The reported high prevalence of human T-cell leukaemia virus type 1 (HTLV-1) among the Aboriginal population in Australia triggered an open letter to WHO by Fabiola Martin and colleagues, urging action against HTLV-1 infection in May, 2018. 1 Japan is well known for having 1 million people living with HTLV-1 infection, the largest number in the world. 2, 3 HTLV-1 infection is concentrated in the southern islands of Kyushu and Okinawa, but it has also spread to urban areas such as Tokyo and Osaka because of internal migration. Given the large burden of HTLV-1 in Japan, the Government of Japan has maintained its strong commitment towards the elimination of HTLV-1 and has been a leader in implementing various policies to address HTLV-1 infection and related diseases. Japan has been taking a leading role in advancing science regarding HTLV-1, from the identification of mechanisms of HTLV-1 transmission to the discovery and treatment of HTLV-1-related diseases, including adult T-cell leukaemia-lymphoma, HTLV-1-associated myelopathy and tropical spastic paraparesis (HAM-TSP), and various inflammatory disorders. 4–6 Japan was the first country to implement two main strategies for prevention of HTLV-1 transmission. For the prevention of mother-to-child transmission (MTCT) through breastfeeding, antenatal HTLV-1 antibody screening and the recommendation for mothers with positive results to refrain from breastfeeding have been implemented in the Nagasaki prefecture in Kyushu since 1987; 7 and HTLV-1 antibody screening of all donated blood in Japan has been implemented by the Japanese Red Cross since 1986. 3

Efforts towards the elimination of HTLV-1 were further accelerated after the establishment of the HTLV-1 Task Force and endorsement of the Comprehensive Measures for HTLV-1 by the Japanese Government in 2010. The Comprehensive Measures consist of five main pillars. First, routine HTLV-1 antibody testing was incorporated into antenatal pregnancy screening throughout Japan in 2010. Second, counselling was made available for people living with HTLV-1 infection and associated diseases, and training materials and courses for health-care providers and counsellors were organised. Third, the coordination of care for HTLV-1-associated diseases was strengthened, with better coordination between health-care facilities that care for patients with HTLV-1-associated diseases and the development of guidelines for the management of adult T-cell leukaemia-lymphoma and HAM-TSP. Fourth, the website of the Ministry of Health, Labour and Welfare was updated to provide information on HTLV-1 infection and associated diseases, and communication materials were developed and distributed to raise public awareness. Fifth, research on epidemiology, pathophysiology, diagnosis, and therapy was strategically promoted, with JP¥ 10 billion (approximately US $9 million) specifically assigned on a recurring annual basis for the research of HTLV-1-associated diseases.