The coronavirus disease 2019 (COVID-19) first reported in Wuhan, China in December 2019 is a global pandemic that is threatening the health and wellbeing of people worldwide. To date there have been more than 274 million reported cases and 5.3 million deaths. The Omicron variant first documented in the City of Tshwane, Gauteng Province, South Africa on 9 November 2021 led to exponential increases in cases and a sharp rise in hospital admissions. The clinical profile of patients admitted at a large hospital in Tshwane is compared with previous waves. 466 hospital COVID-19 admissions since 14 November 2021 were compared to 3962 admissions since 4 May 2020, prior to the Omicron outbreak. Ninety-eight patient records at peak bed occupancy during the outbreak were reviewed for primary indication for admission, clinical severity, oxygen supplementation level, vaccination and prior COVID-19 infection. Provincial and city-wide daily cases and reported deaths, hospital admissions and excess deaths data were sourced from the National Institute for Communicable Diseases, the National Department of Health and the South African Medical Research Council. For the Omicron and previous waves, deaths and ICU admissions were 4.5% vs 21.3% (p<0.00001), and 1% vs 4.3% (p<0.00001) respectively; length of stay was 4.0 days vs 8.8 days; and mean age was 39 years vs 49,8 years. Admissions in the Omicron wave peaked and declined rapidly with peak bed occupancy at 51% of the highest previous peak during the Delta wave. Sixty two (63%) patients in COVID-19 wards had incidental COVID-19 following a positive SARS-CoV-2 PCR test . Only one third (36) had COVID-19 pneumonia, of which 72% had mild to moderate disease. The remaining 28% required high care or ICU admission. Fewer than half (45%) of patients in COVID-19 wards required oxygen supplementation compared to 99.5% in the first wave. The death rate in the face of an exponential increase in cases during the Omicron wave at the city and provincial levels shows a decoupling of cases and deaths compared to previous waves, corroborating the clinical findings of decreased severity of disease seen in patients admitted to the Steve Biko Academic Hospital. There was decreased severity of COVID-19 disease in the Omicron-driven fourth wave in the City of Tshwane, its first global epicentre.

(1) Background: By October 2022, vaccination rates with at least one dose of a COVID-19 vaccine were low among adolescent girls aged 12–17 (38%) and young women aged 18–34 (45%) in South Africa. This study aimed to measure and identify barriers to and facilitators of motivation to take up, access to, and uptake of COVID-19 vaccines among schoolgoing adolescent girls and young women in two districts in South Africa. (2) Methods: Using the theory of the HIV prevention cascade, we conceptualised the relationship between motivation, access, and uptake of COVID-19 vaccines, and associated barriers. Potential barriers and facilitators were identified using bivariate and multivariable Poisson regression. (3) Results: Among all 2375 participants, access was high (69%), but motivation (49%) and vaccination with at least one COVID-19 vaccine (45%) were lower. Fear of injections was a barrier to vaccine uptake (aRR 0.85 95% CI 0.82–0.88), while being tested for COVID-19 (aRR 2.10 95% CI 1.85–2.38) and believing that the COVID-19 vaccine was safe (aRR 1.31 95% CI 1.18–1.44) and would prevent you from getting very sick (aRR 1.11 95% CI 1.04–1.19) were facilitators. (4) Conclusions: The controversy about the value of vaccinating adolescents and the delay in vaccine rollout for adolescents and young adults may have contributed to fears about the safety and efficacy of COVID-19 vaccines, as well as a lack of motivation to get vaccinated.

First social impact bond for the SAMRC: A novel financing strategy to address the health and social challenges facing adolescent girls and young women in South Africa

Poor mental health, including high levels of stress, is associated with increased risk behaviours and subsequent negative sexual and reproductive health (SRH) outcomes amongst adolescent girls and young women (AGYW). Multilevel mental health stressors reflect various levels of AGYW’s social ecology. We use the social-ecological model as a framework to analyse qualitative data collected through interviews with 51 AGYW in two South African communities characterised by high rates of HIV, early pregnancy and school drop-out. We explore AGYW’s narratives of stressors, coping strategies, and impacts of participating in an intervention on mental well-being. Individual level stressors included low self-esteem, non-heteronormative sexuality, academic stress, and early child-bearing. Interpersonal level stressors included perceived lack of psychosocial support, emotional isolation, communication barriers, peer pressure and bullying. Microlevel stressors at the family or household level included violence, conflict and substance use. Structural level stressors included household food insecurity, economic hardship and gendered inequalities. Coping strategies and resilience enablers at the individual level included maintaining a positive outlook, engaging in self-care activities and spending time with family. Resilience strategies at the interpersonal level included seeking psychosocial and emotional support and talking about feelings, whilst resilience enablers at the macrosystem level included faith communities and access to social workers. Respondents who had participated in the intervention reported improved mental health and well-being due to increased access to psychosocial support. Intersecting factors across individual, interpersonal and structural levels are salient mental health stressors experienced by AGYW. However, some AGYW manage to draw on internal individual resources and external interpersonal and contextual resources to increase resilience and promote coping. Strengthening and bolstering resilience enabling resources available to AGYW, through enhancing AGYW’s competence and self-efficacy in accessing psychosocial support, alongside ensuring that support is available, may be important components to include in future interventions to support AGYW mental wellbeing.

Several tuberculosis (TB) vaccines intended for adults and adolescents are in late-stage clinical trials, but there is limited research into how a new TB vaccine would be introduced. South Africa is at the forefront of TB vaccine research, with involvement in the clinical trials of leading candidates. We sought to understand what the priorities and implementation approach of a potential new TB vaccine in South Africa would be. We conducted semi-structured interviews with 26 stakeholders with different expertise during April and May 2025. Deductive analysis was used to develop a coding framework for thematic content analysis of the data. Stakeholders supported introducing a new TB vaccine in South Africa due to the high disease burden, but feasibility of the roll out was said to depend on vaccine price, cost-effectiveness, efficacy, regulatory approval, and implementation logistics. Efficacy below 50% could raise concerns unless supported by robust modelling demonstrating significant public health impact and cost-effectiveness. Stakeholders preferred a cheaper vaccine course to enable a broad population-based introduction. Priority populations for vaccination included adolescents and adults for a broad population approach, and high-risk groups such as, people living with HIV, healthcare workers and TB household contacts. Whilst a national broad population-based approach was preferred, constraints may result in a phased introduction in high-burden areas and/or targeted vaccination to high-risk groups first. Strong advocacy, detailed cost effectiveness assessments, regulatory alignment, and integrated service delivery were seen as essential to successful implementation. With the introduction of a new TB vaccine potentially as early as 2030, this study provides valuable insights, particularly regarding target populations, that can be utilised for the implementation of a new TB vaccine in South Africa to ensure a successful introduction. Further research is required on vaccine acceptability, TB infection prevalence and modelling to estimate cost effectiveness and budget impact.