Without a Template: South Africa Confronts COVID-19, 2020–2021


News of the outbreak of an unknown virus in Wuhan, China, quickly caught the attention of South African disease experts in December 2019. In the event the virus spread globally, those experts understood that the South African government would find itself face to face with two persistent challenges. First, although an upper-middle-income country, South Africa was also the world’s most unequal. Within the country, household access to health care varied dramatically, as did the vulnerability of livelihoods to economic shocks. Second, there were wide disparities in the levels of readiness across the provinces, districts, and cities that would manage the front lines of any response. During mid-March 2020, as the first South African residents fell ill, the government set up a structure for making policy decisions. It vested responsibility for pandemic response coordination in the security services, implemented stringent restrictions on movement, and used the country’s natural disaster management system to try to align policy with the provinces. The Department of Health, already focused on disease surveillance, testing, and other technical functions, cochaired many of the work streams in those institutions. Nonetheless, during the first wave, poorer provinces and districts struggled to respond effectively, and the national government—with external help—surged assistance to those areas. The investment helped contain the spread of infection and return the country to lower alert levels, but disparities in capacity, illness, and deaths persisted in subsequent waves. The country continued to adapt and performed better on several metrics than did a number of similarly situated counterparts. However, the experience pinpointed the difficulties of boosting local preparedness and addressing underlying inequalities amid a crisis.

Jennifer Widner and Andile Cele drafted this case study based on interviews conducted in South Africa during 2021. Tyler McBrien assisted with some of the background research. Case published March 2024.

public trust
disease control
Focus Area(s)
Pandemic Response
Critical Tasks
Core Challenge
Trust and legitimacy
Country of Reform
South Africa
Case Studies
Jennifer Widner & Andile Cele