 This review analyzes the vaccination coverage and impact of higher-valent pneumococcal conjugate vaccines, PCVs, on overall invasive pneumococcal disease, IPD, in southern European countries, including Portugal, Spain, Italy, Greece, and Cyprus. The study found that while PCVs were licensed from 2009 in Europe and showed similar worldwide clinical effectiveness, vaccination coverage remained suboptimal in southern Europe until 2015-16. Vaccination coverage in the Portuguese private market peaked at 75% in 2008, but declined to 63% in 2012. In Madrid, coverage dropped from 95% 2007-2012, to 67% 2013-14, after funding termination in May 2012. PCVs were recently introduced in the National Immunisation Programme of Portugal and Spain. In Italy, coverage for the complete PCV schedule was 88%, although highly variable between regions. In Greece, overall IPD has decreased, but pneumococcal meningitis incidents remained stable. The study recommends continued IPD surveillance or national registers using ICD, 10 codes of clinically-suspected IPD and timely publicly-available reports to assess trends in vaccination coverage and evaluate PCVs in NIPPs.