Global Review Finds Gaps in Pneumococcal Vaccine Policies for High-Risk Children

Pneumococcal disease remains a leading cause of illness and death in children globally, and although most countries have routine pneumococcal vaccination programs for infants, targeted policies for children who are at an increased risk of severe disease are far less common and highly variable. An emerging study highlights the urgent need for more consistent, detailed, and inclusive vaccination strategies to protect these vulnerable populations.

Gloved hand holding vaccine vial and syringe | Image Credit: © kittisak - stock.adobe.com

Pneumococcal disease is caused by Streptococcus pneumoniae and can lead to a range of illnesses in children, including pneumonia, meningitis, and bloodstream infections. These conditions can result in long-term complications or death, particularly in young children or those with weakened immune systems. Although all children are susceptible, those with certain chronic illnesses such as heart or lung disease, immunodeficiencies, or asplenia face a much higher risk of both contracting the disease and experiencing more severe outcomes.¹

Vaccination is the most effective way to prevent pneumococcal disease. Most national immunization programs include pneumococcal conjugate vaccines (PCVs) for infants as part of their routine schedules. PCVs protect against multiple strains of the bacterium and have been shown to reduce invasive disease significantly. For children with medical risk factors, additional protection is often recommended through booster doses of PCV and/or administration of the 23-valent pneumococcal polysaccharide vaccine (PPV23), which covers more strains.^2,3

To understand global vaccination policy for at-risk children, researchers examined immunization schedules from 195 countries. Their data were sourced from the WHO, the European Centre for Disease Prevention and Control, and official government or public health websites. Their aim was to identify whether countries had vaccine policies that were tailored for children with underlying health conditions, and if so, to document the specific recommendations, including vaccine type, dose schedule, and which health conditions were considered high risk.⁴

The findings reveal a concerning gap in coverage: only 37.9% of countries (n = 74 of 195) have published immunization policies tailored to high-risk children. Among those, 85.1% (n = 63 of 74) recommend a vaccination schedule that differs from the routine infant series. Of the 63 countries with risk-targeted recommendations, 65.1% suggest giving one or more PCV booster doses followed by PPV23; 20.6% recommend only PCV revaccination, and 12.7% recommend only PPV23 following the initial PCV series.⁴

PCV13 remains the most commonly recommended conjugate vaccine, though higher-valency versions like PCV15 and PCV20 are now being adopted by a small number of countries. The study also found substantial variation in which risk conditions are recognized and the specificity of vaccine timing and dosing.⁴

This analysis underscores a critical disparity in vaccine policy. Although routine infant vaccination against pneumococcal disease is widespread, children with health conditions who are at greater risk are often left without specific guidance or access to enhanced protection. Standardizing risk-based vaccination policies and expanding access to newer, broader-coverage PCVs could help prevent avoidable illnesses and deaths in this population. As the global health community continues to push for equity in immunization, children with risk factors must not be overlooked. Consistent guidelines and targeted outreach are essential steps toward closing the gap in protection.

REFERENCES

1. Pneumococcal disease. Cleveland Clinic. September 27, 2022. Accessed May 9, 2025. https://my.clevelandclinic.org/health/diseases/24231-pneumococcal-disease#prevention

2. Pneumococcal vaccination. CDC. October 26, 2024. Accessed May 9, 2025. https://www.cdc.gov/pneumococcal/vaccines/index.html

3. Pneumococcal vaccine recommendations. CDC. October 26, 2024. Accessed May 9, 2025. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html?utm_source=chatgpt.com

4. Daigle D, Morales G, Hayford K, et al. Recommendations for pneumococcal immunization of at-risk children: A global overview (2022-2024). SSRN. May 2, 2025. Doi:0.2139/ssrn.5233731