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The article discusses the Hawaii Pneumococcal Disease Initiatives established in 1988 by the Hawaii Department of Health and the U.S. Public Health Service. The purpose of the initiative is to investigate practical and cost-effective methods of increasing pneumococcal vaccine in the state. The initiative implemented a review of pneumococcal bacteremia to establish baseline incidence, a survey to assess physicians' current standards of practice and related attitudes on adult immunization, a consumer survey of elderly adults on immunization knowledge, attitudes and practices and a Pneumococcal vaccination campaign for residents aged 65 years and older. It also conducted 115 community-based pneumococcal vaccine clinics at 79 sites from September 1988 through February 1989.