, there have been concerns about vaccine hesitancy among Japanese youth due to the spread of misinformation and skepticism regarding COVID-19 vaccines. Additionally, there are reports of low personal vaccination rates among Japanese healthcare providers, particularly for the measles vaccine.
