Measuring the broad impact of pneumococcal disease requires multiple surveillance modalities. Four major data sources elucidate the burden of pneumococcal disease in Bangladesh. The Bangladesh Demographic and Health Survey has identified pneumonia as the leading cause of childhood death. By extrapolation of mortality rates in the survey to the Bangladesh population, it has been estimated that approximately 90,000 children >1 month and <5 years of age die of pneumonia every year in Bangladesh. Through hospital-based surveillance, a wide range of pneumococcal serotypes leading to hospitalization and pneumonia have been identified as a leading cause of pediatric hospitalization. Urban community-based surveillance has demonstrated that invasive pneumococcal disease (IPD) is common in the community. Rural community-based surveillance has demonstrated that serious IPD is common in rural areas. Together, these data provide a strong scientific case for the importance of pneumococcal disease prevention to child health in Bangladesh and, therefore, the potential benefit of an effective vaccine.