Foreword: Preparedness and response to SARS-CoV-2 in South Africa Foreword

The World Health Organization's (WHO) China Country Office was informed of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China on the 31st of December 2019. On 7 January 2020, the causative pathogen was identified as the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and on 11th of March 2020, the WHO declared a global pandemic. This paper serves as an introduction to a series of research articles which consider South Africa's preparedness and response to SARS-CoV-2.

Governing a pandemic: A case study of South Africa?s coordination and management structures used to respond to the COVID-19 pandemic

During a public health emergency, coordination and management are essential for ensuring timeous, decisive, and harmonised leadership. In this paper, the governance structures utilised in South Africa (SA) during the COVID-19 pandemic are recorded and the key strengths and weaknesses of response in the country are discussed. A qualitative methodology is used for the case study and comprises insights from stakeholders who were at the forefront of SA???s response as well as from documentation that was used to guide the response. Structured, transparent, science-based and agile coordination and management systems are necessary to gain the public???s trust during a public health emergency. This case study contributes to the literature on governing a pandemic and shares lessons learned from the COVID-19 response. The lessons learned by the stakeholders within the SA governance structures can be leveraged in future public health emergencies within SA and other low-and middle-income countries.

Recovery and transforming the South African health system

The COVID-19 pandemic has devastated lives and livelihoods globally and in South Africa (SA). The SA government has been lauded for its swift response to the pandemic, in March 2020 and subsequently. Many routinely provided health services were severely disrupted and there is an urgent need to recover to 2019 levels at least. In this paper, the lessons from the COVID-19 response are discussed and proposals for transformation of the SA health system are considered.

Leveraging epidemiology as a decision support tool during the COVID-19 epidemic in South Africa.

By May 2021, South Africa (SA) had experienced two 'waves' of COVID-19 infections, with an initial peak of infections reached in July 2020, followed by a larger peak of infections in January 2021. Public health decisions rely on accurate and timely disease surveillance and epidemiological analyses, and accessibility of data at all levels of government is critical to inform stakeholders to respond effectively. In this paper, we describe the adaptation, development and operation of epidemiological surveillance and modelling systems in SA in response to the COVID-19 epidemic, including data systems for monitoring laboratory-confirmed COVID-19 cases, hospitalisations, mortality and recoveries at a national and provincial level, and how these systems were used to inform modelling projections and public health decisions. Detailed descriptions on the characteristics and completeness of individual datasets are not provided in this paper. Rapid development of robust data systems was necessary to support the response to the SA COVID-19 epidemic. These systems produced data streams that were used in decision-making at all levels of government. While much progress was made in producing epidemiological data, challenges remain to be overcome to address gaps to better prepare for future waves of COVID-19 and other health emergencies.

Eliminating malaria from the margins of transmission in southern Africa through the elimination 8 initiative. (Special issue on malaria in Southern Africa.)

Four southern Africa countries, namely, Botswana, Eswatini, Namibia and South Africa, were identified by the World Health Organization as having the potential to eliminate malaria in the near future. However, the extreme interconnectedness of southern African countries facilitates the constant movement of malaria parasites across country-borders, predominately from higher-burden "source" countries to lower-burden "sink" countries, reinforcing the notion that malaria elimination in any southern African country would not be possible without regional cooperation and collaboration. The Elimination 8 initiative (E8) was therefore, created by Health Ministers from eight countries (Angola, Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia and Zimbabwe) to coordinate the implementation of a regional malaria elimination strategy. The E8 supported the implementation of five cross-border malaria control initiatives and the deployment of malaria health units at strategic points along shared borders. These units have contributed to a 30% and 46% reduction in malaria incidence and mortality, respectively, in the E8 border regions. The Situation Room, a novel data sharing platform developed and supported by the E8, has allowed for the early detection of and prompt response to malaria outbreaks. This platform played a vital role in identifying resources gaps due to the COVID-19 pandemic. Despite advancing the elimination agenda, the E8 region faces challenges which include, significant increases in malaria in certain member states, limited domestic funding and health system bottlenecks. These must be urgently addressed if the gains made through the E8 are to be sustained and malaria elimination is to be achieved across southern Africa.

Implementing malaria control in South Africa, Eswatini and southern Mozambique during the COVID-19 pandemic

The COVID-19 pandemic has strained healthcare delivery systems in a number of southern African countries. Despite this, it is imperative that malaria control and elimination activities continue, especially to reduce as far as possible the number and rate of hospitalisations caused by malaria. The implementation of enhanced malaria control/elimination activities in the context of COVID-19 requires measures to protect healthcare workers and the communities they serve. The aim of this review is therefore to present innovative ideas for the timely implementation of malaria control without increasing the risk of COVID-19 to healthcare workers and communities. Specific recommendations for parasite and vector surveillance, diagnosis, case management, mosquito vector control and community outreach and sensitisation are given.