Nearly a third of South African children are not vaccinated, placing them at risk of catching serious diseases. This is, in part, because parents are hesitant to immunise, believing that vaccines are dangerous, says Charles Wiysonge a member of the African Task Force on Immunisation of the World Health Organisation.
And although the country has more resources than many others on the continent, South Africa has lower vaccine coverage rates than the estimated average for Africa where 25% of children are thought to have not received their required immunisations, according to the World Health Organisation (WHO) and the United Nation's Children's Fund.
Wiysonge says while a lack of access to vaccines in the public sector contribute to this low rate, a "new phenomenon is emerging in well-served urban settings in South Africa known as 'vaccine hesitancy'", which prevents or delays parents from immunising their children. "The anti-vaccination movement is growing in South Africa and we should be very concerned."
A 2009 study published in the medical journal BMC Public Health identified "anti-immunisation rumours and resistance from parents" as one of the "key challenges" facing the country's vaccination programme.
"Immunisation is one of the most successful and cost-effective means to save children's lives and help them grow into healthy adults," says Wiysonge.
"In addition to benefits to the individual who receives the vaccine, immunisation helps protect his or her family members, friends and the community at large."
But last year the South African Medical Journal published a study which proved for the first time that there are a growing number of anti-vaccination lobbying websites originating from South Africa. The study, conducted between 2011 and 2013 found hundreds of website pages making claims that vaccines were either ineffective or dangerous - causing life-long debilitating diseases such as multiple sclerosis or autism. Many of these websites also contained advertisements for natural alternatives and were authored by concerned parents, people claiming to be medical professionals and companies promoting natural health products.
The study found that two thirds of the anti-vaccination claims on South African websites originated from the United States.
For example the website naturalnews.com repeatedly describes immunisation as a "holocaust" intended to "harm children everywhere".
Closing the immunisation gapThe WHO estimates that more than three million deaths globally are prevented each year by vaccines – saving lives from often deadly and preventable diseases such as measles, whooping cough (pertussis), tetanus, diphtheria and forms of pneumonia.
Vaccine hesitancy has caused controversy in many developed countries such as the United States (US) and the United Kingdom (UK) for years but has only recently become a local problem, according to Shabir Madhi, head of the National Institute for Communicable Diseases.
Immunisations are mandatory in the public health sector in South Africa and the department of basic education also requires parents or guardians to provide proof that a child has been vaccinated for them to be enrolled in schools.
Madhi says it's mainly a problem in "certain high-income communities" among people who use private healthcare services.
Rise of the anti-vaccine movementThe anti-vaccine stance began with a 1998 publication of a study in the reputable medical journal The Lancet, which stated that the measles, mumps and rubella vaccine is linked to children developing autism (a range of neuro-developmental disorders affecting a person's ability to function, the US's Centre for Disease Control and Prevention).
This study was later retracted by the journal and countless research papers have discredited the link and provided extensive proof of the safety and efficacy of this particular vaccine and others.
Despite the evidence, 9% of Americans believe this vaccine is unsafe, according to the Pew Research Centre, a fact checking scientific organisation in the US.
After the publication of The Lancet study, vaccination rates in the UK fell from 92% to 80% and, decades later, have only recently begun to rise above 90%.
More recently, claims that the human papilloma virus vaccine, which can prevent cervical cancer, among other cancers, causes two debilitating syndromes led to a "detailed scientific review" by London's European Medicines Agency (EMA).
Published in 2015, the review disproves any link and says "therefore, there is no reason to change the way the vaccines are used or amend the current product information".
In response to the EMA's review, Andy Gray, from the University of KwaZulu-Natal's pharmacy department, laments that "as always … this news will be welcomed by health authorities, and immediately discounted and ignored by anti-vaxxers".
Wiysonge says "it goes without saying" that if the South African public increasingly subscribe to anti-vaccine sentiments it "will lead to vaccine-preventable disease and deaths". "Can you imagine that in this day and age, children are still getting measles and dying from the disease in Europe? All because some parents choose not to vaccinate their children."
Vaccines save lives – here's proofThe WHO and South Africa's department of health say:
• Between 2000 and 2015, there was an 80% reduction in measles deaths in young children as a result of increased immunisation globally. The number of deaths dropped from half a million a year to 100 000 last year;
• From 2000 to 2010, an estimated 2.5-million deaths were prevented annually among children younger than five through the use of measles, polio and diphtheria-tetanus-pertussis vaccines;
• Polio vaccination programmes have reduced the number of countries with the diseases from 20 to four;
• In South Africa, since the 2009 introduction of a pneumococcal vaccine, there has been a 70% reduction in pneumonia and meningitis cases among children under two; and
• Another vaccine was introduced into the South African immunisation programme in 2009 to prevent diarrhoeal disease. By 2014, 40% fewer children under the age of five were being admitted to hospital with severe diarrhoea.
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