- 2026 is set to be another tumultuous year in healthcare.
- The biggest HIV story is likely to be the rollout of a new HIV-prevention jab at around 360 clinics.
- Here are nine stories that Spotlight will keep a close eye on.
1. How will things go with the local rollout of a new HIV-prevention jab?
Given the high rates of HIV in South Africa, the biggest HIV story this year is likely to be the rollout of a new HIV-prevention jab at around 360 (roughly 10%) of South Africa’s public sector clinics.
The jab, which contains the antiretroviral medicine lenacapavir, provides six months of protection against HIV infection at a time.
It could be a game-changer for people who, for whatever reason, struggle to take daily prevention pills. Spotlight will be tracking how and to whom the jab is made available and whether uptake meets expectations.
READ | Motsoaledi outraged at failures highlighted in health ombud’s damning hospital report
As Spotlight reported last year, work is also under way on a new lenacapavir formulation that could provide 12 months of protection per shot.
Spotlight will be scouring journals and conference programmes for new data on this formulation.
2. Will we see better access to weight-loss medicines?
The class of diabetes and weight-loss drugs called GLP1-RAs have taken the world by storm in recent years.
Until recently, drugs like semaglutide (brand names Ozempic or Wegovy) and tirzepatide (brand names Zepbound or Mounjaro) were only available as injections.
The GLP1-RA market is, however, set to be upended by the introduction of some of these medicines in pill form.
Health Minister Aaron Motsoaledi.
The United States Food and Drug Administration (FDA) recently registered a semaglutide pill for use in weight loss.
Another weight-loss pill called orforglipron is also expected to be registered this year.
One big question is when these pills will be registered and made available in South Africa, and at what price.
Another important GLP1-RA development this year will be the expiration of a key patent on semaglutide in India.
This will open the door to generic manufacturers bringing their own versions of semaglutide to market – something that usually leads to substantial price reductions.
Spotlight will be keeping a close eye on how this situation plays out and analysing what the implications are for people in South Africa.
3. Might we see earlier than expected findings from pivotal TB vaccine trials?
The one TB vaccine we have is over 100 years old and only provides limited protection for kids.
Several experimental vaccines are, however, currently being evaluated in late-stage clinical trials.
Arguably, the most notable of these is the M72 vaccine, which is being assessed in a massive phase 3 study, partly conducted in South Africa.
While timelines suggest most of the key TB vaccine studies will not yet have anything to report this year, it is possible that we might see a surprise or two.
Findings are sometimes reported early if it becomes apparent ahead of schedule that a medicine or vaccine is clearly working, or clearly not working, as the case may be.
Whether or not we see findings this year, it is important to start thinking about what a rollout might look like in our health system should results be as good as hoped.
The M72 vaccine had around 50% efficacy in phase 2 trials, so there is reason for optimism.
4. Will we see a concrete plan to address public sector healthcare worker shortages?
Arguably, the most important dynamic in South Africa’s public healthcare system today is that provincial health departments are not employing enough healthcare workers across multiple categories.
One reason for this is simply that budgets have generally shrunk over the last decade – obviously, corruption and mismanagement in several provincial departments have made things even worse.
There was a glimmer of hope in last year’s Budget in which we saw a meaningful upturn in health funding for the first time in years, but that was at best a good first step toward recovery.
As we enter 2026, our understanding is that all nine provinces are still facing severe healthcare worker shortages.
More money for health in the next budget will certainly help, but there is a broader sense that the government doesn’t really have a big picture vision for how to address the crisis.
We do have a 2030 Human Resources for Health Strategy, but as with many such strategies, it seems to have so far gone largely unimplemented.
5. Will enablers be held accountable for corruption such as that at Tembisa Hospital?
One of last year’s big media moments was a Special Investigating Unit (SIU) press conference in which it described the extensive corruption said to have taken place at Tembisa Hospital.
One snag, however, is that while the SIU can recoup funds and take matters to the Special Tribunal, the SIU does not conduct criminal prosecutions – though it can refer matters to the National Prosecuting Authority (NPA) for prosecution.
Whether we will see successful NPA prosecutions relating to the Tembisa Hospital corruption is one of the year’s top questions.
Unfortunately, even when the SIU does sterling work and delivers cases to the NPA on a plate, there is no guarantee that the NPA will do its job.
One depressing example is that of Buthelezi EMS.
Last year, the Special Tribunal ordered Buthelezi EMS (and other companies with similar names) to pay over half a billion rand back to the State.
The SIU also referred a related matter to the NPA in 2024 for prosecution, but Spotlight understands that the NPA has rather mind-bogglingly decided to drop the matter.
6. Which, if any, senior health leaders will lose their jobs this year?
While we won’t have national or provincial elections this year, that is no guarantee that we won’t see any health leaders losing their jobs.
Over the past two decades, there have after all been many examples of people being ousted between elections, be it for purely political reasons or due to corruption scandals.
Possibly the political leader in the health sector at greatest risk is KwaZulu-Natal MEC for Health, Nomagugu Simelane.
Should the currently governing coalition of political parties in the province crumble, as it seems it might do, chances are several new MECs will be deployed, including for the health portfolio.
There is also an outside chance that the country’s top health official, Dr Sandile Buthelezi, director-general for health in the National Department of Health, might be forced to step down.
As reported by AmaBhungane, Buthelezi played a central role in an “irregular” R836-million oxygen procurement process and is also “at the centre of a Hawks investigation into allegations that he solicited a R500 000 bribe”.
Our understanding is that Buthelezi has not been charged and that in the absence of charges, he will stay in the job.
7. What will happen in the landmark NHI court cases?
Despite a new call for dialogue from Finance Minister Enoch Godongwana, chances for a political settlement over National Health Insurance (NHI) remains very low.
The bottom line remains that Health Minister Dr Aaron Motsoaledi refuses to yield an inch on the version of NHI described in the act, and President Cyril Ramaphosa is not willing to force the matter.
Instead, it seems the battle over NHI will this year be fought mainly in the courts.
At our count, there are at least eight cases challenging the NHI Act, parts of the act, or the process resulting in the act.
A first development to look out for is whether or not some of the cases will be combined and heard together.
In case you missed it, last year Spotlight published a two-part series in a bid to pin down the issues on which these court cases are likely to turn (see part 1 and part 2).
While Spotlight will cover the NHI court cases in some depth, we will also try to foster constructive discussions on health reforms on our opinion pages and in our analysis.
In our view, it is dangerously limiting to reduce the debate over South Africa’s healthcare reforms to a simple binary of whether one is for or against NHI.
8. What will be left of the FDA, NIH, and CDC by the end of 2026?
It used to be the case that FDA decisions and health advice from the United States Centres for Disease Control and Prevention (CDC) carried a lot of weight around the world.
In recent months, however, there have been increasing signs of political interference at these institutions and a turn away from evidence-based policymaking.
It seems inevitable that we will see more of the same in 2026 and the credibility of both the CDC and probably also the FDA will be further diminished.
Similarly, the US National Institutes for Health (NIH) has been the world’s leading funder of health research for many years.
But as with the CDC, the work of the NIH has been overly politicised over the last year, and its reputation for rigour and scientific excellence has already been severely degraded.
As with the FDA and CDC, the outlook is bleak.
9. How well will SA and other countries recover from last year’s US aid cuts?
With the dust settling after last year’s severe and abrupt cuts to US healthcare aid and US funding for medical research, the longer-term impacts of those cuts in South Africa and neighbouring countries should become clearer this year.
Among others, we will get the first reliable estimates of key HIV and TB indicators for 2025 (reliable figures for a specific year are typically only published in the subsequent year).
New HIV estimates from the Thembisa mathematical model (Spotlight’s preferred source for HIV estimates) should be out around the middle of the year, while new World Health Organisation (WHO) TB estimates are usually released in November.
Last year, Motsoaledi was widely criticised by activists for underplaying the seriousness of the cuts for South Africa’s HIV response and the scale of specialised services and capacity that was destroyed here.
Eventually, some extra funds were made available in response to the cuts, but it amounted to only a small fraction of what was lost.
The harsh reality is that, in some places, the aftermath of the aid cuts will be felt for years to come.
At an international level, we are also not convinced that a clear roadmap has been set out for building back better after the US withdrawal, though we’d be happy to be proven wrong.
What is clear, though, is that entities like the WHO and UNAIDS are facing unprecedented financial and political pressures – it seems possible that UNAIDS will no longer exist a year from now.
Much reform has already been undertaken at the WHO.
By the end of the year, we should have some sense of whether things have stabilised and whether a coalition of willing nations is truly committed to keeping the WHO and multilateralism in health alive.
*This piece was published by Spotlight – health journalism in the public interest. Sign up for the Spotlight newsletter.
