Africa's childhood vaccination gap

Josephine Dlamini, not her real name, has heard claims about the possible risks of childhood vaccines. Some of the information she has encountered has left her questioning what to believe.

But the Johannesburg mother of two continues to vaccinate her children.

“I think it’s crazy, but I would do it just in case. They’re just theories. Even if they’re true, what if my kids never get affected by whatever they are doing? But they will definitely get sick if they don’t get vaccinated,” she said.

Her concerns come as South Africa faces a sharp decline in childhood immunisation. The National Department of Health says routine coverage has fallen across all 52 health districts.

The proportion of infants under one recorded as having received no vaccinations rose from 12.1% in 2017 to 36.3% between January and April 2026, the department says. First-dose coverage among children under one also fell from 87% in 2021 to 67% in 2025.

The decline has coincided with outbreaks of vaccine-preventable diseases, including measles and diphtheria.

For Dr Lesley Bamford, a specialist at South Africa’s National Department of Health, the reasons for the decline are varied.

“There is low demand due to a lack of knowledge and appreciation of the benefits and value of vaccines among parents, caregivers and family,” she said.

But Bamford said the problem is not only whether parents want their children vaccinated. There are also missed opportunities within the health system.

Children who visit a health facility for any reason should have their vaccination status checked and be offered routine or catch-up vaccines if they have fallen behind.

“All health care contacts should check immunization status and provide routine and catch-up vaccines,” she said.

Bamford said the department also receives reports that vaccines are not always available at some facilities, although there are no national vaccine stock-outs. Provincial health departments are responsible for ensuring vaccines remain available at facilities.

The department is also reviewing the population figures used to calculate vaccination coverage. Bamford said inaccurate population denominators could make coverage appear lower than it is, and work is under way to improve the figures.

But she said the decline remains a serious concern.

“We are already seeing outbreaks of measles and diphtheria, which had become very rare,” Bamford said. “If we don't address the decline, we are likely to see more cases and that threatens the lives and well-being of children.”

The problem extends beyond South Africa.

Across Africa, vaccination programmes have recovered from some of the disruption caused by the COVID-19 pandemic, but coverage remains below pre-pandemic levels.

Coverage for the third dose of the diphtheria, tetanus and pertussis vaccine reached about 77% in Africa in 2025, up from 73% in 2021 but below the 79% recorded in 2019, according to the World Health Organization and the United Nations Children's Fund. In West and Central Africa, coverage was even lower at 71%.

Dr Paul Ngwakum of the United Nations Children’s Fund said the continent's vaccination gap is being driven by several factors, including limited access to health services, weaknesses in health systems, children dropping out before completing their vaccination schedules, and growing misinformation or declining confidence in some communities.

Children in remote, conflict-affected and fragile areas can be particularly difficult to reach, he said. But countries also need to identify children who are being missed in urban areas, including informal settlements.

“You have to identify where the children are and then go and reach them,” Ngwakum said.

That requires stronger primary health-care systems, sufficient health workers and better use of data to identify children who have received no vaccines or have started their vaccination schedules but not completed them.

Financing is another concern, Ngwakum said, as countries face increasing pressure on health budgets and international funding.

But reaching children with vaccines is only one part of the problem.

In some communities, concerns about vaccine safety and misinformation can affect whether parents seek vaccination for their children or return for subsequent doses.

Ngwakum said health authorities need to engage with communities and understand their wider concerns rather than simply telling people to vaccinate.

“You cannot go to be giving a polio vaccination to a child when the community says our problem is water,” he said. “So you have to package it in such a way that it’s appetizing for the community.”

That means linking immunisation with other health and community services where possible, he said.

“If you bring supply and there’s no demand, you don’t get to the result. It has to be both,” Ngwakum said.

The consequences of these gaps are already being seen in measles outbreaks across the continent.

Measles is highly contagious, and very high vaccination coverage is needed to prevent sustained transmission. The World Health Organization recommends at least 95% coverage to prevent outbreaks.

The disease continues to circulate in several African countries in 2026. In South Africa, the National Institute for Communicable Diseases had recorded 4,188 laboratory-confirmed measles cases between December 29, 2025 and August 30, 2026. Other countries are also responding to measles outbreaks. Sierra Leone, for example, has been working to identify and vaccinate children who have never received routine vaccines. The Democratic Republic of Congo also continues to face recurrent measles outbreaks alongside other health emergencies.

The outbreaks come despite broader progress against measles in Africa. The World Health Organization said in April that measles cases across the region had fallen by 40% and deaths had been halved, while vaccination had averted nearly 20 million measles-related deaths in Africa since 2000.

Cape Verde, Mauritius and Seychelles have eliminated measles and rubella, demonstrating what sustained vaccination programmes can achieve.

Ngwakum said other countries can make similar progress when immunisation is treated as a priority.

He pointed to South Sudan, where health authorities and partners have worked to identify children who are being missed and reach them despite a difficult humanitarian environment.

The approach requires political commitment, investment in primary health care, reliable data and sustained engagement with communities, he added.

Officials agree that closing the vaccination gap will require addressing both sides of the problem: making vaccines available and accessible while ensuring parents and communities understand their value and trust the health system delivering them.

“Immunization is one of the most cost-effective interventions or investments that any country can make in the health and the future of their children,” Ngwakum said.

Africa has made substantial gains through vaccination. The challenge now is to ensure that gaps in access, completion and confidence do not erode them.