The primary advice from both the Committee on Infectious Diseases of the American Academy of Pediatrics1 and the Immunization Practices Advisory Committee2 is to recommend that a newly licensed vaccine against Haemophilus influenzae type b should be given to all children at 24 months of age. It is a bold step, a milestone in pediatrics which is emotionally appealing but controversial. The inclusion of a vaccine of such limited efficacy as a routine immunization is unprecedented and the cost of the vaccine will strain the financial resources of some state health departments. Thus, although this initiative will be welcomed by many, there is much upon which to reflect.