Reducing the Cost of Saving Children’s Lives

This editorial discusses two cost-saving strategies for pneumococcal conjugate vaccine (PCV) programs in low- and middle-income countries: fractional dosing and reduced-dose schedules. Gallagher et al. report that 40% doses of PCV13 in Kenyan infants yielded noninferior immunogenicity compared to full doses, though lower serotype-specific antibody concentrations may affect herd immunity. Yoshida et al. present a cluster-randomized trial in Vietnam showing that one-primary-one-booster or no-primary-one-booster schedules of PCV10 were noninferior to standard schedules in reducing vaccine-serotype carriage. The editorial emphasizes the differing rationales of direct versus indirect protection, the need for long-term carriage data, and the importance of context-specific recommendations. Ongoing trials in Niger and Gambia, supported by the Gates Foundation, aim to inform WHO guidance on deploying cost-effective PCV strategies in resource-limited settings.

This editorial discusses two cost-saving strategies for pneumococcal conjugate vaccine (PCV) programs in low- and middle-income countries: fractional dosing and reduced-dose schedules. Gallagher et al. report that 40% doses of PCV13 in Kenyan infants yielded noninferior immunogenicity compared to full doses, though lower serotype-specific antibody concentrations may affect herd immunity. Yoshida et al. present a cluster-randomized trial in Vietnam showing that one-primary-one-booster or no-primary-one-booster schedules of PCV10 were noninferior to standard schedules in reducing vaccine-serotype carriage. The editorial emphasizes the differing rationales of direct versus indirect protection, the need for long-term carriage data, and the importance of context-specific recommendations. Ongoing trials in Niger and Gambia, supported by the Gates Foundation, aim to inform WHO guidance on deploying cost-effective PCV strategies in resource-limited settings.