There are 12 childhood vaccines in wide use in South Africa. This guide unpacks what you need to know about each of them.
South Africa provides routine vaccination against polio, tuberculosis, measles, pertussis, diphtheria, tetanus, hepatitis B, Hib, pneumococcal disease, rotavirus, rubella, and HPV for girls. These vaccines are provided free of charge through public clinics and school-based health services.
Routine vaccines are vaccines that are included in South Africa's Expanded Programme on Immunisation (EPI) and should be given to all children in the country unless they have a contraindication. Contraindications are medical reasons to delay or not give certain vaccines. For example, the health department's vaccination guidance notes that patients with primary immune deficiency or known HIV-infection should not be given the BCG vaccine. The BCG vaccine protects infants and children against tuberculosis.
The health department aims to vaccinate at least 90% of eligible children against these diseases, but actual vaccine coverage remains below this target.
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There are several vaccines available in the private sector that are not routinely provided in the public sector. These include vaccines against hepatitis A, mumps, chicken pox, meningococcal disease, and seasonal influenza. The costs of vaccines in the private sector add up quickly - not all of them are cheap.
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Polio
Before vaccines against polio were available and widely used, the highly contagious virus caused paralysis in hundreds of thousands of children per year. But widespread use of polio vaccines has virtually eliminated the disease (unlike smallpox, polio has not yet been fully eliminated due to ongoing gaps in vaccination in some countries). South Africa introduced the polio vaccine in 1963.
All babies born in South Africa should receive an oral polio vaccine shortly after birth, before they are discharged from hospital, and again at six weeks. In addition to the oral vaccine, babies should receive a combination vaccine (a vaccine that protects against more than one pathogen), which includes protection against polio at 6 weeks, 10 weeks, 14 weeks and 18 months.
Tuberculosis
Despite tuberculosis' ancient history, only one vaccine is currently in use globally to protect against TB. This vaccine, known as the BCG vaccine, has been a critical part of South Africa's efforts to combat TB since the 1970s. It provides children with some protection against TB, but unfortunately the protection wanes over time and does not help for adults. This is why several large clinical trials are testing new experimental TB vaccines.
Today all babies born in South Africa - excluding babies with a known immune deficiency or known HIV infection - should be given the BCG vaccine shortly after birth, before they are discharged from hospital. This vaccine is administered via injection in the upper right arm.
Measles
The measles vaccine has prevented more childhood deaths than any other vaccine, accounting for 60% of the 154 million lives saved globally by childhood vaccines since 1974. However, measles remains an ever-present public health threat, rearing back in communities whenever measles vaccination rates drop.
South Africa aims to ensure that 95% of children receive the two-dose measles vaccine by their first birthday. This is the level of coverage required to achieve herd immunity and prevent measles outbreaks.
Concerningly, South Africa has seen a drop in its measles vaccines coverage rates in recent years. Only 76.2% of children had received two doses of the measles vaccine by their first birthday in 2024/25 - down from a high of 85.7% in 2016/2017, according to South Africa's latest District Health Barometer.
All children in South Africa should be vaccinated against measles at 6 and 12 months. Government also offers targeted measles booster vaccines to older children and adults as needed to contain potential measles outbreaks.
Pertussis - Whooping cough
Pertussis, also known as whooping cough, is a highly contagious respiratory illness that can cause severe coughing fits. Complications from pertussis can be deadly. South Africa introduced pertussis vaccination in 1974, the same year the WHO recommended universal use of the pertussis vaccine.
All children in South Africa should be vaccinated against pertussis at 6 weeks, 10 weeks, 14 weeks, 18 months, 6 years, and 12 years. Vaccination against pertussis is administered through combination vaccines that also provide protection against other pathogens.
As of 2024, all pregnant women in South Africa should be vaccinated against pertussis (as part of a combination vaccine also targeting diphtheria and tetanus) between 26 and 34 weeks of pregnancy. This vaccine provides temporary protection against pertussis to infants in their first weeks of life until they are old enough to receive their own vaccines against pertussis (starting at 6 weeks).
Diphtheria
Diphtheria is a contagious bacterial infection that typically affects the throat and nose. Diphtheria can cause a build-up of thick grey tissue in the throat, which makes swallowing and breathing difficult. South Africa has vaccinated against diphtheria since 1974.
All children in South Africa should be vaccinated against diphtheria at 6 weeks, 10 weeks, 14 weeks, 18 months, 6 years and 12 years. Vaccination against diphtheria is administered through combination vaccines that also provides protection against other diseases.
As of 2024, all pregnant women in South Africa should be vaccinated against diphtheria (as part of a combination vaccine also targeting pertussis and tetanus) between 26 and 34 weeks of pregnancy. This vaccine provides temporary protection against diphtheria to infants in their first weeks of life until they are old enough to receive their own vaccines against pertussis (starting at 6 weeks).
Tetanus
Tetanus occurs when the bacteria causing tetanus enters the body through a cut or wound and produces toxins. Tetanus, also known as lockjaw due to the seizing of jaw muscles caused by the infection, can be fatal. South Africa has vaccinated against tetanus since 1974.
All children in South Africa should be vaccinated against tetanus at 6 weeks, 10 weeks, 14 weeks, 18 months, 6 years, and 12 years. Vaccination against tetanus is administered through a combination vaccine that also provides protection against other diseases.
Neonatal tetanus
All pregnant women in South Africa should be vaccinated against tetanus (as part of a combination vaccine also targeting diphtheria and pertussis) between 26 and 34 weeks of pregnancy. This vaccine provides protection against tetanus to infants in their first weeks of life until they are old enough to receive their own vaccines against pertussis (starting at 6 weeks). It also provides protection to pregnant mothers against tetanus.
In 2000, South Africa eliminated neonatal tetanus, tetanus in newborns that is generally caused by use of non-sterile materials to cut and cover the umbilical cord. Elimination status is achieved when less than 1 case of neonatal tetanus occurs for every 1 000 births.
Professor of Vaccinology at the University of the Witwatersrand, Shabir Madhi, told Spotlight in 2025: "Traditionally, we've been vaccinating pregnant women with the tetanus vaccine for decades now, and as of last year [2024], we actually introduced the acellular pertussis, tetanus, diphtheria combination vaccine for pregnant women."
Hepatitis B
Hepatitis B is a viral infection that can be transmitted from a mother to her child during childbirth. Hepatitis B symptoms may not appear until later in life as the infection causes progressive liver damage.
The WHO has recommended universal vaccination against hepatitis B since 1995. South Africa introduced routine vaccination against hepatitis B in the same year.
All children in South Africa should be vaccinated against hepatitis B at 6 weeks, 10 weeks, 14 weeks, and 18 months. Vaccination against hepatitis B is given through a combination vaccine that also provides protection against other illnesses.
Where South Africa's Hepatitis B vaccination approach falls short against the WHO's recommendations is that the country does not yet provide universal hepatitis B birth dose vaccines. In 2016, the WHO recommended that all babies receive a hepatitis B birth dose vaccine within 24 hours of birth.
In 2018, South Africa's National Advisory Group on Immunisation (NAGI) advised the health department to implement targeted birth dose vaccination to infants of mothers with confirmed hepatitis B infection. In 2023, the department implemented targeted birth dose vaccination.
Hepatitis B specialists in the country have called on South Africa's health department to provide universal hepatitis B birth dose vaccination, noting that the vaccine is needed because of South Africa's high burden of hepatitis B and limited screening of pregnant women for hepatitis B, despite policy guidelines recommending that all pregnant women should be screened.
Hib
Haemophilus influenzae type b (Hib) is a bacterial infection that can cause serious illness in children under 5, including pneumonia and meningitis. In 1998, the WHO recommended that countries universally vaccinate against Hib and in 1999, South Africa introduced routine Hib vaccination.
All children in South Africa should be vaccinated against Hib at 6 weeks, 10 weeks, 14 weeks, and 18 months. Vaccination against Hib is administered through a combination vaccine that also provides protection against other illnesses.
Pneumococcal disease
The pneumococcal vaccine protects against infections caused by Streptococcus pneumoniae (pneumococcus), including severe diseases such as pneumonia, meningitis, bloodstream infections, and ear infections.
Pneumococcal conjugate vaccines (PCV) that protect infants and children against pneumococcal disease became available in the early 2000s. In 2007, the WHO recommended that countries include pneumococcal conjugate vaccines into their routine vaccination schedules. In 2009, South Africa added the pneumococcal conjugate vaccine into its routine immunisation schedule.
There are several different versions of pneumococcal conjugate vaccines targeting varying numbers of pneumococcal bacteria serotypes. South Africa's health department previously provided a vaccine targeting 13 serotypes but switched to a vaccine targeting 10 serotypes in 2023, stating the vaccine targeting 10 serotypes "contains the prevalent pneumococcal serotypes in South Africa".
The vaccines targeting 10 and 13 serotypes, which most children in the country receive, should be given at 6 weeks, 14 weeks and 9 months.
In the private sector, children may receive the Synflorix, Prevenar 13, or Vaxneuvance vaccine to protect them against pneumococcal disease. The vaccines, respectively, target 10, 13, and 15 pneumococcal bacteria serotypes.
Synflorix should be given as three doses with each dose costing between R1 086 and R1 372, depending on the dispensing fee charged. Prevenar 13 should be given as three doses with each dose costing between R1 041 and R1 320. Vaxneuvance should be given as three doses with each dose costing between R1 146 and R1 440, depending on the dispensing fee charged.
Rotavirus
Rotavirus is a highly contagious viral infection that can cause severe diarrhoea, vomiting and dehydration. Before rotavirus vaccines became available in 2006, almost half a million children around the world died every year from rotavirus.
In 2009, the WHO recommended universal vaccination of infants against rotavirus. South Africa introduced routine rotavirus vaccination in the same year. All children in South Africa should be vaccinated against rotavirus at 6 and 14 weeks.
HPV
The HPV vaccine protects against the human papillomavirus, which can cause genital warts, cervical cancer, throat cancer, anal and other cancers. Vaccines against HPV became available in 2006. In 2009, The WHO recommended that countries provide universal HPV vaccination for girls.
Since 2014, the department of health has provided HPV vaccination to girls in public schools. In 2024, the department switched from a two-dose to a single-dose HPV vaccination strategy and expanded its HPV vaccination campaign to include private schools. The health department's HPV vaccination campaign, which provides girls one dose of the Cervarix HPV vaccine, targets girls in grade 5 that are 9 years old.
South Africa's health department does not provide free HPV vaccination to boys despite the vaccines effectiveness in preventing certain cancers and genital warts in boys.
Caregivers seeking to vaccinate their boys or wanting to get a second dose of the HPV vaccine for their girls must purchase the HPV vaccine in the private sector.
Cervarix, which is typically given as two doses in the private sector, costs between R1 103 and R1 392 per dose, depending on the dispensing fee charged. Gardasil, which is typically given as two doses, costs between R1 081 and R1 367 per dose.
Gardasil 9, which provides protection against a broader number of HPV types than earlier products, is also available in the private sector. Gardasil 9, which is given over two doses, costs between R2 122 and R2 472 per dose.
Rubella
Rubella, also known as German measles, is a contagious viral infection that can cause serious health problems, particularly in infants. Rubella is spread from person to person through respiratory droplets, as well as from mother to child during pregnancy. Rubella infection often presents with a fever, cold-like symptoms, and a red rash that spreads from the face down.
Rubella infection during pregnancy can result in miscarriage or congenital rubella syndrome. Babies with congenital rubella syndrome are at risk of developing birth defects that can cause blindness and deafness. Rubella infection is one of the leading causes of preventable congenital birth defects globally.
In 2011, the WHO recommended that countries consider adding rubella vaccination to their national vaccination schedules. In 2024, it adopted recommendations for universal rubella vaccination.
In 2022, South Africa's National Advisory Group on Immunization (NAGI) recommended that the health department add rubella vaccination to its national vaccination schedule, which the health department did in 2024.
In the public sector, children are vaccinated against rubella through a combination vaccine that protects against both rubella and measles. This vaccine is given at 6 and 12 months. The rubella vaccine provides life-long immunity, which is particularly important for woman of childbearing age who risk transmitting rubella to their infants.
While South Africa now provides routine immunisation against rubella, girls born before the rubella vaccine was routinely provided still risk transmitting rubella to their infants during pregnancy. The address this, NAGI has recommended that the health department include a third dose of the measles-rubella vaccine to its EPI schedule targeting 9-year-olds for a period of 9 years following the introduction of rubella vaccination in South Africa (until 2034).
According to NAGI, adding a third dose of the measles-rubella vaccine to South Africa's vaccine schedule targeting nine-year olds "will reduce the number of rubella-susceptible women entering childbearing age and will contribute to the elimination of CRS."
Non-routine vaccines: Vaccines not provided through the public sector
Caregivers that can afford private sector health services have access to additional childhood vaccines beyond those routinely provided through the public sector. These include vaccines against RSV, meningococcal disease, mumps, chicken pox, hepatitis A, and seasonal influenza. However, the costs of some vaccines can be prohibitive for some private sector users and medical aids often reject coverage for childhood vaccines, given that they are not legally required to cover their costs.
RSV
Respiratory syncytial virus (RSV) is often confused with the common cold because both conditions are very common and share similar symptoms. However, while RSV generally clears without causing serious illness, it can, in some cases, result in severe disease. Babies are particularly vulnerable to severe RSV disease, including bronchiolitis, an inflammation of the airways that makes breathing difficult and often requires hospitalisation and supplemental oxygen therapy. RSV is the leading cause of hospitalisation among young children in South Africa.
In October 2024, the WHO recommended that countries introduce maternal RSV vaccination. Pregnant women should be given the maternal RSV vaccine in their third trimester of pregnancy, which passes protective immunity against RSV from mother to their babies across the placenta.
There is currently only one maternal RSV vaccine available globally: Pfizers' Abrysvo. This vaccine has been available in South Africa since 2025 and can be purchased in the private sector but is not yet provided to pregnant mothers accessing care through the public sector.
In April 2025, NAGI recommended that the health department make this vaccine available to all pregnant mothers in the country. The health department told Spotlight in July 2025 that it was considering this recommendation but did not respond to a request for clarification for this article as to whether the department would implement NAGI's recommendation and roll out the maternal RSV vaccine in the public sector.
A barrier to broad rollout of the maternal RSV vaccine is its high cost. In the private sector, the single dose vaccine costs between R3 746 and R4 189, depending on the dosage used.
Understanding meningitis
Meningitis is the inflammation of the membranes surrounding the brain and spinal cord. Symptoms can include light sensitivity, neck stiffness, fever, nausea, and confusion. Meningitis is a serious condition that requires urgent medical care, as it can rapidly progress to disability or death.
There is no single vaccine against meningitis, as meningitis can be caused by several different types of bacteria, including, most commonly, Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae type b (Hib), and Streptococcus agalactiae (group B streptococcus). In rare cases, Mycobacterium tuberculosis infection can cause Tuberculous meningitis.
South Africa already provides routine vaccination against pneumococcus and Hib through its childhood vaccination programme. Both vaccines are recommended for universal use by the WHO. The BCG vaccine, which is routinely provided in South Africa to infants at birth, protects against TB meningitis in young children.
No vaccine yet exists against group B streptococcus, although maternal vaccines against group B streptococcus are currently under development and have been identified by the WHO as an important tool needed to prevent meningitis and other severe infections in infants.
Vaccines against meningococcal disease
Meningococcal disease includes meningococcal meningitis and meningococcal sepsis, a severe bloodstream infection. Vaccines against different serogroups of Neisseria meningitis (meningococcus) are available and used in South Africa's private sector but are not provided routinely through South Africa's national immunisation programme. The WHO recommends meningococcal vaccination primarily for countries, populations, or outbreak settings at higher risk of meningococcal disease.
Menactra (serogroups A, C, W, Y)
The Menactra vaccine, which protects against the meningococcal serogroups A, C, W, Y is available in South Africa's private sector. The two-dose vaccine is given at 9 months and 12 months. Each dose costs between R885 and R1 137, depending on the dispensing fee charged.
While the health department does not routinely provide the Menactra vaccination to all children in South Africa, it does procure the vaccine for targeted use. The health department procures this vaccine for public sector use at a cost of R526 per dose. The health department did not respond to a question from Spotlight regarding who is eligible to receive this vaccine through the public health sector.
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However, in February 2026, the Western Cape health department said that while the meningococcal vaccine is "not" part of the national immunisation programme, it "is accessible at tertiary hospitals where it is offered to individuals identified as being at high risk for invasive meningococcal disease or privately when prescribed by a doctor".
Bexsero (serogroup B)
The Bexsero vaccine, which protects against meningococcal serogroup B, only recently became available in South Africa and is only available through the private sector. It costs between R1 493 and R1 850 per dose, depending on the dispensing fee charged. Bexsero, which is typically given as three doses when started in infants, can be given to babies from 2 months and older.
Mumps
Mumps illness, which typically presents as painful swelling around the jaw and cheeks, is caused by the mumps virus. While severe complications of mumps are rare, these complications include hearing loss, paralysis and infertility.
The WHO has not recommended universal vaccination against mumps, but it does recommend "integrating strategies to control mumps with existing high priority goals of measles and rubella control or elimination".
South Africa's public health sector does not vaccinate against mumps. In the private sector, mumps can be vaccinated against using two dose combination vaccines that also protect against measles and rubella. The first dose is given between 12 and 15 months and the second dose is given between 5 and 6 years of age.
Chicken pox - Varicella
Chicken pox is caused by the highly infectious varicella-zoster virus, a type of herpes virus that stays dormant in your body and can cause shingles later in life. Chicken pox is known for its telltale, itchy, blister-like skin rash.
South Africa's public sector does not vaccinate against chicken pox. In the private sector, children can get vaccinated against chicken pox with the two dose Varilrix vaccine, given between 12 and 15 months and again at six years, or the one dose Onvara vaccine, given from 12 months up. The Onvara vaccine costs between R622 and R829, depending on the dispensing fee charged. While the two-dose Varilix vaccine costs between R517 and R705 per dose.
Hepatitis A
Hepatitis A is a viral infection of the liver that is caused by ingesting contaminated food or water or by close contact with someone with the viral illness. Symptoms of hepatitis A include fever, nausea, diarrhoea, dark coloured urine and jaundice. In rare cases, hepatitis A is fatal - causing sudden, acute liver failure.
South Africa's public health sector does not vaccinate against hepatitis A. In the private sector, children may receive a two-dose vaccine against hepatitis A (Avaxim 80 and Havrix Jnr) from 12 months. These vaccines, which are typically given at 12 months and 18 months, range between R250 and R450 per dose.
Seasonal influenza
Annual influenza vaccines can be taken by people 6 months and older to protect themselves from the flu. The national health department does not provide children who access health care from the public sector with annual influenza vaccines.
The health department procures limited stock of the seasonal influenza (around 1 million shots a year) for targeted vaccination of individuals at high-risk of infection and severe disease, including older persons, pregnant women, people who are immunocompromised or with chronic medical conditions, and healthcare workers.
The annual flu vaccine can be bought from private pharmacies, mom and baby clinics, and travel clinics. The single dose vaccine costs between R100 and R200.
COVID-19
COVID-19 is a highly contagious disease caused by the SARS-CoV-2 virus. COVID-19 causes cold and flu like respiratory symptoms. In severe cases, COVID-19 can cause trouble breathing, requiring hospitalisation and oxygen support.
As seen in other countries, the introduction of the COVID-19 vaccine was delayed by global inequities in vaccine distribution as wealthy countries secured most early stock.
In August 2021, COVID-19 vaccines became available for all adults over 18 (prior to this, they were only available to high priority groups including health care workers and the elderly). In October 2021, children and adolescents between the ages of 12 and 17 became eligible to receive the COVID-19 vaccine. In February 2023, children over 5 also became eligible to receive COVID-19 vaccination, however eligibility was limited to children at risk of severe disease. South Africa never extended COVID-19 vaccine eligibility to children under 5.
It is unclear how or where COVID-19 vaccines for eligible children can currently be accessed. The health department did not respond to a request for clarification as to where and how eligible children can access COVID-19 vaccines.
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