Abstract
Barriers to vaccination can significantly impact the uptake of influenza vaccines among school-aged children. Offering influenza vaccination within schools could reduce these barriers and promote higher vaccination rates. This commentary critically evaluates an economic evaluation comparing the cost-effectiveness of school-located influenza vaccination (SLIV) programs for elementary and secondary school students against the standard of care, i.e. vaccination in primary care settings. The economic evaluation suggested that SLIV could be cost-effective, particularly when considering indirect cost savings and spillover effects. However, the commentary highlights an insufficient explanation of the underlying mechanisms of spillover effects in improving cost-effectiveness, and a lack of discussion of similar programs aimed at boosting vaccination rates. Future research should investigate population preferences, examining why parents and children opt for SLIV or end up taking practice-based vaccination as a spillover effect of the SLIV program. The role played by heterogeneity, exploring factors such as gender, ethnicity, income, and other socioeconomic characteristics should also be investigated to better understand the program's impact on different population groups.