Why are some SA children still not vaccinated?

As the African Vaccination Week concludes on Wednesday, 30 April 2025, serious concerns remain about the number of South African children and adolescents not receiving life-saving vaccines.

According to the South African Medical Research Council (SAMRC), efforts to increase vaccine uptake must urgently address the complex reasons behind vaccine hesitancy.

This comes as the continent commemorates African Vaccination Week, observed from 24 April to 30 April, a time that highlights the crucial role of immunisation in preventing disease and saving lives across the continent.

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Deeper issues behind missed vaccinations

Findings from two recent reviews by Cochrane South Africa (Cochrane SA), a unit within the SAMRC, highlight why some parents and caregivers do not vaccinate their children.

According to the unit’s specialist scientist, DR Sara Cooper, the reviews draw on global qualitative studies to identify the personal, social, and systemic barriers to vaccination.

“[Our findings] highlight that effective public health interventions must go beyond simply providing access to vaccines. They must also address the broader context in which vaccine decisions are made,” Cooper said.

While vaccines are widely recognised as one of the most effective tools to prevent serious illness and death in children, the research shows that poor caregivers may be deterred by poor access to health facilities, transport challenges, and unaffordable indirect costs.

“Others experience distrust in vaccination programmes due to broader political concerns or past negative interactions with health systems.

“Cultural and social norms, as well as individual health beliefs, also play a critical role,” Cooper noted.

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HPV vaccine under threat

The research also examined Human Papillomavirus (HPV) vaccination among adolescents.

HPV vaccination, which can prevent cervical cancer and other related diseases, remains an essential but underutilised intervention.

Cooper added that limited knowledge about the vaccine, confusion over decision-making roles in families, and cultural attitudes about adolescence, gender, and sexuality all contribute to low uptake.

“Caregivers and adolescents are also heavily influenced by extended social networks, media messages, and their trust (or lack thereof) in institutions such as schools, governments, and the pharmaceutical industry,” she said.

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No one-size-fits-all solution

Cooper cautioned against one-size-fits-all approaches.

“Some parents in high-income countries may resist vaccination due to a belief in individual choice and risk management that conflicts with public health messaging,” she said.

However, in lower-income areas, social exclusion and unreliable public services foster distrust in health programmes.

The specialist scientist highlighted that information campaigns alone are insufficient.

“The most common interventions only target a narrow range of concerns, mainly around knowledge and risk. Yet the actual reasons for hesitancy are far more diverse and nuanced,” she added.

Cooper concluded by urging policymakers, researchers and programme implementers to engage more deeply with the communities they serve.

“Tailoring vaccination efforts to local realities — including cultural norms, access barriers, and trust dynamics — will lead to more relevant, acceptable, and ultimately more effective interventions.”

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