Vaccination of both newborns and susceptibles is included in a transmission model for a disease that confers immunity. The interplay of the vaccination strategy together with the vaccine efficacy and waning is studied. In particular, it is shown that a backward bifurcation leading to bistability can occur. Under mild parameter constraints, compound matrices are used to show that each orbit limits to an equilibrium. In the case of bistability, this global result requires a novel approach since there is no compact absorbing set.