WHO estimates that about 1· 6 million people, including up to 1 million children under 5 years old, die every year of pneumococcal pneumonia, meningitis, and sepsis. 1 In populations with high child-mortality rates, pneumonia is the leading infectious cause of mortality and accounts for about 20–25% of all child deaths. 2 In these populations, Streptococcus pneumoniaeis identified consistently as the leading cause of bacterial pneumonia, and pneumococcal bacteraemia is an important cause of child mortality. 3–5 HIV infection increases risk for pneumococcal disease 20–40-fold, and antibiotic resistance makes treatment difficult and expensive. 6 Thus pneumococcal disease is a major global-health issue. Clinical trials in Africa have shown that pneumococcal conjugate vaccines improve child survival and protect the most vulnerable children. A trial with nine-valent vaccine in The Gambia reduced all-cause mortality in vaccinated children by 16%(95% CI 3–28%), all-cause hospital admissions by 15%(7–21%), and radiographyconfirmed pneumonia by 37%(27–45%). 7 In South