OBJECTIVES: China has experienced several severe outbreaks of influenza over the past century: 1918, 1957, 1968, and 2009. Influenza itself can be deadly; however, the increase in mortality during an influenza outbreak is also attributable to secondary bacterial infections, specifically pneumococcal disease. Given the history of pandemic outbreaks and the associated morbidity and mortality, we investigate the cost-effectiveness of a PCV7 vaccination program in China from the context of typical and pandemic influenza seasons.  METHODS: A decision-analytic model was employed to evaluate the impact of a 7-valent pneumococcal vaccine (PCV7) infant vaccination program on the incidence, mortality, and cost associated with pneumococcal disease during a typical influenza season and influenza pandemic in China.  Estimates were performed comparing an 85% level of PCV7 coverage among all newborn infants during a single year in China relative to a case where no PCV7 vaccinations occur for both a typical influenza season and a severe influenza pandemic in China. The model incorporates Chinese data where available and includes both direct and indirect (herd) effects on the unvaccinated population, assuming steady state. Costs were calculated using a payer perspective and included vaccination program costs and direct medical expenditures from pneumococcal disease.  RESULTS: The model predicts that PCV7 vaccination in China would prevent 4,855,878 cases of pneumococcal disease and 66,351 deaths in a single year during a normal influenza season. The estimated incremental-cost-effectiveness ratios were ¥24,383 per life-year saved and ¥25,519 per quality-adjusted-life-year gained.  During an influenza pandemic, the model estimates that vaccination with PCV7 would prevent 8,192,158 cases of pneumococcal disease and 659,216 deaths, and would be cost-saving.  CONCLUSIONS: Vaccination with PCV7 in China is cost-effective during typical influenza season.  During an influenza pandemic, the benefit of PCV7 in preventing excess pneumococcal morbidity and mortality renders a PCV7 vaccination program cost-saving.