Characterising reasons for reversals of COVID-19 vaccination hesitancy among Japanese people: One-year follow-up survey

Shuhei Nomura*, Akifumi Eguchi, Daisuke Yoneoka, Michio Murakami, Cyrus Ghaznavi, Stuart Gilmour, Satoshi Kaneko, Takayuki Kawashima, Hiroyuki Kunishima, Wataru Naito, Haruka Sakamoto, Keiko Maruyama-Sakurai, Arata Takahashi, Yoshihiro Takayama, Yuta Tanoue, Yoshiko Yamamoto, Tetsuo Yasutaka, Hiroaki Miyata

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background: Vaccine hesitancy is a global public health threat. We present unique data that characterises those who experienced reversals of COVID-19 vaccination hesitancy in Japan. Methods: We administered a questionnaire on vaccination intention among 30053 Japanese adults aged 20 years or older before the COVID-19 vaccination was available to the general population (first survey) and conducted a follow-up survey on vaccination status one year later in February 2022 (second survey). Those who responded in the first survey that they did not intend to be vaccinated or were unsure and then responded in the second survey that they were vaccinated or intend to be vaccinated were asked about the reasons for their change of heart. Based on previous literature and expert opinion, 31 reasons for changing vaccination intention were compiled and respondents were asked to choose which among them applied to themselves, with multiple responses possible. Based on the results of those responses, each individual was then clustered using the Uniform Manifold Approximation and Projection (UMAP) dimensionality reduction technique and Ordering Points To Identify the Clustering Structure (OPTICS) algorithm. We then identified unique characteristics among each of the sub-populations (clusters). Findings: In the second survey we received 19195 responses (response rate 63.9%), of which 8077 responded ‘no’ or ‘not sure’ in the first survey regarding their intention to be vaccinated. Of these, 5861 responded having received or intending to receive the vaccine (72.6%). We detected six and five sub-populations (clusters) among the ‘no’ group and ‘not sure’ group, respectively. The clusters were characterized by perceived benefits of vaccination, including the COVID-19 vaccine, awareness of the COVID-19 vaccination status of those close to them, recognition of the social significance of COVID-19 vaccination for the spread of infection, and dispelled concerns about short-term adverse reactions and the safety of the COVID-19 vaccine. Work and personal relationship reasons were also found to be a unique overarching reason for vaccination changes of heart only among those who did not intend to vaccinate. Interpretation: Those who changed their intention to accept COVID-19 vaccination as well as their unique characteristics as detailed in this study will be important entry points when discussing how to promote vaccination to those who are hesitant to vaccinate in the future. Funding: The present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

Original languageEnglish
Article number100541
JournalThe Lancet Regional Health - Western Pacific
Publication statusPublished - 2022 Oct


  • COVID-19
  • Japan
  • Reasons
  • Reversals
  • Vaccination hesitancy

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Health Policy
  • Obstetrics and Gynaecology
  • Public Health, Environmental and Occupational Health
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Infectious Diseases


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