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Background: In Quebec, the pneumococcal conjugate vaccine was available on the private market as early as 2001 and has been included in the publicly funded immunization program since December 2004. Objectives: To compare the advantages and limitations of two different sources for assessing vaccination coverage in the target population of children and to evaluate the impact of the public health program on uptake rates. Methods: Data from a province-wide survey of a random sample of parents and from the Quebec City Immunization Registry were used to compute vaccination rates over time in different population groups. Results: Data from the immunization survey and the regional registry were congruent regarding trends. Immunization rates were overestimated, more in the registry than in the survey. During the 2001-2004 period, uptake rates were low, and many children received fewer than the recommended number of doses. As soon as free vaccination was granted, uptake increased markedly and close to 90% of children received the recommended three doses, the level required for inducing herd effects. Delay in the administration of the third booster dose was observed. Conclusions: Free vaccination is a major determinant of vaccine uptake and should remain a fundamental principle of the Canadian health system. Key words: Evaluation study; immunization; pneumococcal vaccine La traduction du resume se trouve a la fin de l'article. Can j Public Health 2009;100(6):413-16. Contexte : Au Quebec, le vaccin pneumococcique conjugue est disponible depuis 2001 sur le marche prive et a ete inclus dans le programme public d'immunisation depuis decembre 2004. Objectifs : Comparer les avantages et limites de deux sources differentes pour mesurer la couverture vaccinale de la population ciblee (les enfants) et evaluer l'impact du programme de sante publique sur les taux de couverture. Methodes : Des donnees provenant d'une enquete provinciale aupres d'un echantillon representatif de parents et d'autres provenant du registre de vaccination de la region de Quebec ont ete utilisees pour estimer les taux de couverture au fil du temps dans differents groupes de population. Resultats : Les resultats provenant de l'enquete provinciale et du registre regional de vaccination sont congruentes en ce qui concerne les tendances. Les taux de couverture sont surestimes, plus dans le registre regional que dans l'enquete. Durant les annees 2001-2004, les taux de couverture sont restes bas et beaucoup d'enfants ont recu moins que le nombre recommande de doses. Des que le programme de vaccination gratuite a ete offert, la couverture vaccinale a augmente de facon marquee et pres de 90% des enfants ont recu les trois doses recommandees, un niveau de vaccination necessaire a l'obtention d'une immunite de groupe. Des retards dans l'administration de la dose de rappel ont ete constates. Conclusion : La vaccination gratuite est un determinant majeur de la vaccination et devrait rester un principe fondamental du systeme canadien de sante., A7-valent pneumococcal conjugate vaccine (PCV7) was licensed in Canada in May 2001, and the vaccine was available on the private market soon thereafter. (1) It is an expensive product with [...]