Vaccines represent one of humanity’s most significant public health achievements, preventing millions of deaths and debilitating illnesses worldwide. While their importance has long been recognised, the COVID-19 pandemic brought a newfound, heightened awareness and global discussion around vaccines. In South Africa, vaccines play a particularly critical role in protecting the population. However, like many countries, South Africa faces both strong support for vaccination and persistent challenges, including hesitancy.

We spoke with Prof Shabir Madhi, Professor of Vaccinology at Wits, Dean of the Faculty of Health Sciences, and a world-renowned expert on vaccines, to explore the benefits and challenges of vaccination.

The benefits

Halting disease spread: Vaccines have dramatically reduced the incidence of contagious diseases such as measles, polio, and whooping cough. Prof Madhi highlights this, noting how unvaccinated children are “less protected against what can be life-threatening diseases.”  In recent years, several outbreaks of life-threatening, vaccine-preventable diseases, including measles, mumps, and whooping cough, occurred in the country. Most of the cases were children under five who hadn’t been vaccinated. Complications of these diseases include encephalitis, blindness, diarrhoea, heart, kidney, and nerve damage, and infertility.

Creating herd immunity: When enough people are vaccinated, it establishes “herd immunity,” making it difficult for diseases to spread. This crucial protection extends to vulnerable groups unable to be vaccinated, such as infants, the elderly, and those with compromised immune systems.

Relieving healthcare burdens: Fewer severe illnesses mean less strain on hospitals.

Boosting economic stability: Healthy individuals contribute to the workforce and education system, fostering economic growth and reducing financial strain from medical bills.

Eradicating diseases: South Africa has contributed to the near eradication of diseases like polio and the complete elimination of smallpox, demonstrating the power of collective vaccination efforts.

Challenges

Despite these clear benefits, achieving widespread vaccination in South Africa faces hurdles such as:

Misinformation and distrust: While many are willing to vaccinate, hesitancy persists due to fear of rare side effects, lack of trust stemming from past negative experiences with authorities, personal beliefs, or simply not fully understanding vaccine mechanisms. As Professor Madhi puts it, “We’re selling ourselves short by not ensuring that we’re doing everything possible to actually get children to be vaccinated.”

Logistical complexities: Reaching every individual, especially in remote areas, is challenging due to maintaining cold chains for vaccines and ensuring sufficient trained vaccinators.

Supply chain issues: South Africa, like many African nations, has faced reliance on external manufacturers for vaccine supply.

Competing health priorities: The country’s battle against other widespread health issues like HIV/AIDS and TB can divert resources and attention from routine vaccination programs.

Key vaccines

South Africa’s free government vaccination programme for children covers crucial diseases, while adult vaccination depends on age, health, and travel.

  • For children (routine shots): These include BCG (for TB), Polio, Hexavalent (Diphtheria, Tetanus, Whooping Cough, Polio, Hib, Hepatitis B), Rotavirus (RV), Pneumococcal, Measles, Td boosters, and HPV for girls.
  • For Adults: Recommended vaccines include annual flu shots, Tdap boosters, MMR, Pneumococcal (especially over 65), Hepatitis B for high-risk individuals, Shingles, and various travel shots. Prof Madhi emphasises ‘Maternal Vaccines’ for pregnant women as a ‘three-in-one’ deal, protecting mother, pregnancy, and crucially, the vulnerable newborn against “invisible killers” like the respiratory syncytial virus or RSV.

Vaccination equals a healthier future

Vaccines are vital to public health in South Africa. “They hold huge potential to make a big difference over a short period… not on an individual level, but at a community level,” Prof Madhi concludes.

While we’ve made significant strides, overcoming misinformation and distrust requires ongoing commitment to education, transparency, and accessibility. For a healthier South Africa, the message is clear: Don’t Hesitate, Vaccinate!