Journal of Vaccine Research 2024, Vol.14, No.2, 76-84 http://medscipublisher.com/index.php/jvr 81 organizational factors, such as leadership, communication, and workforce capacity, can help identify best practices and areas needing attention (Perman et al., 2017). Additionally, conducting prospective, well-controlled trials to assess the cost-effectiveness of specific vaccination strategies can inform future program design and policy decisions (Cawley et al., 2010). By implementing these strategies and continuously evaluating their impact, school-based vaccination programs can be optimized to improve vaccination coverage and protect the health of school-aged children and adolescents. 7 Future Directions 7.1 Research gaps and areas for future study Despite the growing body of literature on school-based vaccination programs, several research gaps remain. One significant gap is the lack of theory-informed research to guide the implementation of these programs. Most studies are descriptive and do not utilize robust theoretical frameworks to understand the organizational factors influencing program delivery (Perman et al., 2017). Additionally, there is a need for more prospective, well-controlled trials to establish the cost-effectiveness of specific vaccination strategies (Cawley et al., 2010). Research should also focus on standardizing methods to estimate vaccine coverage to facilitate better program evaluation (Paul and Fabio, 2014). Furthermore, the impact of school-based clinics and policy and legislation on overall vaccination coverage remains uncertain and warrants further investigation (Siddiqui et al., 2022). 7.2 Technological innovations Technological advancements offer promising avenues to enhance the effectiveness of school-based vaccination programs. For instance, web-based educational programs have shown potential in increasing vaccination coverage among adolescents by improving their knowledge and reducing vaccine hesitancy (Esposito et al., 2018). Integrating digital tools for consent management and communication with parents and students could streamline the vaccination process and address logistical challenges (Cawley et al., 2010; Perman et al., 2017). Additionally, leveraging social media platforms for accurate information dissemination and countering misinformation could play a crucial role in improving vaccine uptake (Delany-Moretlwe et al., 2018). 7.3 Policy recommendations for sustainable programs To ensure the sustainability of school-based vaccination programs, several policy recommendations can be made. First, programs should be designed to optimize service delivery efficiency, such as integrating vaccination with other adolescent health services (Rosen et al., 2023). Policymakers should also consider the economic sustainability of these programs, particularly in regions with high proportions of Vaccines for Children (VFC) eligible children. Subsidies or increased reimbursement rates for Medicaid could enhance program viability (Tran et al., 2016). Furthermore, strong partnerships between government ministries, schools, and healthcare providers are essential for successful program implementation and sustainability (Delany-Moretlwe et al., 2018). Finally, streamlined consent processes and proactive commodity procurement and security measures are critical to maintaining high vaccination coverage and program effectiveness (Delany-Moretlwe et al., 2018; Rosen et al., 2023). By addressing these research gaps, leveraging technological innovations, and implementing sustainable policy recommendations, school-based vaccination programs can significantly improve vaccination coverage and contribute to better public health outcomes. 8 Concluding Remarks School-based vaccination programs have demonstrated significant potential in improving vaccination coverage among children and adolescents. Various studies have highlighted the effectiveness of different strategies and interventions. These have been shown to increase vaccination coverage by 19% and 15%, respectively. Offering financial incentives can significantly boost vaccination rates, with an increase of up to 67%. Provider-directed interventions have also been effective, increasing coverage by 13%. High coverage rates were achieved in school-based HPV vaccination programs, particularly when grade-based eligibility criteria were used. School-located influenza vaccination programs have been effective in increasing coverage and reducing absenteeism. Successful implementation of school-based vaccination programs often involves ensuring that all
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