Pneumococcal vaccine developed by the Pune-based Serum Institute of India has been pre-qualified by the World Health Organisation (WHO) in the third week of December 2019. The prequalification of the vaccine by WHO was based on the results of a phase-3 trial (the final phase of human clinical trial) carried out in 2,250 children in Gambia, a small West African country. According to a November 2019 UNICEF report, pneumonia caused 1,27,000 deaths in India in 2018, the second highest number of child mortality under the age of five in the world. In India, pneumonia and diarrhoea cause the most deaths in children under five years. The pneumococcal vaccine PNEUMOSIL is a conjugate vaccine to help produce stronger immune response to a weak antigen. Serum Institute had optimised an efficient conjugate vaccine manufacturing processes for its meningitis A vaccine (MenAfriVac), which was used for manufacturing the pneumococcal vaccine. This helped the company reduce the manufacturing cost of pneumococcal vaccine.