Government Policy, Infectious Diseases, Vaccination

HPV Vaccination in the Japanese MSM Community: A Call to Action

~Written by David Boedeker (Contact:; Twitter: @dhboedeker)

HPV vaccination has faced pushback from communities since its introduction in 2006. Perhaps the most shocking story comes from Japan. In 2010, the Japanese government began to give girls ages 12 to 16 the vaccine for free. The government recommended girls receive the vaccine[1], and vaccination rates climbed. However, all of that changed in 2013 when an anti-HPV vaccination movement successfully advocated that the government withdraw its recommendation. The aftermath has been dramatic: vaccination rates dropped from roughly 70% to 1%, leaving millions of adolescents unprotected from HPV-related cancers. Interestingly, this decision coincided with the United States moving to ramp up vaccination efforts. Moreover, the scientific data that prompted the Japanese government to withdraw its recommendation is based in theories that are not biologically possible, as one critic noted[2].

In response, many researchers and physicians are advocating for increased vaccination campaigns in Japan. Historically, these initiatives have focused on females since it has been established that HPV vaccination is important to prevent cervical cancer and other HPV-related cancers. However, it is increasingly recognized that HPV vaccination for males is also critical, especially to prevent throat cancers, which are expected to surpass cervical cancers as the most common HPV-related cancer by 2020.

HPV infection is not only related to throat and cervical cancers; it also increases the risk of developing mouth, tongue, and anal cancers. These are all cancers men can develop, and these are all cancers that Japanese men are currently at risk of developing because they are not vaccinated. Physicians, researchers, and government officials in Japan must expand vaccination efforts to include males, particularly the men who have sex with men (MSM).

MSMs are especially susceptible to anal cancer, a rare cancer, but one that disproportionately affects the LGBTQ+ community. Gay men are 20 times more likely to develop anal cancer compared to the general population, and HIV positive gay and bisexual men are 40 times more likely than the general population to develop this cancer[3].

Why must the Japanese government in particular take action? In Japan, same-sex behavior is stigmatized, which makes the LGBTQ+ community a hard-to-reach population [4] that may face challenges [5] when seeking healthcare services. These challenges may negatively impact the likelihood that they will receive the HPV vaccine. Also, the oncogenic (cancer-causing) HPV infection rate in the Japanese MSM community is 75.9%. Among MSMs who are HIV positive, the oncogenic HPV infection rate is 66% [6]. Most of these infections would have been preventable with administration of the HPV vaccine.

So, what can these government officials do? A driving force behind HPV vaccination is provider recommendation. Many patients state the reason they ultimately received the HPV vaccine is because their provider recommended it to them[7]. Some Japanese OB/GYNs are currently advocating that the government reinstate its HPV vaccination recommendation. A reinstatement might encourage more Japanese physicians to recommend the HPV vaccine, increasing the country’s vaccination rate and protecting its currently vulnerable population. However, it is important for these providers to advocate that the government not only recommend the vaccine to females, but to males as well. Moreover, this policy may benefit the MSM community by improving healthcare access and decreasing oncogenic HPV infection rates.


[1] Hanley SJB, Yoshioka E, Ito Y, Kishi R. HPV vaccination crisis in Japan. The Lancet. 2015 June 27; 385(9987): 2571. DOI:

[2] The Public Hearing on Adverse Events following HPV vaccine in Japan [Internet]. Japan: Ministry of Health, Labour and Welfare; 2014 Feb [cited 2016 Sep 10]. Available from:

[3] Margolies L, Goeren B. Anal cancer, HIV, and gay/bisexual men [Internet]. New York: Gay Men's Health Crisis; 2009 Sep [cited 2016 Sep 10]. Available from:

[4] Nomura Y, Poudel KC, Jimba M. Hard-to-reach populations in Japan. Southeast Asian J Trop Med Public Health. 2007 Mar;38(2):325-7.

[5] Hidaka Y, Operario D, Tsuji H, et al. Prevalence of Sexual Victimization and Correlates of Forced Sex in Japanese Men Who Have Sex with Men. Stephenson R, ed. PLoS ONE. 2014;9(5):e95675. doi:10.1371/journal.pone.0095675.

[6] Nagata N, Watanabe K, Nishijima T, Tadokoro K, Watanabe K, Shimbo T, Niikura R, Sekine K, Akiyama J, Teruya K, Gatanaga H, Kikuchi Y, Uemura N, Oka S. Prevalence of Anal Human Papillomavirus Infection and Risk Factors among HIV-positive Patients in Tokyo, Japan. PLoS One. 2015;10(9):e0137434. doi: 10.1371/journal.pone.0137434. PMID: 26368294, PMCID: PMC4569050

[7] Hanley SJ, Yoshioka E, Ito Y, Konno R, Hayashi Y, et al. Acceptance of and attitudes towards human papillomavirus vaccination in Japanese mothers of adolescent girls. Vaccine. 2012 Aug 24;30(39):5740-7. PubMed PMID: 22796375.