How do vaccine reductions affect public health? Ask Japan

When US officials announced earlier this month that they were reducing the country’s list of recommended immunizations for children, doctors and scientists alike wondered what to expect. How high will rates of infectious diseases rise? Who will be most affected?

Half a world away, specialists in Japan say they have some hard-earned wisdom to offer. They saw deaths from influenza and pneumonia rise after the Japanese government stopped pressuring parents to vaccinate their children against the flu. They have seen a rubella outbreak caused by changing vaccine directives, leaving a segment of the population vulnerable. They argued that an unfounded media scare was turning the general public away from vaccinations against human papillomavirus (HPV), which is responsible for almost all cases of cervical cancer.

From this perspective, the US decision to withdraw from vaccines is puzzling, several researchers said nature. “It was shocking,” says Akihiko Saitoh, a pediatrician at the Graduate School of Medical and Dental Sciences at Niigata University in Japan. “The United States has been leading immunization policy around the world. Now, it is a very different story.”

Change schedules

List of new childhood vaccines in the United States Announced on January 5It no longer recommends that all children receive vaccines against rotavirus, COVID-19, influenza, meningococcal disease, hepatitis A, and hepatitis B. That doesn’t mean vaccines will be out of reach: Many are still recommended for certain at-risk groups, and all vaccines will still be covered by federal health insurance programs. Parents can still make their own decisions about whether their children will get vaccines, at least for now.

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However, a sudden shift in guidance and rhetoric by the US government could impact vaccination rates by fueling vaccine hesitancy, which was already rising in some pockets of the country. The lack of government support for vaccines may create legal risk for doctors who provide them, ultimately discouraging or encouraging pediatricians from offering immunization.

“There’s uncertainty about what might happen, both in terms of how it will affect people’s behavior, and what impacts it will have on public health and health care,” says Lauren Myers, a computational epidemiologist at the University of Texas at Austin.

But some researchers in Japan say there are some general lessons to be learned from their country’s troubled history with vaccines. Although Japan is a wealthy country with a strong health care system, it has seen several cases in which vaccine hesitancy and low government recommendations have led to decreased immunizations. In some cases, a rush to make up missed vaccines followed when recommendations were reinstated.

Among the changes in the United States, eliminating the recommendation that all children get the flu vaccine was particularly surprising in light of Japan’s experience, says Hiroshi Nishiura, an infectious disease epidemiologist at Kyoto University in Japan. For decades, Japanese school children have been required to get flu vaccines. But by the 1990s, vaccine hesitancy was on the rise and there was general skepticism about the effectiveness of the flu vaccine in children. This, combined with lawsuits against the government, led officials to halt the flu vaccine policy in 1994. Vaccination rates plummeted, Nichora says. “Influenza transmission has become widespread among school children.”

Deaths from influenza and pneumonia, often caused by influenza, have risen, especially among older people¹. “Now, what really shocks me is that the United States is following this kind of path,” Nishiura says.

Playing catch-up

The damage from removing vaccine recommendations in the United States may last a long time even if the guidelines are reinstated. When the rubella vaccination was first introduced in Japan, it was only recommended for girls. The goal was to prevent congenital rubella syndrome, which can cause intellectual disabilities and heart defects in babies born to infected mothers.