Fewer vaccinations, more disease: outbreaks of preventable illness in SA

The health department is calling on parents and the public to take urgent action to halt declining immunisation coverage to help to prevent outbreaks of vaccine-preventable diseases.

The worsening vaccination level in South Africa could threaten to reverse decades of public health gains, including significant reductions in under-five and infant mortality achieved since the mid-2000s.

The decline in routine immunisation rates has created a public health emergency characterised by childhood disease outbreaks

The proportion of unvaccinated infants (children under one year receiving no vaccinations) has increased from 12.1% in 2017 to an alarming 36.3% between January 2026 and April 2026 — effectively tripling the number of completely unvaccinated children and leaving hundreds of thousands of infants at risk of life-threatening illnesses.

Routine coverage has fallen severely across all 52 districts in the country. First-dose coverage among children under one year dropped from 87% in 2021 to 67% in 2025. Coverage of the hexavalent (6-in-1) infant vaccine declined from 87% to 60.5% over the same period.

Department spokesperson Foster Mohale said at current rates, South Africa is unlikely to reach the World Health Organisation’s critical 90% coverage threshold for childhood immunisation, unless urgent interventions are implemented.

“These include parents and families taking their unvaccinated children to health facilities and healthcare providers for immunisation,” he said.

“The consequences of declining coverage include the resurgence of serious vaccine-preventable diseases, the erosion of community [herd] immunity, and higher rates of long-term disability and death among infants.

“This is no longer a theoretical risk because active outbreaks are occurring in multiple provinces across the country,” Mohale said.

Since January, South Africa has recorded 3,462 laboratory-confirmed measles cases, with outbreaks reported in the Western Cape, Free State, KwaZulu-Natal, Northern Cape and other provinces. The majority of cases (70.9%) are in children aged one to 14 years, directly linked to low immunisation coverage.

Sporadic cases of diphtheria — a serious bacterial infection of the nose and throat that can obstruct breathing — have been detected, primarily in the Western Cape, underscoring gaps in booster coverage and disease surveillance.

Pertussis (whooping cough) cases have also been identified in several provinces, predominantly affecting infants under six months who are too young to be fully vaccinated. “This pattern signals a failure of herd immunity to protect the most vulnerable,” Mohale said.

Nearly 400 rubella (German measles) cases have been recorded, mostly among children aged one to 14 years in several parts of the country. This poses severe risks for pregnant women due to the potential for congenital rubella syndrome (CRS).

Mohale underscored the importance of ensuring that South Africans remain protected from polio in line with its status as a polio-free country. This is despite the recent confirmation of imported polio virus strains detected in wastewater in Cape Town.