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Objective The COVID-19 pandemic is a biosecurity threat, and many resource-rich countries are stockpiling and/or making plans to secure supplies of vaccine, therapeutics, and diagnostics for their citizens. We review the products that are being investigated for the prevention, diagnosis, and treatment of COVID-19; discuss the challenges that countries in sub-Saharan Africa may face with access to COVID-19 vaccine, therapeutics, and diagnostics due to the limited capacity to manufacture them in Africa; and make recommendations on actions to mitigate these challenges and ensure health security in sub-Saharan Africa during this unprecedented pandemic and future public-health crises. Main body Sub-Saharan Africa will not be self-reliant for COVID-19 vaccines when they are developed. It can, however, take advantage of existing initiatives aimed at supporting COVID-19 vaccine access to resource-limited settings such as partnership with AstraZeneca, the Coalition for Epidemic Preparedness and Innovation, the Global Alliance for Vaccine and Immunisation, the Serum Institute of India, and the World Health Organization’s COVID-19 Technology Access Pool. Accessing effective COVID-19 therapeutics will also be a major challenge for countries in sub-Saharan Africa, as production of therapeutics is frequently geared towards profitable Western markets and is ill-adapted to sub-Saharan Africa realities. The region can benefit from pooled procurement of COVID-19 therapy by the Africa Centres for Disease Control and Prevention in partnership with the African Union. If the use of convalescent plasma for the treatment of patients who are severely ill is found to be effective, access to the product will be minimally challenging since the region has a pool of recovered patients and human resources that can man supportive laboratories. The region also needs to drive the local development of rapid-test kits and other diagnostics for COVID-19. Conclusion Access to vaccines, therapeutics, and diagnostics for COVID-19 will be a challenge for sub-Saharan Africans. This challenge should be confronted by collaborating with vaccine developers; pooled procurement of COVID-19 therapeutics; and local development of testing and diagnostic materials. The COVID-19 pandemic should be a wake-up call for sub-Saharan Africa to build vaccines, therapeutics, and diagnostics manufacturing capacity as one of the resources needed to address public-health crises.

Diagnostics are critical for preventing COVID-19 transmission, enabling disease management and engagement with care. However, COVID-19 testing uptake remained low in low- and middle- income countries in Sub-Saharan Africa (SSA) during the recent pandemic, due to issues of supply, access and acceptability. Early studies conducted outside of the region provide insight into uptake of COVID-19 testing, however there has been no systematic research within the region. The aim of this scoping review is to investigate factors influencing uptake of COVID-19 testing in different settings across SSA. Inclusion criteria was any study employing qualitative or mixed methodologies, addressing uptake of COVID-19 testing conducted in SSA. MEDLINE, PubMed, Google Scholar, Web of Science, and Africa-Wide Information were searched. Thematic content analysis was conducted across all included articles until saturation was attained. In total 2994 articles were identified and fourteen reviewed. Structural, social, epidemiological, informational, and political elements affected how the public interacted with COVID-19 testing. Coverage was limited by insufficient diagnostic capabilities caused by a shortage of laboratory resources and trained personnel. False information spread through social media led to testing misperceptions and apprehension. Testing hesitancy was ascribed to fear of restrictive measures and the possibility of social harms if positive. Facility-based testing was physically inaccessible and perceived as lacking privacy, whereas self-testing distributed by the community removed lengthy distances and prevented stigma. Perceptions that COVID-19 was not severe and low numbers of confirmed cases in comparison to other settings undermined public urgency for testing. Low testing frequency led to low-rate assumptions, which in turn generated denial and othering narratives. Politicians' acceptance or denial of COVID-19 affected the mobilization of the health system, and their model actions-such as testing openly-promoted public confidence and involvement in interventions. This review emphasizes the necessity of strong political commitments to enhancing health systems for future pandemic preparedness. Response plans should consider contextual elements that affect how people react to interventions and perceive health emergencies. Community-driven self-testing distribution could enhance the uptake of diagnostics through addressing socio-economic constraints impacting facility-delivered testing.

We evaluated the dynamic impacts of three types of human mobilities—provincial inflows, cross-district flows, and within-district flows—on daily reported COVID-19 cases for 2020. Using a structural equation modeling approach, we conducted regressions on dynamic panel datasets. Our findings indicate that these three types of mobility influenced daily new COVID-19 case numbers in distinct and sometimes overlapping ways during the early stages of the epidemic. Within-district flows played a particularly significant role in increasing cases during the spreading stage. During the epidemic stage, we observed a sustained but gradually declining impact of within-district mobility on daily new cases, potentially highlighting the effectiveness of non-pharmaceutical interventions (NPIs). In addition, signs of social distancing fatigue were evident. Our model further shows that the first and most stringent lockdown policy significantly curtailed human mobility, whereas the second, less restrictive lockdown had negligible impact on human mobility.

People living with HIV (PLWH) and people who use drugs are vulnerable populations who may face barriers to accessing health services and may have irregularities in immune function. People with undiagnosed HIV infection may be particularly likely to have compromised immune function. However, research about whether/how HIV status is related to COVID-19-related health outcomes has been equivocal, and research on the predictors of COVID-19-related health service access/uptake has been limited in Sub-Saharan African settings. Among 470 participants of a peer-recruitment-based HIV-testing intervention in KwaZulu-Natal, we examined whether HIV status and/or hard drug use were associated with uptake of COVID-19 testing and vaccination, and whether they moderated the relationship between COVID-19 vaccination status and COVID-19 IgG antibody status. Women were significantly more likely than men to report testing for COVID-19 (OR = 1.84; p = 0.002) and being vaccinated (OR = 1.79; p = 0.002). Neither HIV status nor drug use was associated with likelihood of getting tested or vaccinated. Vaccinated participants (90% of whom obtained vaccines more than 6 months before the study) were significantly more likely to test positive for COVID-19 IgG antibodies (OR = 6.86; p < 0.0005). This relationship held true for subgroups of PLWH and participants with previously undiagnosed/uncontrolled HIV infection, and was not moderated by HIV status or hard drug use. These findings may suggest that both people who use drugs and PLWH were served as well as other people by KwaZulu-Natal’s COVID-19 response. However, gender-based disparities in COVID-19 service uptake suggest that special care should be taken during future COVID-19 outbreaks or other new epidemics to improve access to related healthcare services among men in this region.

Uneven transmission of the SARS-CoV-2 coronavirus has had tragic consequences — but also offers clues for how best to target control measures. Uneven transmission of the SARS-CoV-2 coronavirus has had tragic consequences — but also offers clues for how best to target control measures.

Background Evidence on the impact of COVID-19 and lockdown remains at an early stage. There is limited research about the impact of hard lockdown restrictions on families, specifically how these restrictions impact on women and children’s experiences of domestic violence, including intimate partner violence (IPV) and child abuse in South Africa. We conducted research among men and women in Gauteng province, South Africa to understand their experiences of the COVID-19 national lockdown and its impact and link to women and children’s experiences of domestic violence. Methods We conducted a qualitative study, using social media to recruit men and women who were 18 years and older, living with a spouse and/or children in Gauteng province, South Africa during the lockdown. To collect the data, we conducted telephone interviews, and analyzed data using the thematic approach. Results The lockdown had unprecedented negative economic impacts on families, and exacerbated some of the risk factors for violence against women and children in the home in South Africa. Some women reported experiences of emotional violence. Experiences of physical violence were mostly amongst children. The risk factors for women and children’s experiences of violence in the home differed by socio-economic class. Job losses and reduction in earnings resulted to food insecurity which was a key driver of violence in most low socio-economic status (SES) families. Confinement in the home with spouses was an unfamiliar and difficult experience, associated with conflict and perpetration of violence by men in high SES families. Participants across socio-economic groups reported high levels of stress with limited psychosocial support available during the lockdown. Conclusions Our finding showing a link between low-socio-economic status and increased risk for domestic violence during the lockdown in South Africa suggests the need for socio-economic interventions to mitigate these risks. Structural and social relief measures need to be strengthened to reduce the loss of jobs and income and to address food insecurity during pandemics. Psychosocial support should be provided to men and women to mitigate the mental health impacts of the pandemics and lockdown.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new strain of virus in the Coronavirus family that has not been previously identified. Since SARS-CoV-2 is a new virus, everyone is at risk of catching the Coronavirus disease 2019 (Covid-19). No one has immunity to the virus. Despite this, misconceptions about specific groups of people who are immune to Covid-19 emerged with the onset of the pandemic. This paper explores South African communities’ misconceptions about who is most vulnerable to Covid-19. A rapid qualitative assessment was conducted remotely in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Recruitment of study participants took place through established relationships with civil society organizations and contacts made by researchers. In total, 60 key informant interviews and one focus group discussion was conducted. Atlas.ti.8 Windows was used to facilitate qualitative data analysis. The qualitative data was coded, and thematic analysis used to identify themes. The results show a high level of awareness and knowledge of the transmission and prevention of SARS-CoV-2. Qualitative data revealed that there is awareness of elderly people and those with immunocompromised conditions being more vulnerable to catching Covid-19. However, misconceptions of being protected against the virus or having low or no risk were also evident in the data. We found that false information circulated on social media not only instigated confusion, fear and panic, but also contributed to the construction of misconceptions, othering and stigmatizing responses to Covid-19. The study findings bring attention to the importance of developing communication materials adapted to specific communities to help reduce misconceptions, othering and stigmatization around Covid-19.

Globally, as of December 2023, over 700 million cases of COVID-19 were confirmed since the initial outbreak late in 2019, claiming around 7 million lives and fuelling widespread fear and anxiety. However, prospective patient-data are unavailable to assess individuals' perceptions of risk of severe COVID-19 illness, which may imply actual disease severity and inform risk perception for future epidemics. We surveyed 1701 adults about their concern for severe COVID-19 disease using a population-based survey of rural South Africans. The initial telephonic survey was conducted between August-October 2020 with a follow-up survey conducted between August-October 2021. Multinomial logistic regression was used to investigate predictors of perceived COVID-19 illness severity (low, medium, or high) controlling for measured confounders. The prevalence of concern for COVID-19 illness severity in 2020 was 28.7% low, 26.8% moderate and 44.5% severe, with corresponding levels in 2021 of 42%, 31.8% and 29.2%, respectively. Although older age was associated with a lower odds of COVID-19 concern [50-59 years (aOR=0.54, 95% CI: 0.38-0.75)], [≥60 years (aOR=0.41,95% CI: 0.41-0.57)], adults having ≥1 chronic conditions (aOR=1.38,1.00-1.89) or residing outside of the study community (aOR=1.29,1.01-1.65) were more likely to experience moderate and high concern for illness severity, respectively. Understanding presumptive COVID-19 disease severity may help disentangle various underlying mechanisms behind personal risk assessment. This may inform current thinking and practice of public health emergency medicine in managing emerging and re-emerging respiratory diseases with pandemic potential such as hPMV.

The impact that COVID-19 had on individuals globally has been immense. Our study aims to determine if the various COVID-19 related beliefs (information seeking; invulnerability; disruption; health importance and response effectiveness) are predictors of perceived stress and if self-efficacy acts as a mediator in reducing perceived COVID-19 related stress. From a large sample of 23,629, data were assessed using validated multi-item measures for seven COVID-19 related beliefs, self-efficacy and perceived stress. After conducting a series of tests and checks via Confirmatory Factor Analyses, linear modelling and mediation analyses with bootstrapping were applied to test direct and mediation hypotheses. It is found that stress perception is most strongly affected by self-efficacy and perceived disruption. Except for information seeking, which positively affected perceived stress, self-efficacy partially mediates all other COVID-19 related beliefs (perceptions of disruption, health importance and response effectiveness) in conjunction with their direct effects. Only perceived invulnerability elicited opposite effects on stress, increasing stress directly but decreasing stress indirectly by increasing self-efficacy. This finding gives reason to believe that individuals may disclose that they are less vulnerable to COVID-19, fostering their self-efficacy, but still accept that stressing factors such as economic and social consequences apply. Overall, reinforcing self-efficacy was carved out as the most important resilience factor against perceiving high levels of stress. On this basis, implications for research and practice are provided.