The Western Cape Department of Health & Wellness recently flagged a concerning decline in infant immunisation rates, and is intensifying its campaign to step up numbers, while experts have called for the appointment of provincial immunisation managers countywide and improved budgeting to avoid stockouts.
The department’s Professor Hassan Mahomed told Daily Maverick that immunisation coverage for children under 12 months in the Western Cape had dropped to 67.4% in 2024/25, from 67.6% in 2023/24 – far below the goal of 95% needed to achieve “herd immunity”.
“This is a significant gap that leaves thousands of infants vulnerable to preventable diseases, he said, adding that the department had launched outreach programmes, with teams going door to door to encourage communities to obtain immunisations at clinics, or easily accessible wellness sites.
He said the country’s immunisation coverage has been declining nationally, with data showing it had been under pressure since the Covid-19 pandemic, when disruptions to routine health services during lockdowns created gaps.
This was compounded by vaccine hesitancy fuelled by misinformation.
Mahomed noted that vaccine hesitancy had become a “significant barrier” both globally and locally, underscoring the need for community engagement and clear communication to rebuild confidence in immunisation.
Shabir Madhi, Dean of the Faculty of Health Sciences and Professor of Vaccinology at the University of the Witwatersrand, said the Western Cape was one of the more reliable provinces when it came to data collection around vaccination, as much of its information was captured electronically.
“For other provinces, it’s really difficult to unpack what the trends are. What we do know, and this is based on a survey in 2019 across all provinces, down to the district and sub-district level, is that even then there was quite a bit of heterogeneity in terms of vaccine coverage,” he said.
According to the South Africa Child Gauge 2025, immunisation coverage in the country remains suboptimal, with only 83.3% of infants under one year fully immunised in 2023/24.
Linking to outbreaks
Mahomed confirmed that there was a link between the decline in immunisation and recent outbreaks of measles and diphtheria in the province, as lower vaccine coverage weakened herd immunity and made outbreaks more likely.
“Less than satisfactory immunisation coverage in infants is more directly related to the measles outbreak. Diphtheria has been affecting mainly adults, and this is due to low vaccination rates in older children (at age six and age 12),” he said.
There were 282 laboratory-confirmed cases of measles in the Western Cape between 1 January and 8 November 2025, with most cases in the Cape Town metro. No deaths had been reported.
Between 1 January 2024 and 2 November 2025, South Africa recorded 81 confirmed cases of respiratory diphtheria, one probable case and 56 asymptomatic carriers of toxigenic C. diphtheriae identified through contact tracing – a total of 138 individuals affected nationally, said Mahomed.
“The Western Cape accounted for 73% of cases (101 out of 137), including 57 respiratory diphtheria cases and 44 carriers,” he added.
Most confirmed cases were young adults over 20, while 25 cases were children under 15. There were 10 deaths in the Western Cape, including three children under 15.
In November, the Western Cape Department of Health & Wellness – along with all public health facilities countrywide – offered free catch-up immunisations, school and preschool outreaches, vitamin A supplementation and health education as part of a National Immunisation Catch-up Drive.
“The main focus is to find children who have never been vaccinated or have missed vaccinations at any age, not just infants,” Mahomed said.
In the longer term, Western Cape Health was aiming to strengthen its promotion of vaccines using platforms like social media to improve public confidence in vaccines and combat misinformation, he told Daily Maverick.
Improving confidence in the healthcare system
A key reason behind under-immunisation was parents’ loss of confidence in the healthcare system because of vaccine outages at facilities, according to Madhi.
“It’s a cost to the parent, to be taking time off work… finding transport. It’s an inconvenience… to take children to be vaccinated only to end up at the clinic and be told to come back at a later stage. It diminishes confidence in the public health system, but also obviously undermines the efforts of the immunisation programme.
“If there’s proper stock management and proper budgeting on the part of the provinces, you shouldn’t be having vaccine outages.”
Madhi said the factors behind under-immunisation could differ between communities. But as long as South Africa was not meeting the 95% immunisation coverage target, he said, there would continue to be outbreaks of vaccine-preventable diseases.
His suggestions for improving vaccine coverage included:
- Employing immunisation managers in provinces’ health structures;
- Integrating immunisation services with primary healthcare; and
- Ensuring more robust data collection at a facility and sub-district level through a vaccine register.
“There are issues related to budgets. In some provinces they end up not having all of the vaccines for children – mainly those that cost more. What the provinces seem to be doing is when they’re facing budgetary constraints, they become selective about which vaccines they actually procure, so children don’t get all of the shots,” said Madhi.
He urged the ring-fencing of funds for vaccine procurement, adding that these could be acquired at a national level and distributed to provinces to ensure funds for immunisation were not redirected.
Vaccine coverage in children was just a starting point, rather than the end, he said, adding that there was increased focus on pregnant women in countries’ immunisation responses.
He pushed for some vaccines to be targeted at adults to reduce admissions to hospital and preventable diseases in older populations.
The National Department of Health had not responded to requests for comment by the time of publishing.
See more from MedicalBrief archives:
Infant immunisations drop in Western Cape
Waning immunity, low jab rate, trigger SA diphtheria cases
WHO, Unicef flag worst decline in childhood immunisations in 30 years