Definition and present status　Vaccine hesitancy, defined as “delay in acceptance or refusal of vaccination despite availability of vaccination services,” is a global public health concern. Specifically, COVID-19 and human papillomavirus (HPV) vaccine hesitancy remains a major social challenge in Japan, and effective preventive strategies are urgently required. In this review, we discuss previous studies that have described vaccine hesitancy.

Associated factors　Vaccine hesitancy is affected by several factors, primarily psychological variables (referred to as the “3Cs” comprising confidence, complacency, and convenience regarding individuals’ perceptions of vaccination) and sociodemographic variables (age, sex, socioeconomic status, race, and social capital). “Behavioral and Social Drivers of Vaccination Framework”, developed recently by the World Health Organization, has focused on vaccination-specific beliefs and reports that programs may affect and are likely to have wide applicability in the development of effective interventions.

Measurement　Identification of psychological factors associated with vaccination hesitancy is important to establish strategies to increase vaccine uptake. Many scales are available to measure vaccine hesitancy and psychological factors that affect vaccine hesitancy. These scales include different evaluation items, validity, reliability, and availability of validated Japanese versions. Therefore, careful selection of scales based on their intended purpose and the target population in whom the desired intervention is intended are important. A representative 7C scale is widely used globally. It has been translated into more than 10 languages, including Japanese.

Approach　Several studies and articles, mainly developed for the European and American populations provide guidelines for selection of evidence-based strategies and interventions to increase vaccine uptake. Evidence-based strategies may be broadly classified into the following categories: (1) Strengthening the healthcare system through implementation of the principles of behavioral science. (2) Development of tailored approaches using systematic listening activities. (3) Provision of evidence-based resources to support healthcare personnel. (4) Utilization of media. Based on findings described by previous studies discussed in this report, it may be important to plan strategies to improve the uptake of each vaccine in Japan, such as those for COVID-19, HPV, and also childhood vaccines.

Objectives　This study aimed to examine the status of implementation and details of population-based approach projects that primarily target fathers nationwide. It also seeked to discuss the possibility of providing childcare support to fathers in the community.

Methods　This study analyzed the overall results of two surveys undertaken. The primary survey was conducted between December, 2020 and February, 2021 by administering a mail questionnaire within 1,741 municipalities across Japan. A secondary interview survey was then conducted from August to September, 2021, among the municipalities that responded that they are “implementing projects mainly for fathers,” and those that obtained consent to participate in this survey.

Results　The 837 municipalities (response rate = 48.1%) that responded to the primary survey were included in the analysis. Many municipalities provided paternal and family support in addition to childcare support for mothers, at the time of issuing maternal and child health handbooks and in parent classes. This support was inclusive of distributing leaflets and pamphlets for fathers (P=0.036), encouraging fathers to participate in parent classes (P<0.001), setting dates and times that are easy for fathers to participate in (P<0.001), and including content for fathers (P<0.001). There were significantly more responses from local governments of the municipalities with a total population of 70,000 or more. The number of municipalities that “implemented childcare support that primarily targeted fathers instead of mothers” was 54 or 6.5% of the total. However, about 70% of the municipalities that had not implemented such programs recognized the need for their implementation. In the 21 municipalities where the interviews were conducted, there were 10 projects implemented during pregnancy, 12 during the childcare period after delivery, and 1 implemented across both. The contents of the implemented programs varied widely, with each municipality devising its own programs based on regional characteristics, which had generally favorable evaluations from the participants. In contrast, many municipalities mentioned that the small number of participants was an issue.

Conclusion　Although fathers are encouraged to participate in childcare and housework within households, it is rare for them to be given opportunities to gain the required knowledge and skills. Most projects provide support for fathers as supporters of mothers. Going forward, in addition to surveys targeting fathers, there is a need to present project models that can be implemented by the local governments.