[Potential and limitations of school vaccination programs to increase HPV vaccination rates in Germany]

Even more than 15 years after the first vaccination recommendation by the Standing Committee on Vaccination (STIKO) against human papillomaviruses (HPV), vaccination coverage in Germany remains low. As a possible measure to increase HPV vaccination coverage in Germany, the widespread introduction of HPV school vaccination programs, as they exist in other European countries, is often called for. However, any implementation of a widespread health intervention should be preceded by an evidence assessment that also takes national circumstances into account. This article provides an overview of the evidence available to date on the effect of school vaccination programs in Germany and discusses the results. Corresponding evidence is so far limited and comes from three local (pilot) programs. These show that about one-third of those not vaccinated took up the school vaccination offer, while two-thirds did not. No program in Germany has yet collected data on the reasons for not accepting the vaccination offer or whether any hesitancy that may exist relates to the place of vaccination (school) or the vaccination itself. Furthermore, there is a lack of cost-benefit analyses of school vaccination programs. This would be important for their evaluation due to the structures that would have to be newly established in Germany for this purpose. Based on the evidence available to date, it seems rather unlikely that the introduction of a comprehensive school vaccination program could significantly increase HPV vaccination rates in Germany. However, in addition to other measures, school vaccination programs could possibly be part of a structured vaccination system for specific target groups or in certain defined regions. In contrast to the existing vaccination system in Germany, such a structured vaccination system could ensure that all members of the target group are actively offered HPV vaccination.