Journal of Vaccine Research 2024, Vol.14, No.2, 76-84 http://medscipublisher.com/index.php/jvr 77 best practices to increase immunization rates and reduce the burden of vaccine-preventable diseases in school Settings. 2 Historical Context of School-Based Vaccination Programs 2.1 Early implementation and evolution School-based vaccination programs have a long history, with their roots tracing back to the early 20th century when schools were first recognized as effective venues for mass immunization efforts. The initial focus was on diseases such as smallpox and diphtheria, which posed significant public health threats at the time. Over the decades, the scope of these programs has expanded to include a variety of vaccines aimed at preventing diseases like measles, mumps, rubella, and more recently, human papillomavirus (HPV) and meningococcal infections (Paul and Fabio, 2014; Perman et al., 2017; Tiley et al., 2020). 2.2 Key milestones and policy developments Several key milestones have marked the evolution of school-based vaccination programs. In the 1970s, the introduction of mandatory vaccination policies for school entry in the United States significantly increased vaccination coverage and reduced the incidence of vaccine-preventable diseases (Greyson et al., 2019). The implementation of the HPV vaccination program in schools in the early 2000s represented another significant milestone, with countries like Australia and the United Kingdom achieving high coverage rates through these initiatives (Skinner and Robbins, 2010; Paul and Fabio, 2014; Muhamad et al., 2018). Policy developments have also played a crucial role, with many countries adopting laws that require vaccination records to be checked upon school entry, thereby ensuring higher compliance and coverage rates (Greyson et al., 2019; Zuo et al., 2020). 2.3 Expansion and adaptation across different regions The success of school-based vaccination programs in high-income countries has led to their adaptation and expansion in various regions worldwide. For instance, Malaysia's school-based HPV vaccination program, launched in 2010, achieved high coverage rates through a well-coordinated, multi-sectoral approach (Muhamad et al., 2018). Similarly, in China, the implementation of a vaccination record check program at school entry has significantly increased coverage rates for multiple vaccines and reduced the incidence of diseases like measles (Zuo et al., 2020). These programs have demonstrated that with proper planning and execution, school-based vaccination can be an effective strategy in diverse settings (Cawley et al., 2010; Perman et al., 2017; Tiley et al., 2020). 3 Effectiveness of School-Based Vaccination Programs 3.1 Impact on vaccination coverage rates School-based vaccination programs have demonstrated a significant impact on increasing vaccination coverage rates among children and adolescents. A meta-analysis revealed that educational interventions, reminders, provider-directed interventions, financial incentives, and multilevel interventions can improve vaccination coverage by varying degrees, with financial incentives showing the highest increase at 67% (Siddiqui et al., 2022). Additionally, a systematic review highlighted that school-located vaccination programs are feasible and effective, particularly when strategies such as incentives, education, and reminders are employed (Cawley et al., 2010). In Hong Kong, a school outreach vaccination program significantly improved influenza vaccination rates among primary school students, achieving a coverage rate of 69.2% compared to 34.3% in control schools (Lau et al., 2019). Furthermore, a review of HPV vaccine delivery strategies found that school-based programs achieved high vaccination coverage rates in 9 to 13-year-old girls across different geographic locations (Paul and Fabio, 2014). 3.2 Reduction in vaccine-preventable diseases The implementation of school-based vaccination programs has also been associated with a reduction in vaccine-preventable diseases. For instance, a study on school-based influenza vaccination found that households with children attending intervention schools had significantly fewer influenza-like symptoms compared to control-school households (King et al., 2006). Similarly, the Hong Kong school outreach vaccination program reported a significant reduction in influenza-like illness (ILI) rates among vaccinated students, with an ILI rate of
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