Pneumococcal conjugate vaccines (PCVs) are highly effective in preventing invasive and non-invasive pneumococcal infections in all age groups through a combination of direct and indirect protection. In many industrialised countries with established PCV programmes, the maximum benefit of the PCV programme has already been achieved, with most cases now due to non-PCV serotypes. On Jan 1, 2020, the UK changed its childhood pneumococcal immunisation programme from a two-dose infant priming schedule with the 13-valent PCV at 8 and 16 weeks after birth, to a single priming dose at 12 weeks after birth, while retaining the 12-month booster. This decision was made after reviewing the evidence from surveillance data, clinical trials, epidemiological analyses, vaccine effectiveness estimates, and modelling studies to support the reduced schedule. In this Review, we summarise the epidemiology of pneumococcal disease in the UK, the evidence supporting the decision to implement a reduced schedule, and the national and global implications of the proposed schedule.