Vaccination coverage for human papilloma virus (HPV) in Japan has plummeted following unconfirmed media reports of severe adverse reactions such as chronic pain and cognitive decline (see S. J. B. Hanley et al. Lancet 385, 2571; 2015). In response, and presumably to avoid lawsuits, the government has suspended its proactive vaccination recommendation.

Several scandals in the past few decades have fuelled the Japanese public's scepticism. These include health hazards associated with some drugs and vaccines, widely publicized cases of misconduct among researchers, and questionable connections between medical professionals and pharmaceutical companies (see T. Tanimoto et al. Nature 512, 371; 2014).

At the heart of the debate is Japan's compensation scheme for vaccine injury, which depends on a causal relationship being confirmed by the government. Claimants may also seek further compensation through private litigation against the government. In most countries, claimants must pursue one scheme or the other, not both.

In our view, the government should introduce a no-fault compensation system, following the lead of other countries, including the United States and Scandinavian nations (see C. Looker and H. Kelly Bull. World Health Organ. 89, 371–378; 2011). Exemption from liability would make for a fairer and more transparent judgement in policymaking and pave the way for a new Japanese vaccination programme in which public trust is restored.