Progress towards reduced-dose pneumococcal vaccine schedules for children in Africa.

Pneumococcal conjugate vaccines (PCVs) have been available for more than 20 years 1 and incorporated into the childhood immunisation programmes of 168 countries. Although they have been remarkably successful at reducing the burden of pneumococcal disease globally, 1 there remain concerns about the sustainability of PCV programmes given the emerging threats and competing public health interests. Importantly, PCV remains the most expensive vaccine in childhood immunisation programmes, and between 2009 and 2020 Gavi, the Vaccine Alliance spent more than US$4 billion on PCV alone. In 2021, all but nine African nations had introduced PCV, with the high cost being a major barrier to introduction.