School vaccination
Students at Kafin Liman Primary School, Nigeria
Global strategic plans for the elimination of measles and rubella and maternal neonatal tetanus (MNTE) both call for strengthening of the role of schools in the delivery of routinely recommended vaccines and checking vaccination status at entry to, or during school, to achieve and sustain elimination of these vaccine-preventable diseases (VPDs). Where enrollment is high, the school setting offers an effective platform for reaching children and adolescents with vaccination services, as well as an opportunity to catch up children who may not have received all age-appropriate vaccines.
Ensuring children in formal education or care settings are protected against all VPDs is important not only for the health of the child, their family and community, but also for a healthy care/school environment, which is a prerequisite for optimal learning.
School-based immunization
With the availability of newer vaccines (e.g. human papillomavirus (HPV), meningococcal) and greater attention to providing booster doses of routine vaccines to older children (e.g. tetanus-diphtheria, polio, measles), there is growing interest in using schools as a platform for immunization delivery.
Assessing the country’s capacity to vaccinate in schools
Before implementing school vaccination programmes, countries should assess the capacity of their school and health systems to support such programmes. Undertaking a readiness assessment will aid countries in their decision-making and planning, but can also be used by countries wishing to improve the performance of their existing school vaccination activities. WHO has developed an assessment tool to assist countries to identify strengths and weaknesses in the current school environment to consider introduction of vaccines through schools.
Considerations regarding consent for vaccination
For childhood vaccination, parental consent can be implied when a parent voluntarily brings the child to be vaccinated at a health clinic. However, for school-based vaccination, implicit parental consent cannot be as easily assumed, and explicit written or verbal consent may require additional steps.
When vaccination is carried out in schools, local or national school authorities normally authorize the intervention to take place at their premises. This authorization is needed for planning and implementing the vaccination sessions in schools. This authorization, however, does not imply informed consent by the individuals in that school or community.
WHO has developed a guidance note outlining the considerations for the consent process when implementing school based vaccination programmes for older children and adolescents.
Opportunities for integrating vaccines with other school health interventions
WHO guideline on school health services
Comprehensive school health services may include preventive services such as administration of recommended immunizations and screening for vaccination status as part of a health check.
WHO guideline on school health services
Making every school a health-promoting school: Implementation Guidance
A health-promoting school (HPS) approach was introduced over 25 years ago and has been promoted globally since. This publication is based on an extensive review of global evidence on the barriers to and enablers of implementation, maintenance and scaling-up of the health-promoting school approach. Its aim is to guide adaptation and implementation of the global standards for HPS.
Documenting country experiences
WHO and partners have documented experiences from several countries with existing school-based immunization programmes. To date, the programmes in Indonesia, Malaysia, Sri Lanka and Tunisia have been documented. These countries have well-established nationwide school immunization programmes that have been implemented for decades. Other countries contemplating the introduction of similar strategies can look to these case studies for guidance on designing, organizing and implementing such programmes.
For each of these reports, information on the school-based immunization programme was collected in close collaboration with the Ministries of Health and Education, and other government institutions, using structured questionnaires, reported data, and observation of processes. These are not evaluations.
Checking vaccination status at entry to, or during school
Vaccination status checks can be used to implement laws or policies requiring proof of vaccination for entry into formal childcare or school, however these two things should not be confused: vaccination status checks can be implemented without such entry requirements (i.e. as another touch-point for updating coverage and encouraging catch up of children that may have been missed, without excluding students who may not have documented vaccinations).
A recent global survey indicated that almost two thirds of WHO Member States report a routine practice of checking vaccination status in at least one level of the education system.
Countries reporting a vaccination status check at daycare, kindergarten, and/or primary school
Documenting country experiences
Little has been documented about the extent of implementation, design, and effect of this strategy, particularly in low- and middle-income settings. To facilitate sharing of lessons learned, WHO and partners are documenting experiences from several countries
with existing vaccination screening programmes in place.
In November 2020, a global consultation was convened to bring together countries and immunization partners across all regions that have successfully implemented this strategy to discuss key learnings, challenges and factors for success.
To date, the programmes in China, Thailand, and Jamaica have been documented as case studies, and several other programmes are highlighted in the Meeting Report. Countries considering implementing this strategy can look to these case studies and the Meeting Report for guidance on designing and implementing such programmes.
Key factors for success
Before implementing a policy on checking vaccination status at school, countries should assess the capacity of their school and health systems to support such an activity. Some key facilitating factors that have been identified in successful programmes include:
- Strong collaboration between ministries of health and ministries of education with clear roles and responsibilities for each
- Existence of legislation or written policy requiring the collection of vaccination history at enrollment, or during school
- A well-defined and enabling catch up policy
- Clear implementation guidance and standard operating procedures (SOPs) outlining how records are collected, kept, and reported
- Widespread availability of up-to-date home-based records or electronic register that summarize the vaccination history on one page for easy reference
- Availability of sufficient funding and staff time to carry out this activity on an annual basis
- Public outreach and sensitization to promote cooperation from the community
