“South Africa’s Department of Health has sounded the alarm over a steep decline in childhood immunisation rates, with unvaccinated infants tripling since 2017. The crisis has already triggered measles outbreaks in several provinces and threatens to reverse decades of public health progress.”
South Africa is grappling with a severe public health emergency as declining childhood immunisation rates have reached critical levels. The Department of Health issued a national call to action on 26 August 2026, warning that the country risks losing hard-won gains in reducing infant and child mortality.
The Numbers Behind the Crisis
- Unvaccinated infants rose from 12.1% in 2017 to 36.3% in early 2026.
- First-dose coverage among children under one year dropped from 87% in 2021 to 67% in 2025.
- Hexavalent vaccine coverage fell from 87% to 60.5% in the same period.
- South Africa is now far below the WHO’s 90% coverage threshold needed to maintain herd immunity.
Outbreaks Already Underway
The consequences are visible:
- Measles: 3,462 confirmed cases since January 2026, with outbreaks in Western Cape, Free State, KwaZulu-Natal, Northern Cape, and more.
- Rubella: Nearly 400 cases, posing severe risks for pregnant women due to Congenital Rubella Syndrome (CRS).
- Pertussis (Whooping Cough): Cases in multiple provinces, mainly affecting infants under six months.
- Diphtheria: Sporadic but dangerous cases detected, especially in the Western Cape.
- Polio: Imported strains detected in Cape Town wastewater, though South Africa remains officially polio-free since 2014.
Causes of Declining Coverage
Several factors contribute to the crisis:
- COVID-19 pandemic disruptions weakened routine immunisation services.
- Healthcare access inequalities across rural and urban districts.
- Vaccine hesitancy fueled by misinformation.
- Systemic challenges in supply chains and staffing shortages.
Public Health Implications
The decline in immunisation coverage threatens:
- Resurgence of deadly diseases once under control.
- Collapse of herd immunity, leaving vulnerable infants exposed.
- Increased infant mortality and long-term disability.
- Economic strain on healthcare systems due to preventable outbreaks.
Government Response
The Department of Health has announced urgent measures:
- Mass immunisation campaigns across all 52 districts.
- Community outreach programs to counter misinformation.
- Enhanced surveillance systems to detect outbreaks early.
- Partnerships with NGOs and international agencies to restore coverage.
Expert Opinions
Public health experts warn that unless coverage rebounds quickly, South Africa could face a multi-disease epidemic. Pediatricians emphasize that measles alone can cause blindness, pneumonia, and encephalitis, while rubella threatens unborn children.
International Context
Globally, declining immunisation rates have been linked to resurgent outbreaks in several countries. South Africa’s crisis mirrors trends seen in parts of Europe and Asia, but the scale of decline here is particularly alarming.
Call to Action
The Department urges parents to immediately take unvaccinated children to clinics. Communities are reminded that vaccines are free and available nationwide.
