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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The prevention of pneumococcal infections deserves more attention because of aging populations and antimicrobial resistance.¹ In this light, Nichol and colleagues² reported important positive findings from a community-based, nonexperimental study on influenza and pneumonia immunization among those at highest risk: elderly patients with chronic pulmonary disease. In spite of this report, however, the issue of the incremental health and economic benefit of combined pneumococcal and influenza vaccination compared with influenza vaccination alone among a wider target group of high-risk patients remains unsolved.

So far, the Dutch Health Council has only recommended the latter vaccination for all elderly patients and those with high-risk disease. To further enhance physician adoption of the influenza immunization guideline, a nationwide collaborative program among general practitioners was initiated in 1995.³ As vaccine uptake remained persistently low among patients with chronic lung disease, we conducted a general practitioner–based cost-effectiveness study.⁴ In accordance with data of Nichol et . . . [Full Text of this Article]