Sanofi and UNICEF are targeting childhood immunisation gaps in three Eastern Cape districts as South Africa confronts a sharp decline in children receiving routine vaccines.
The new Immunisation for Every Child programme will operate in OR Tambo, Alfred Nzo and Amathole, focusing particularly on children who have received no routine vaccines or have started but not completed their vaccination schedules.
Running from July 2026 to March 2027, the initiative will work alongside the National Department of Health and Eastern Cape Department of Health to strengthen existing immunisation services rather than create a parallel system.
The intervention comes amid concerning national immunisation figures.
According to the latest World Health Organization and UNICEF estimates cited by the partners, coverage for the first dose of a DTP-containing vaccine in South Africa declined from 87% in 2019 to 67% in 2025.
Third-dose coverage fell from 85% to 65% over the same period.
This means approximately one in three infants may not have received their first routine DTP-containing vaccine in 2025, with an even greater proportion potentially not completing the three-dose course.
WHO and UNICEF note that the figures rely largely on administrative data and may not capture every immunisation provided through the private healthcare sector.
Finding children who have been missed
Rather than waiting for children to arrive at healthcare facilities, the programme will help health teams identify where vaccination gaps exist and actively respond.
Local immunisation data will be used to identify low-coverage communities, track children who have missed appointments and determine where services are failing to reach families.
“Every child should have access to routine vaccines, regardless of where they live or their family’s circumstances,” said Jean-Baptiste Bregeon, Country Lead for Sanofi South Africa.
“This partnership will help local health teams find children who have been missed and build the capacity needed to protect them. It reflects Sanofi’s commitment to improving healthcare access in underserved communities.”
A particular focus will be on zero-dose children, defined by WHO and UNICEF as children who have not received a first DTP-containing vaccine.
Children who have received some vaccinations but have not completed their immunisation schedules will also be targeted.
UNICEF Representative in South Africa Johannes Wedenig said district-level averages do not necessarily reveal where individual communities are being left behind.
“Every child missed by routine immunisation represents a child left unnecessarily vulnerable to preventable disease,” Wedenig said.
“While immunisation coverage varies across South Africa, district averages can mask communities where children are still being missed.”
He said concentrating efforts in OR Tambo, Alfred Nzo and Amathole would enable teams to identify these gaps, understand why children are being missed and strengthen services to reach them.
Health teams receive direct support
The programme will use the WHO’s Reaching Every District (RED) strategy, which targets immunisation coverage of at least 80% in every district and 90% nationally.
RED focuses on five areas: restoring outreach services, supporting and supervising healthcare workers, strengthening links with communities, using data to guide interventions and improving local planning and resource management.
The approach has previously produced significant results across Africa.
According to WHO figures cited by the partners, third-dose DTP coverage across Africa increased from 57% in 2000 to 80% in 2014 during the implementation of RED.
Three RED strategy consultants will now be embedded within the selected Eastern Cape districts to provide practical support and mentoring to district teams and healthcare facilities.
They will assist facilities with microplanning and mapping communities, identifying children who have missed vaccinations and developing targeted outreach with affected communities.
Healthcare worker training, supportive supervision, stakeholder engagement, advocacy and quality-improvement initiatives will operate across provincial, district, facility and community levels.
Building services beyond the programme
The initiative is also intended to strengthen the ability of local health services to continue reaching children after the Sanofi and UNICEF-supported programme ends in March 2027.
This will involve strengthening healthcare worker skills and improving the way facilities use local data to identify where children are being missed.
Working directly with communities will also be used to better understand the practical barriers preventing parents and caregivers from accessing routine immunisation services.
Lessons from OR Tambo, Alfred Nzo and Amathole could ultimately help inform interventions aimed at closing childhood immunisation gaps elsewhere in South Africa.
For the partnership, success will therefore not only be measured by reaching children who have already missed vaccines.
The longer-term objective is to strengthen routine immunisation systems so that fewer children are missed in the first place.
