Objective: To evaluate the structural challenges in the Japanese national immunization program (NIP) that has caused the “Vaccine Gap”.
Methods: Medical opinion leaders out of four stakeholder categories (political, policy, practice, and public) were selected and interviewed. Their observations were analyzed and applied to a case of policy change of replacing oral polio vaccine with inactivated vaccine.
Results: Three issues were identified as the cause of the vaccine gap . First was the lack of evidence-based policy making, derived from the lack of public health human resources and shortage of cost effectiveness studies, as well as the weak surveillance and risk management of adverse events related to immunization. Second was the inappropriate public perception and education for public that can be improved by the strong communication strategy. Third was the weak vaccine development and manufacturing capacities. The case study pointed out that the interaction of public perception and political dynamism at local level can successfully plug the scientific evidence into the national policy.
Conclusions: The Japanese vaccine gap can be improved by strengthening public health infrastructures. Political leadership can facilitate the national policy change.