Japanese Vaccination Methods to Boost US Child Vaccine Efficacy

Executive Summary

Unfortunately, the United States has a mediocre child vaccination rate, especially when compared to Japan, a country which has one of the highest rates of child vaccination in the world. An analysis is required to understand the reasons behind high child vaccination rates in Japan. Once an analysis is done, key methods utilized by the Japanese government in increasing child vaccination rates should be highlighted, then subsequently modified plus adapted in a way that can be implemented within United States health care programs. Thereby aiding the United States in its quest to continue improving the child vaccination rates. One of the key differences between the United States vaccination system and that of Japan, is the volume of vaccines administered per person. Upon researching the topic, it appears that Japan is significantly more reserved when it comes to actually administering vaccines to its child population. This methodology is a stark contrast to the United States, where vaccinations are given through pregnancy, and then throughout the infancy of a child.

Introduction

It is apparent that the United States as a country prides itself in being the number one country in a variety of sectors, however an area that clearly requires growth is child vaccination rates. As previously mentioned, it appears that Japan is in fact one of the leading nations with respect to child vaccination rates. The purpose of this policy brief is to analyze how Japan has achieved the public health feat of being one of the leading countries in regard to vaccination rates, and then use it as an inspiration for new policies for the United States to attempt to implement.

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Context and Background

Contextually speaking, it is apparent now that the United States is playing catch up to reach the esteemed honor of having one of the highest vaccination rates globally. According to OECD’s data, it appears that Japan has the third highest rate of vaccinations (for Diphtheria, Tetanus, Pertussis/Measles) whereas United States lags behind at roughly twenty-seventh place (Child vaccination rates - OECD Data, 2019). This begs the question, how is Japan able to achieve such high rates, and what is enabling the country to do so.

Firstly, it important to look at what exactly Japans vaccine policy constitutes. The current policy began in 1994, when the vaccine laws were restructured to incorporate an individual’s consent as a “core conceptual component” (Doshi, P., & Akabayashi, A., 2010). The policy is also fundamentally considered a voluntary vaccination policy, where the population receives vaccinations under recommendations rather than necessity. This system was created due to the distraught brought upon the Japanese government when mandatory vaccination was still in effect. From one of the many studies done by the Japanese one “6-year-long survey tracking over 70,000 children a year failed to find a difference in the size of epidemics between those areas vaccinated and those unvaccinated, prompting the national government to relax the law” (Doshi, P., & Akabayashi, A., 2010). It appears that the Japanese do not see any value in mandating vaccines, thus why the use of a voluntary program.

Now it’s time to dive into what are some of the differences between the Japanese and United States vaccine methodology. From Children’s Health Defense, Japan has 6 unique methods of maintaining such high vaccine rates that should be highlighted. Firstly, Japan has no vaccine mandates. Rather than making vaccines mandatory they are recommended and are either covered by insurance (routine) or self-paid for (voluntary) (Children's Health Defense, 2019). Secondly, Japan does not vaccinate newborns with the Hep-B vaccines until unless the mother has already been determined to be Hepatitis B positive (Children's Health Defense, 2019). Thirdly, Japan does not vaccinate pregnant mothers with the Tdap or tetanus-diphtheria acellular pertussis vaccine (Children's Health Defense, 2019). Fourth, Japan does not give flu shots to pregnant mothers, or to six-month-old infants (Children's Health Defense, 2019). Fifth, Japan does not give the MMR vaccine, instead the MR vaccine is recommended (Children's Health Defense, 2019). Last but not least, Japan does not require the Human Papillomavirus vaccine (Children's Health Defense, 2019). On top of these six differences, Japan also has an extremely “safe” approach to vaccinating children. For instance, “When two infants died within 24 hours of receiving DTwP in the winter of 1974–1975, the government suspended licensure of DTwP. Licensure was reinstated two months later with a change in the minimum recommended age from 3 months to 2 years as a precaution” (Kuwabara, N., & Ching, M. S., 2014). This is indicative of the Japanese vaccine culture, and the mentality to be precautious even when a handful of deaths occur potentially due to vaccines. These methodologies have aided in the success of Japans vaccination status, to an almost enigmatic degree.

The United States vaccine structure in contrast is heavily a proponent for vaccines, recommending routine vaccination through pregnancy, specifically the HepB vaccine within the first day of birth, this occurs even though “99.9% of pregnant women, upon testing, are [HepB] negative” (Children's Health Defense, 2019). Moreover, the amount of vaccines administered to mothers in the first two years of life is absurd, being roughly between 20 and 22 vaccine doses (Children's Health Defense, 2019). Not only are mothers heavily vaccinated the United States also administers Flu and Tdap vaccines to pregnant women, even though FDA has not officially licensed any of the administered injections as safe or specifically usable by pregnant women (Children's Health Defense, 2019). It appears that vaccine the methods utilized by the United States are opposite to that of the Japanese methodology; rather than being precautious in how and when vaccines are administered, the mentality is to give all the vaccinations as soon as possible in order to create resistance early on, yet ironically this same mentality is harming the United States ability to stand on top of the vaccination-rate charts.

To assess and recognize which of these Japanese methods the United States should attempt to implement is no easy feat, yet through there implementation may in fact potentially increase child as well as general vaccination rates.

Policy Implications

The first concern to address, is why should policy makers care about the issue at hand. The response is simple, greater vaccination rates leads to healthier working-class citizens (plus the reduction in spread of disastrous diseases or infections), which leads to greater productivity, which ultimately leads to a stronger, booming economy.

Current vaccination rates in the United States, in particular Texas are not to par with what the Health People 2020 target is. Texas currently has roughly 70% vaccinated population whereas the goal is 80% (Policy and Advocacy., 2019). If Japanese methodologies were implemented, the current vaccination rate number could in fact see a serious increase, thus enable the country to increase its national rate of vaccinations. This statistic is representative of the Texan population; however, it is also clear that the nation as a whole is not at its target percentage of 80%, thus making it an imperative to try and adapt or create new policies to help advance the vaccine rates.

On top this, it is apparent that current vaccine methods are not preventing diseases of the past, for instance measles. Unfortunately, through current United States vaccine policies, it appears that the amount of measle cases has increased by almost 256% (Kluberg, S. A., Mcginnis, D. P., Hswen, Y., Majumder, M. S., Santillana, M., & Brownstein, J. S., 2017).

Overall it is clear that United States vaccination policies are not up to par with the goals in mind, the implications of attempting new policy methods could be astronomical for national vaccination efficacy.

Recommendations

With these concerns addressed, it important to look at what actions are in fact available for us to take. At a fundamental level, Japanese vaccination procedures need to be analyzed and then used to create new more profound policies in the United States. As mentioned in the background, it is apparent Japan already does utilize some radical methods that are surprisingly effective.

One area that could be seen as a weakness within the United States policy is the concept of mandatory vaccines. It is apparent that “all 50 states require children to receive…vaccinations before attending… school” (Barraza, L., Schmit, C., & Hoss, A., 2017). Not only are vaccines mandatory in schools, they have also become mandatory in the healthcare workforce (Barraza, L., Schmit, C., & Hoss, A., 2017). The concept of mandatory vaccines is controversial in nature, but more than its controversial nature is the reality that it does not achieve rates of vaccination like Japan, with its voluntary vaccination program.

This leads to the first recommendation, which is to transform the current policies from mandatory to a more voluntary style of administering vaccines. This would a challenge, however if successfully implemented could transform the vaccine rate outcome of the United States.

The next area of improvement is the quantity of vaccines being administered to child population. In Japan it is clear that the amount of vaccines being administered are to a minimum and the age vaccines are given are 6 months to 2 years after a child’s birth. This methodology of vaccination is very passive and should be adopted for the United States, thus being the second recommendation. If the United States can begin to reduce the sheer volume of vaccines given to children and also reduce vaccine doses “from three to two…may sever to increase vaccination rates by reducing costs and logistical barriers…by providing a motivation for initiating vaccination at younger” age (Hirth, J. M., Berenson, A. B., Cofie, L. E., Matsushita, L., Kuo, Y.-F., & Rupp, R. E., 2019).

These two recommendations combined have the potential to make a significant impact on the child vaccine efficacy rates.

Conclusion

Through changing mandatory vaccine mentality to a more voluntary one, and by changing the amount of vaccines given to children, it is possible to increase vaccine rates within the United States. All in all, through an analysis on the Japanese health care system, the United States should implement these recommendations influenced by the Japanese system in order to attempt to increase the child vaccination rates.

Bibliography

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2. Berenson, A. B., Rupp, R., Dinehart, E. E., Cofie, L. E., Kuo, Y., & Hirth, J. M. (2018, 10). Achieving high HPV vaccine completion rates in a pediatric clinic population. Human Vaccines & Immunotherapeutics, 15(7-8), 1562-1569. doi:10.1080/21645515.2018.1533778
3. Doshi, P., & Akabayashi, A. (2010, 05). Japanese Childhood Vaccination Policy. Cambridge Quarterly of Healthcare Ethics, 19(3), 283-289. doi:10.1017/s0963180110000058
4. Health care use - Child vaccination rates - OECD Data. (n.d.). Retrieved October 24, 2019, from https://data.oecd.org/healthcare/child-vaccination-rates.htm
5. Hirth, J. M., Berenson, A. B., Cofie, L. E., Matsushita, L., Kuo, Y.-F., & Rupp, R. E. (2019). Caregiver acceptance of a patient navigation program to increase human papillomavirus vaccination in pediatric clinics: a qualitative program evaluation. Human Vaccines & Immunotherapeutics, 15(7-8), 1585–1591. doi: 10.1080/21645515.2019.1587276
6. Japan Leads the Way: No Vaccine Mandates and No MMR Vaccine = Healthier Children • Children's Health Defense. (2019, April 23). Retrieved October 24, 2019, from https://childrenshealthdefense.org/news/vaccines/japan-leads-the-way-no-vaccine-mandates-and-no-mmr-vaccine-healthier-children/
7. Kluberg, S. A., Mcginnis, D. P., Hswen, Y., Majumder, M. S., Santillana, M., & Brownstein, J. S. (2017, 11). County-level assessment of United States kindergarten vaccination rates for measles mumps rubella (MMR) for the 2014–2015 school year. Vaccine, 35(47), 6444-6450. doi:10.1016/j.vaccine.2017.09.080
8. Kuwabara, N., & Ching, M. S. (2014, December). A review of factors affecting vaccine preventable disease in Japan. Retrieved October 24, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300546/
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