The role of school health education on vaccine acceptance: a systematic review and meta-analysis

Abstract Background Pediatric and adolescent vaccine coverage remains suboptimal worldwide, often due to knowledge gaps, misinformation, and low vaccine confidence. School-based education offers a promising approach to address these barriers by engaging students within their learning environments. This systematic review evaluated the effectiveness of school-based interventions in improving vaccine-related knowledge, attitudes, and uptake. Methods We conducted a systematic review and meta-analysis across six databases (PubMed, Scopus, Web of Science, ERIC, PsycInfo, and Cochrane Library; PROSPERO: CRD42022376791). A meta-analysis assessed the impact of school-based programmes on HPV vaccine uptake. Results From 19,298 records, 38 studies met inclusion criteria: 11 RCTs, 12 quasi-experimental, and 15 pre-post studies, published between 1985 and 2024 across 16 countries. Sample sizes ranged from 63 to 17,411 students, mainly from secondary schools (n = 16, 42%). Most studies (n = 25, 66%) focused on HPV vaccination. Interventions ranged from classroom sessions and peer education to multi-day programmes and community-linked vaccination. Outcomes were assessed via surveys, focus groups, and immunization records over follow-ups from 1 week to 2 years. Most studies (n = 25, 66%) reported significant short-term knowledge gains, with partial decline after one year. Improvements in attitudes, intentions, and vaccine uptake were commonly observed. Meta-analysis of RCTs on HPV vaccine uptake showed a pooled RR of 4.18 (95% CI: 1.41-12.37), indicating significant impact; non-randomized studies showed no statistically significant pooled effects. Conclusions School-based educational programmes effectively enhance vaccine knowledge, attitudes, intentions, and -when combined with active delivery- uptake. We recommend integrating structured, evidence-based interventions into school health curricula. Future research should standardize outcomes, assess long-term retention, and explore cost-effectiveness. Key messages • School-based educational programs proved to increase students’ vaccine knowledge, attitudes, and uptake, notably HPV uptake. • Integrating structured vaccine education into school curricula may effectively contribute to enhancing adolescent immunization coverage.