South Africa is considered a middle power in international affairs, maintaining significant regional influence as a member of international organisations such as the Commonwealth of Nations and the Group of Twenty (G20). It has been classified by the World Bank as a newly industrialised country and has the third-largest economy in Africa, ranking 109th on the Human Development Index. Like many African countries, South Africa has a young population, constituting 37% of its total population (19.1 million). However, young people struggle in the labour market, with unemployment reaching 63.9% for youth aged 15-24 and 42% for those aged 25-42 in 2022. The national rate stands at 34.5%. Although graduate unemployment remains low, the general unemployment rate, irrespective of education, remains high.

South Africa’s response to the COVID-19 outbreak has been described as a standout within the continent. Its first cases were confirmed in March 2022, and both local and national channels were utilised to attempt to provide information to reduce the spread of the virus. The State’s initial response was to impose a nationwide lockdown and put in place comprehensive local public health response mechanisms. The President announced a state of disaster in line with the Disaster Management Act and formulated a risk-adjusted strategy with five levels, which determined the intensity of transmission within the country, with the fifth representing the highest form of local-to-local transmission.

Malawi is landlocked in Southern Africa, sharing its borders with Mozambique, Zambia, and Tanzania. Despite making significant economic and structural reforms to sustain economic growth, it remains one of the least developed countries, ranking 166 out of 184 in 2019 on the UNDP Human Development Index. As of 2022, Malawi has a population of about 19.9 million people. Women constitute 50.7% of the population, while men make up 47.3% of the population. About 18.0% of people live in urban areas, as against 82% living in rural areas; almost half (50.7%) live below the poverty line, and 70.9% live on less than US$1.90 a day. The population growth rate is about 3.1%, and projections estimate that the population will reach 43 million by 2050.

Malawi announced a nationwide emergency in response to the global COVID-19 outbreak in March 2022 and recorded its first confirmed coronavirus case on 2 April 2020. Malawi’s pandemic response was multisectoral and executed through 15 thematic working groups named ‘bunches. The response, guided by these working groups, identified vital policies, including an international travel ban, school closures at all levels, cancellation of public events, decongesting workplaces and public transport, mandatory face coverings, and a testing policy covering symptomatic people. Supportive interventions included risk communication and community engagement in multiple languages and over various mediums, efforts to improve access to water, sanitation, nutrition, and unconditional social-cash transfers for poor urban and rural households.

Zambia is landlocked in the centre of southern Africa, sharing its borders with eight countries (Botswana, Angola, Mozambique, Namibia, Tanzania, Zimbabwe, the Democratic Republic of Congo, and Malawi). Zambia maintains friendly relations with its neighbours through trade and as a member of the Southern African Development Community (SADC) and the Common Market for Eastern and Southern Africa. With a population of about 20.29 million (females represent 50.7% and males 49.3%), Zambia is considered one of the world’s most youthful. Its youth account for over 80% of its population, with 53.4% below 18 and the median age at 17.2. However, the youth contend with various socio-economic challenges like poverty, unemployment, access to education, political instability, and access to skills.

On March 18, 2020, Zambia recorded its first two cases of COVID-19, and by August 2020, the numbers had increased, reaching their peak. The second wave began in December 2020 and peaked in January 2021, with the third wave starting shortly after at the end of May 2021. Before the first case was diagnosed, the government had already shut down businesses and schools and banned public gatherings. A Public Health Act, Chapter 295 of the Laws of Zambia, was invoked to prevent and suppress diseases. The Act made provisions concerning matters affecting public health in Zambia, including prevention and suppression of infectious diseases. Part IV of the Act provided for preventing and suppressing contagious diseases, while Part V made a special provision regarding formidable epidemic diseases. To aid suppression of this virus, containment measures such as social distancing and movement restrictions, bans on all non-essential travel to all countries, and controls on the movement of people and products across borders were enforced by law enforcement agencies.

Burundi is a landlocked country in East Africa, bordered by Rwanda to the north, Tanzania to the east and south, and the Democratic Republic of Congo to the west. As of 2022, the estimated population of Burundi is approximately 12.5 million people. The country has faced significant political and social instability in recent years, including a civil war that lasted from 1993 to 2005. The ongoing political tensions have led to limited economic growth and development, and Burundi is currently one of the poorest countries in the world. In 2019, the country ranked 185 out of 189 on the UNDP Human Development Index. The majority of Burundi’s population lives in rural areas, with around 90% of people engaged in subsistence agriculture. The poverty rate is very high, with an estimated 65% of the population living below the poverty line. Additionally, Burundi has one of the highest population densities in Africa, with an average of 445 people per square kilometre.

The Burundian government initially downplayed the severity of the pandemic and took little action to prevent its spread. President Pierre Nkurunziza, who was in power at the time, publicly dismissed the virus as a “hoax” and encouraged citizens to rely on prayer and traditional medicine to protect themselves. The government also expelled World Health Organisation (WHO) officials in May 2020, accusing them of “interference” in the country’s affairs. Despite these challenges, health officials in Burundi have worked to implement measures to control the spread of the virus. These measures include border closures, mandatory quarantine for travellers, and restrictions on public gatherings. However, there have been reports of limited testing and a lack of personal protective equipment for healthcare workers, which have hindered efforts to contain the virus. As of April 2023, Burundi has reported over 12,000 cases and 400 deaths from COVID-19. However, given the limited testing and healthcare infrastructure in the country, experts believe that the actual number of cases and deaths is likely much higher. The government of the day, has taken a more proactive approach to addressing the pandemic, including securing vaccines for the population and working with international organisations such as the WHO.

Rwanda, officially the Republic of Rwanda, is a landlocked country in the Great Rift Valley of Central Africa, where the African Great Lakes region and Southeast Africa converge. Located a few degrees south of the Equator, Rwanda is bordered by Uganda, Tanzania, Burundi, and the Democratic Republic of the Congo. It is highly elevated, giving it the soubriquet “land of a thousand hills”, with its geography dominated by mountains in the west and savanna to the southeast, with numerous lakes throughout the country. The climate is temperate to subtropical, with two rainy and two dry seasons each year. Rwanda has a population of over 12.6 million living on 26,338 km² (10,169 sq mi) of land. It is the most densely populated mainland African country; among countries larger than 10,000 km², it is the fifth most densely populated country in the world. One million people live in the capital and largest city Kigali.

Rwanda reported the first case of COVID-19 on 14 March 2020, and since then, of 1,466,941 tests performed, 27,211 individuals have been confirmed positive, and 1.3% have succumbed to the disease as of 9 June 2021. Following the WHO declaration of the pandemic, the Government of Rwanda immediately adopted and implemented several public health and social measures aimed at slowing down the spread of the pandemic. These measures included countrywide lockdown, border closure, banning unnecessary travel, prohibiting public gatherings, the use of face masks in public places, the closure of schools, churches and non-essential services, and setting up hand hygiene facilities in all public places. The Rwanda Joint Task Force for COVID-19 was established to coordinate and monitor the implementation of these measures. Pre-existing rapid response teams, including the case management workforce, which were initially set up to tackle the spread of Ebola, are now operational from the lowest level of the Rwanda health structure, i.e., from health centres to the national referral hospitals. Case management and infection control teams as part of the task force are mandated to coordinate the clinical aspects of the disease at all levels of the healthcare system.

The Democratic Republic of Congo (DRC), situated in Central Africa, is the largest country in sub-Saharan Africa (SSA). The DRC currently has over 8 million vaccines; however, less than 10% of these have been administered. Now, 0.3% of the population is fully vaccinated. This can be attributed to barriers to vaccine access, logistical issues, and decreased demand for COVID-19 vaccines. DRC’s socio-economic landscape is one that the World Bank has described as poor. Data from the World Bank Organization defines it as one of the five most impoverished nations in the world, with nearly 62% of its 102 million population living on less than USD2.15 a day. Although endowed with rich natural resources such as cobalt, iron, and extensive rainforest, the wealth has not significantly translated into the lives of the ordinary Congolese. Years of political turmoil, conflict, dictatorships, and authoritarian rule have hurt its people, with much of its population displaced and in a refugee crisis, making the country an ongoing humanitarian crisis.

Healthcare systems in DRC have been negatively impacted (understaffed and underfunded) by the history of conflict and political instability. The public healthcare system in the Democratic Republic of the Congo (DRC) is structured around a 4-level pyramid. Community health centres, where nurses provide primary care, make up the first level. The second category consists of reference medical facilities with generalist physicians. Provincial hospitals, which offer specialised care, make up the third level. University hospitals make up the fourth level. The public health care industry is under the government’s and numerous NGOs’ supervision. On March 10, 2020, COVID-19’s first case in the DRC was found. To stop the spread of the virus, the government immediately implemented an outbreak management and control plan that included several public health measures, such as closing bars, restaurants, and schools. A few days later, a state of emergency was declared, and on March 24, 2020, travel into and out of Kinshasa was restricted. The Gombe commune, the disease’s epicentre at the time, was placed under lockdown on April 6, 2020. As a result, all businesses were forced to close, non-essential travel was prohibited into and out of the commune, and only necessary transit was permitted within the commune. With one of Africa’s lowest vaccination rates, the DRC faces many barriers along the ports-to-arms pathway.