Introduction Pneumococcal vaccine is an effective preventive measure to reduce the burden of pneumococcal disease. This vaccine is beneficial for high-risk populations, including elderly healthcare workers and those with comorbidities. However, various studies have demonstrated low vaccination coverage globally. Therefore, we aimed to assess pneumococcal vaccination coverage among at-risk internists and identify its influencing factors. Methods This cross-sectional study is part of the CARMEINA study conducted by the Indonesian Society of Internal Medicine (INASIM) from December 2023 to March 2024. Data was collected from internists at risk of pneumococcal disease recommended for pneumococcal vaccination according to the 2023 Adult Vaccination Recommendation from INASIM. At-risk internist was defined as someone who met the following conditions: (1) over 50 years old; (2) treating immunocompromised patients including patients with malignancy, sickle-cell disease, chronic kidney disease, HIV, primary/secondary immunodeficiency, nephrotic syndrome, patients on long-term immunosuppressants, and transplant recipients; and (3) treating patients with increased risks of pneumococcal disease due to a medical condition. Descriptive analyses and multivariate analysis were performed to identify the medical and demographic profile of pneumococcal vaccination. Results A total of 545 at-risk internists were included in this study. We found that the pneumococcal vaccination coverage among at-risk internists in Indonesia was 11.6% ( n = 63/545). Factors associated with pneumococcal vaccination were: a history of influenza vaccination in the past year (aOR 6.80, 95% CI 3.83–12.08), immunocompromised conditions (aOR 2.95, 95% CI 1.27–6.84), an age of >60 years (aOR 1.99, 95% CI 1.02–3.90), and chronic conditions (aOR 1.88, 95% CI 1.08–3.52). Conclusion Pneumococcal vaccination coverage among at-risk internists in Indonesia is relatively low despite the global burden of pneumococcal disease and adult vaccine recommendations from INASIM. Further targeted interventions are needed in order to improve vaccination coverage, especially among at-risk internists. Copyright © 2026. Published by Elsevier Ltd.