“The South African Department of Health has sounded the alarm over plummeting childhood immunization rates, with unvaccinated infants rising from 12.1% in 2017 to 36.3% in 2026. This decline has already triggered widespread outbreaks of measles, rubella, diphtheria, and pertussis, putting hundreds of thousands of children at risk.”
South Africa is grappling with a severe public health crisis as declining childhood immunization rates fuel outbreaks of vaccine-preventable diseases. The Department of Health has issued an urgent call for a coordinated national response, warning that decades of progress in reducing child mortality and maintaining herd immunity are at risk of being undone.
The Numbers Behind the Crisis
- Unvaccinated infants: Rose from 12.1% in 2017 to 36.3% in 2026.
- First-dose coverage: Dropped from 87% in 2021 to 67% in 2025.
- Hexavalent (6-in-1) vaccine coverage: Declined from 87% to 60.5%.
- Measles cases: Over 3,462 confirmed since January 2026, with hotspots in Western Cape, Free State, KwaZulu-Natal, and Northern Cape.
- Rubella cases: Nearly 400 recorded, posing severe risks for pregnant women.
- Pertussis (whooping cough): Detected in several provinces, disproportionately affecting infants under six months.
Outbreaks and Their Impact
- Measles: Highly contagious, leading to pneumonia, encephalitis, and death.
- Rubella: Mild in most cases but dangerous during pregnancy, causing Congenital Rubella Syndrome (CRS).
- Diphtheria: Sporadic cases in Western Cape, threatening respiratory health.
- Pertussis: Severe coughing fits, particularly dangerous for infants too young to be fully vaccinated.
Causes of Decline
- Vaccine hesitancy: Fueled by misinformation and distrust of health authorities.
- Healthcare access barriers: Rural provinces face infrastructure shortages.
- Equity issues: Vulnerable populations struggle to access vaccines.
- Complacency: Success in eliminating diseases like polio has led to reduced urgency among some communities.
Government Response
- Catch-up campaigns: Targeting under-immunised children across all 52 districts.
- Awareness drives: Combatting misinformation and reinforcing vaccine safety.
- Community engagement: Collaboration with local leaders to rebuild trust.
- Surveillance systems: Strengthened laboratory confirmation and reporting via the Notifiable Medical Conditions Surveillance System (NMCSS).
Expert Perspectives
- Epidemiologists: Warn that South Africa risks reversing decades of progress toward measles elimination.
- Pediatricians: Stress early diagnosis and treatment to reduce complications.
- Public health officials: Emphasize community-driven solutions to overcome hesitancy.
Risks to Society
- Childhood development: School absences and long-term health complications.
- Family impact: Increased caregiving burdens and economic strain.
- National health security: Imported polio strains detected in Cape Town wastewater highlight vulnerabilities.
The Way Forward
Experts recommend:
- Ensuring nationwide vaccine availability.
- Expanding awareness campaigns to counter misinformation.
- Building stronger partnerships between government, NGOs, and communities.
- Enforcing school vaccination requirements to protect children.
