Association a school-based educational program and human papillomavirus (HPV) vaccination uptake in France: A pilot observational study

Human papillomavirus (HPV) vaccination coverage remains insufficient in France, despite national recommendations and the implementation, from 2023 onward, of a school-based vaccination campaign targeting students aged 11–13 years. Parental vaccine hesitancy, often linked to insufficient information and understanding, represents a major barrier to vaccine uptake. This study aimed to assess the association between a school-based educational intervention and parental acceptance and HPV vaccination uptake within the national campaign. We conducted a comparative observational study based on aggregated data from the national school-based HPV vaccination campaign in the Alpes-Maritimes area in southeastern France over two consecutive academic years (2023–2024 and 2024–2025). Parental acceptance rates and vaccination uptake were compared between a pilot middle school implementing the HPV-specific e-Bug educational program, other middle schools in the area, and a subgroup of schools with comparable social characteristics. Parental acceptance and HPV vaccination uptake were consistently higher in the e-Bug pilot school than in comparable schools across both academic years. Absolute differences in parental acceptance ranged from +24.4 to +26.2 percentage points, while differences in first-session vaccination uptake ranged from +20.3 to +24.9 percentage points, with odds ratios between 4.4 and 11.9 ( p < 0.001).While acceptance and vaccination rates declined at the departmental level during the second year, rates observed in the pilot school were maintained or increased. A structured school-based educational intervention implemented upstream of vaccination campaigns may support parental acceptance and improve HPV vaccination uptake. Further large-scale evaluations are warranted to assess the role of health education within vaccination strategies • School-based education was associated with higher HPV vaccine acceptance. • HPV vaccination uptake was higher in the e-Bug pilot school. • Effects were consistent across two consecutive academic years. • Health education may strengthen school-based vaccination strategies.