Objective To review the current literature available regarding the efficacy and safety of the 20-valent pneumococcal vaccine in older people and summarize the current recommendation for use in this patient population. Data Sources PubMed was searched using the following terms: (PCV20 [Title] or 20-valent [Title] or 20-valent Pneumococcal conjugate vaccine [Title]) and English (Language). The current recommendations from the Advisory Committee on Immunization Practices and manufacturer package inserts were also reviewed. Study Selection/Data Extraction Nine articles on 20-valent Pneumococcal vaccine were identified based on the above search terms. Those selected for inclusion were randomized control trials including primary or subgroup analysis of PCV20 in older people. Data Synthesis Two randomized controlled trials have assessed the immunogenicity and safety of PCV20 in adults 65 years of age and older, one in a population previously vaccinated with PPSV23 and one in a vaccine-naive population. Both trials demonstrated PCV20 elicited a robust immune response one month after vaccination. PCV20 was well-tolerated with adverse events similar to earlier Pneumococcal vaccine formulations. Conclusion The simplified Pneumococcal vaccine regimen of a singular PCV20 vaccination offers a compelling advancement. Longer-term studies are needed to show if PCV20 will improve vaccination rates and reduce Pneumococcal morbidity and mortality.