Why is Flanders still using a pneumococcal vaccine that misses the strain killing children?
Four young children in Flanders have died since 2025 from invasive pneumococcal infections caused by the emerging 12F serotype, according to figures confirmed by the Flemish Department of Care, while the region continues to provide a vaccine that does not cover that strain.
The deaths raise an urgent question about how quickly a public vaccination programme should adapt when surveillance detects a lethal strain covered by an authorised broader vaccine. Existing PCV13 vaccination remains valuable, but it does not address the specific emerging serotype at the centre of these cases.
Four young children in have died since the beginning of 2025 after contracting invasive pneumococcal disease caused by serotype 12F, the confirmed on 11 August. Two babies died in 2025 and two more young children in the first half of 2026, according to reporting by HLN and . The cases expose an increasingly difficult gap in Flemish preventive care: children routinely receive the 13-valent PCV13 vaccine free of charge, but 12F is among the additional strains covered by the newer PCV20 vaccine.
For families in , the immediate question is not whether pneumococcal vaccination works. PCV13 still protects against 13 dangerous bacterial variants and remains part of the basic schedule administered through Opgroeien’s service, family doctors and paediatricians. The concern is whether the publicly funded programme is keeping pace with the bacteria now circulating. Invasive disease occurs when pneumococci enter normally sterile parts of the body, potentially causing meningitis, bloodstream infection or severe pneumonia. Young children are among those most vulnerable.
The epidemiological warning has been building. ’s National Reference Centre found that 12F was ’s most prevalent invasive pneumococcal serotype in the first half of 2025, accounting for 18.9% of typed cases across all ages, 24.1% among children under two and almost 30% among those aged two to 17. Its 2024 surveillance report had already identified the emergence of 12F amid a record 2,120 confirmed invasive infections nationally. reported in March 2025 that the totals for December 2024 and January 2025 were the highest recorded since surveillance began.
’s responded in April 2025 by recommending PCV20 for routine childhood vaccination. Its framing is precautionary: the 20-valent product covers more of the serotypes appearing in Belgian surveillance and should be given in a four-dose, or 3+1, schedule to strengthen protection from infancy. The has authorised Prevenar 20 for children in the European Union and concluded that its benefits outweigh its risks. This is therefore not a case of a product awaiting European clearance.
The Flemish administration takes a more procedural position. The Department of Care says it is evaluating the broader vaccine, while its procurement records show a tender for PCV20 supplies for the Flemish immunisation programme from 2027. A switch is more complicated than replacing one vial with another: the council’s preferred PCV20 schedule requires four doses, compared with the three-dose PCV13 schedule now used in , affecting purchasing, appointments, logistics and programme costs. Those constraints explain why implementation requires planning, but they do not settle whether waiting until 2027 is proportionate after four deaths linked to a covered serotype. Flemish Welfare Minister Caroline Gennez has political responsibility for the health-prevention portfolio; no detailed ministerial timetable explaining whether the transition can be accelerated was identified in the official material reviewed for this article.
The broader lesson is one familiar to vaccination programmes worldwide. Once vaccines suppress targeted pneumococcal strains, other serotypes can occupy more of the ecological space—a process known as serotype replacement. Belgian research covering 543 children with invasive disease between 2019 and 2024 found that many infections were already caused by types outside PCV13, although researchers also cautioned that real-world effectiveness against every additional PCV20 serotype remains uncertain. What happens next depends on the Department of Care’s evaluation and procurement decision. Parents should continue the existing schedule rather than delay vaccination, while asking their doctor about individual circumstances. The unanswered policy question is narrower and urgent: whether can introduce broader protection before the planned 2027 supply cycle.
Impact
Regional — Flanders controls its preventive vaccination programme and purchases vaccines for Kind en Gezin and other vaccinators. Its procurement calendar now points towards PCV20 supplies in 2027, leaving policymakers to decide whether the transition should be brought forward.
International — PCV20 has European Medicines Agency authorisation, so the immediate issue is not whether the vaccine may be used in the EU but when regional programmes adopt and procure it. Belgium illustrates how an EU-authorised product and a national scientific recommendation can still lead to different implementation timelines because childhood vaccination purchasing is handled regionally. Surveillance of pneumococcal serotypes also matters beyond Belgium because circulating strains are not confined by regional or national borders.
What it means for you
Parents in Flanders should continue following the existing childhood vaccination schedule because PCV13 still protects against the serotypes it covers; the evidence provided does not support delaying routine doses. Parents concerned about PCV20 or a child’s individual risk can ask their paediatrician or GP whether it is appropriate and what availability or personal cost would apply, as those details are not established here. The main policy date to watch is 2027, when Flemish procurement records anticipate PCV20 supplies, alongside any decision by the Flemish Department of Care to bring that transition forward.
Opposing perspectives
- Belgian Superior Health Council and surveillance specialists
The council frames PCV20 as the better response to Belgium's changed epidemiology because it covers 20 serotypes, including 12F, and recommends a four-dose childhood schedule. Sciensano's surveillance strengthens that case by showing the rapid rise of 12F and other strains outside PCV13.
- Flemish Department of Care and programme administrators
The administration continues to describe PCV13 as offering strong protection against the 13 serotypes it contains and is evaluating the broader product through the regional procurement process. Moving to PCV20 also changes the childhood schedule from three to four doses, with logistical, budgetary and implementation consequences.
Who, where and what
Key people, places and terms in this story
Belgian region whose childhood programme currently supplies PCV13 and is considering the transition to PCV20.
Country in which national scientific advice and surveillance inform regionally implemented vaccination programmes.
Belgian public broadcaster that reported on rising invasive pneumococcal infections and the four child deaths.
Flemish child and family service through which childhood vaccines are administered.
Regional authority that confirmed the four child deaths and manages Flemish vaccine implementation and procurement.
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Belgian region whose childhood programme currently supplies PCV13 and is considering the transition to PCV20.
Country in which national scientific advice and surveillance inform regionally implemented vaccination programmes.
Regional immunisation programme currently providing PCV13 and preparing for possible PCV20 procurement.
Regional authority that confirmed the four child deaths and manages Flemish vaccine implementation and procurement.
Flemish child and family service through which childhood vaccines are administered.
Belgian public broadcaster that reported on rising invasive pneumococcal infections and the four child deaths.
Belgium’s public-health institute monitoring invasive pneumococcal disease and serotype trends.
Reference laboratory source reporting that 12F represented 18.9% of typed Belgian invasive cases in the first half of 2025.
Belgian scientific advisory body that recommended routine childhood vaccination with PCV20 in April 2025.
EU medicines regulator that authorised PCV20.
Thirteen-valent pneumococcal vaccine currently supplied through the Flemish childhood programme; it does not cover serotype 12F.
Twenty-valent pneumococcal vaccine covering seven additional serotypes, including 12F.
EMA-authorised pneumococcal vaccine referred to in the article as PCV20.
Bacterium with multiple serotypes that can cause invasive pneumococcal disease.
Emerging pneumococcal serotype linked to the reported deaths and covered by PCV20 but not PCV13.
Sources & evidence
- View sourceHet Laatste NieuwsPrimaryprimary· hln.be· 11 August 2026Retrieved 26 August 2026· 52 days ago· Dated
- View sourceVRT NWS report indexed by De Krantenkoppencorroborating· dekrantenkoppen.be· 11 August 2026Retrieved 26 August 2026· 52 days ago· Dated
- View sourceBelgian Superior Health Councilofficial· hgr-css.be· 24 April 2025Retrieved 26 August 2026· 526 days ago· Dated
- View sourceSciensano National Reference Centreofficial· sciensano.beRetrieved 26 August 2026
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This briefing was prepared with AI assistance and reviewed by a Belgium Impulse editor before publication. methodology.