Pneumonia is the most serious acute respiratory infection and is caused by numerous etiologic agents, bacteria and viruses. Severe pneumonia is a major challenge to survival of children globally. In this article we examine the causes of global childhood mortality, and the distribution of childhood pneumonia mortality and morbidity, as well as the risk factors that affect pneumonia incidence. Although major bacterial and viral respiratory infections, such as diphtheria, measles, Haemophilus influenzae type b (Hib), and pneumococcal infections, are now preventable through vaccination, bacterial pneumonia, including severe pneumonia (those that require hospitalization), still remain a public health challenge in both resource-poor and wealthy countries. We therefore, review the published literature on the available vaccines and their potential effectiveness in further reducing the burden of childhood bacterial respiratory diseases. There is a need to conduct further epidemiologic studies for identifying the disease burden and for urgent implementation of proven cost-effective interventions. These interventions are a necessary part of public health actions to reduce childhood mortality, a major Millennium Development Goal. The role of vaccines in this regard is critical, as they represent a rapid and feasible intervention with an early and sustained impact.