: The WHO Strategic Advisory Group of Experts is reviewing the technical evidence to inform policy on optimal use of infant pneumococcal conjugate vaccines (PCV)(1). Since 2010, multivalent vaccines (PCV-10, PCV-13) have been successfully introduced with the support of Gavi the Vaccine Alliance into infant immunisation programmes across the developing world(2). One recommended schedule consists of three doses under the age of 6 months (3+0), with the aim of providing maximum protection to infants, the age group at highest risk of pneumococcal disease(3). An alternative schedule consists of two vaccine doses under the age of six months with a booster at 9-15 months (2+1). This schedule may have more impact on reducing carriage and transmission of vaccine serotypes to unvaccinated individuals, leading to indirect or herd protection. The question around the most cost-effective policy to achieve both direct and indirect protection has particular importance for the meningitis belt of sub-Saharan Africa. This article is protected by copyright. All rights reserved.<br/>