The COVID-19 pandemic has put the widespread need for immunisation into sharp focus and is shining a light on the need to drive forward the global agenda on preventing ill health.

For a wealthy and ageing country, Japan remains an outlier in terms of attitudes to adult vaccination. Pre-COVID surveys show that just 4.7% of adults in Japan agreed that vaccines were important, 25.1% agreed they were safe and 9.9% agreed they were effective.

Despite grappling with a flu epidemic in 2019, Japan is still struggling to significantly raise vaccination uptake rates among people aged 65 and over. And COVID-19 has presented a number of new challenges and opportunities to increasing vaccination uptake in Japan.

This innovative ethnographic project, led by ILC and Stripe Partners, has involved identifying, developing, and refining two implementation-ready interventions designed to increase the uptake of vaccinations for people aged 65 and over in Japan. Through field research in Japan during the summer of 2022, ILC and Stripe Partners have produced a final report that has identified some of the key challenges:

• A lack of awareness about vaccination – many Japanese adults interviewed as part of the research suggested that they had little knowledge about vaccine-preventable diseases or had not been recommended vaccination by a doctor
• A lack of taking vaccine-preventable diseases seriously – many interviewees believed they were in good health and that their immune systems were strong enough to fight off infection without the vaccination
• Scepticism toward vaccination – hesitancy about vaccination, though less common than perhaps suspected, with some older Japanese adults expressing concerns about injecting “foreign” entities into their bodies
• Practical barriers – for many, practical barriers, such as a lack of vaccine supply or missing a vaccination reminder letter, got in the way

To respond to these challenges, the report sets out two innovation blueprints that could be applied in Japan to help increase vaccination uptake:

1) Micro-scale interventions

These solutions would involve testing local vaccine events, such as:

• Local health seminars run by trusted and respected health professionals
• Pop-up vaccination hubs where people would be able to engage with a health professional and discuss any vaccine concerns or worries

2) Macro-scale interventions

These solutions would involve the development of a national campaign that would include:

• An annual national vaccine day that would include events and talks from prominent health professionals, as well as a national mascot to help promote vaccination
• Mass vaccination events running alongside the campaign in conjunction with the local government and Japanese Medical Association, to build on the existing COVID-19 vaccination infrastructure

This research was made possible by an unrestricted educational grant from Pfizer via the Global Coalition on Aging.