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Pneumococcal vaccination strategies
Practical Strategies for Pneumococcal Vaccination: Enhancing Uptake Amid Increasing Complexities

Released: March 27, 2026

Robert H. Hopkins, Jr.
Robert H. Hopkins, Jr., MD, MACP
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Key Takeaways
  • Pneumococcal disease prevention continues to advance as new vaccines enter the market, yet vaccination recommendations continue to become more complex.
  • HCPs should always use a strong presumptive approach when making vaccine recommendations targeted to patients and follow up with motivational interviewing as needed to improve uptake.

We have made tremendous progress in the prevention of pneumococcal disease. This is a direct result of pneumococcal vaccination with conjugate vaccines, which have significantly reduced the incidence of invasive pneumococcal disease (IPD) among children and adults.

Although vaccine development continues to advance, a key challenge for healthcare professionals (HCPs) persists: pneumococcal vaccination guidelines for adults are significantly more complex than other vaccine recommendations. In the clinic, this challenge makes it harder for HCPs to implement standing orders, making tools like the CDC’s PneumoRecs VaxAdvisor app and immunization charts even more important. 

My Pneumococcal Vaccine Strategies
In my practice, I carry the PCV20 vaccine for my pediatric patients and the PCV21 vaccine for my adult patients. We use PCV21 in adults who are at least 19 years of age because this vaccine protects against 21 total serotypes of pneumococcus, which, according to data from 2018 to 2022, caused approximately 80% of all US IPD cases among older adults. By contrast, PCV20 only covered serotypes that caused 56% of all IPD cases among older adults during that time.

But there is still a role for PCV20 in vaccinating adults. That is because the PCV21 and PCV20 vaccines only share 10 serotypes; that is, PCV21 does not equal PCV20 plus 1 serotype.

For example, PCV20 protects against serotype 4, whereas PCV21 does not. That is why HCPs in geographic areas with a high prevalence (over 30%) of IPD cases due to serotype 4 should preferentially use PCV20 for adults. Serotype 4 IPD commonly affects unhoused adults in western states like Alaska, Arizona, New Mexico, California, Colorado, and Oregon. It also disproportionately affects Indigenous populations such as the Navajo Nation. Unfortunately, serotype data across the US is not as widely available as one would hope.

“Getting Vaccines Into Arms”
Administering the pneumococcal vaccine to as many willing and eligible patients as possible is the next challenge. This is a particular need considering Americans’ decreasing confidence in vaccines and in the greater healthcare system. It is critical that the entire healthcare team is on the same page. We, as the vaccine experts and champions, must make a strong, presumptive, and personalized recommendation for pneumococcal vaccination and provide reasons that resonate with each patient.

In this era of “doing your own research,” you might ask why a presumptive approach (eg, “Today, you are due for your xyz vaccines”) is best. Evidence shows that this approach results in significantly more vaccinations vs using conversational language (eg, “Would you like the xyz vaccines today?”). I suspect that the reason behind this lies in the implication of the presumptive statement—that vaccination is both the norm and important enough that we are recommending it, rather than offering a choice.

Regardless of the approach you use, not every patient will accept the pneumococcal vaccine, so it is equally important to listen to and watch your patient for any ‘tells’ that may suggest they have concerns or do not want to receive vaccination on this visit.

When this happens, I usually open the conversation with a simple statement, such as, “It looks to me like you have concerns about the pneumococcal vaccine. Can you tell me about your concerns?” If patients are willing, this provides an entry for HCPs to use a brief motivational interview to help patients understand the importance of and become more open to vaccination—either during the same visit or at a later date.

If patients tell you no, or if you cannot have a mutually respectful conversation, then a graceful exit is the best next step. But even in these cases, I believe it is critical to revisit the conversation regarding pneumococcal vaccination at their next visit.

To learn more strategies you can use in these everyday clinical encounters, join me and my colleague Nicolas C. Issa, MD, at our upcoming symposium, “Team Trivia! Are You Keeping Up With Pneumococcal Disease and Vaccine Developments?” You can join us live or in person on April 14. 

Your Thoughts
How do you manage the increasing complexity of pneumococcal vaccine recommendations in your practice? You can get involved in the conversation by posting a comment below.

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