Objectives: We investigated ethical issues in school-based immunization programs for adolescents and how they are addressed. Methods: We used qualitative methods and an ethnographic approach to observe 9 secondary schools on immunization days in South Australia in 2011; concurrently, we conducted 9 focus groups with female secondary school students, 6 semistructured interviews with parents, and 10 interviews with nurses and teachers. We explored ethical challenges from the perspective of these groups. Results: We identified ethical challenges for the delivery of adolescent immunization in a school-based setting in 3 main areas: informed consent, restrictions on privacy, and harm to students in the form of fear and anxiety. Conclusions: We found areas in which the design and delivery of school-based immunization programs can be improved. Information about immunization should be provided in ways that are appropriate to young people and their parents, and privacy protections should be enhanced when possible. Involving young people in the design and delivery of programs would assist with making these improvements. ; Annette Braunack-Mayer, S. Rachel Skinner, Joanne Collins, Rebecca Tooher, Claudia Proeve, Maree O’Keefe, Teresa Burgess, Maureen Watson and Helen Marshall