This document discusses optimal schedules for controlling pneumococcal infection in countries with high and low carriage. It notes that the African Meningitis Belt has seen sub-optimal pneumococcal conjugate vaccine (PCV) coverage due to geopolitical factors and vulnerable populations. Outbreaks in Ghana pre- and post-PCV introduction show that herd protection may be inadequate. Research is needed to better understand pneumococcal biology and prevention. Improving PCV access and coverage, including schedules with boosters and catch-up campaigns targeting 5-29 year olds, may help prevent outbreaks. Strengthening surveillance systems allows rapid response.