Immunization is one of the most effective public health interventions available. However, the difference of how recommendations are established influence the utilization of the vaccine and the number of patients with vaccine preventable diseases (VPDs). In this paper, we compared and highlighted the difference of the situation of the immunization program in Japan and the United States in terms of structure of policy setting system. Since the disease epidemiology clearly indicates that the US has better control of VPDs over Japan, we considered the advantage of development of a comparable vaccine policy setting system of the US in Japan.