AI-driven tools are already making a significant impact in early disease detection within the public sector. A prime example is the local deployment of computer-aided detection (CAD) systems for tuberculosis (TB).

These systems analyse digital X-rays with remarkable accuracy, enhancing diagnostic precision, enabling early intervention, and freeing up resources for direct patient care. Deployed in mobile X-ray vans stationed at community clinics or located in underserved communities, they ensure care reaches those who might otherwise go untreated. With TB remaining the world's leading infectious disease killer, this innovation represents a transformative step forward for the country's healthcare system.⁷

Radiology is also ripe for disruption. AI tools are increasingly able to automate tasks, enhance image analysis, and improve clinical decision-making. As with the TB system, CAD systems, for instance, are excellent at spotting abnormalities like tumours across CT, MRI, and PET scans. While these tools have mostly been limited to private healthcare, their potential for broader public health impact is undeniable.

Beyond diagnostics, AI is lightening the load for clinicians by automating admin, improving triage, and enabling real-time monitoring for faster interventions.

Chatbots like the GREAT4Diabetes initiative, currently active in the Western Cape, and the national implementation of MomConnect are all examples of how AI can boost health education and chronic disease management in the public health space. We anticipate that 2025 will see a proliferation of these applications.

Africa has historically been underrepresented in large-scale genomics projects, hindering the continent's ability to harness the benefits of precision medicine.

This is set to change with South Africa's proposed 110,000 Genomes Project, announced in November 2024 by the Department of Science and Innovation.⁴

The project will sequence the genomes of 100,000 randomly selected South Africans and 10,000 individuals with rare diseases. With fewer than 3% of global genomic research participants being of African descent, this initiative has the potential to significantly enhance health outcomes and place South Africa at the forefront of genomics research.

By identifying unique genetic variants and developing population-specific reference genomes, the project will enable personalised treatments for diseases which disproportionately affecting local populations.  2025 is expected to bring significant progress toward the realisation of this initiative.

These advancements come with legal and ethical challenges. While the Protection of Personal Information Act (POPIA) provides robust privacy protections, unresolved issues around data sovereignty, access, and benefit-sharing remain. Additionally, recent amendments to national health research guidelines that appear to permit heritable human genome editing have thrust South Africa into the centre of global ethical debates. We can expect to see a lot more action in this space in 2025.

An example of personalised medicine in action is that of the  HIV drug Efavirenz. Studies regarding Efavirenz have shown that it can cause severe side effects like rashes and depression in African patients, especially when taken at the standard dose.²

Genetic variants in populations of Botswana and Zimbabwe were also found to cause individuals to metabolise the drug differently, leading to toxicity. By adjusting doses based on genetic data, researchers were able to significantly improve treatment outcomes, where a shift to dolutegravir has enhanced patient compliance and viral control.

By 2025, the practical application of this research could make tailored treatment strategies more widely available.

Another promising area is the development of pharmacogenetics-guided treatment algorithms, such as the one being studied for hypertension in black South Africans. The research, which involves 600 patients from Soweto, aims to create guidelines for healthcare professionals to determine the most effective medications and dosages based on genetic factors, as well as other variables like age, body mass, and lifestyle.

As genomic sequencing becomes more affordable and accessible, the infrastructure to support personalised medicine in Africa is growing. However, challenges such as funding, education, and a deeper understanding of the African genome remain significant hurdles.

By unravelling the genetic diversity of African populations, personalised medicine in Africa could become more relevant and effective, improving treatments for diseases such as cancer, HIV, and others specific to African populations. The advancements have significant impacts not only on individual patients but also on our public health programmes, and we will be monitoring this space closely in 2025.

Similarly, a recent white paper from the Wits/Medical Research Council's Developmental Pathways for Health Research Unit (DPHRU) revealed that 25.7% of South Africans are likely depressed, with over a quarter reporting moderate to severe symptoms. The prevalence of mental illness varies across provinces, with higher rates in the Northern Cape, Eastern Cape, Western Cape, Gauteng, and Mpumalanga.⁸

One significant barrier to people seeking help is the stigma surrounding mental health, particularly in black communities.

While workplace mental health initiatives and destigmatisation efforts are helping to expand access to care, digital apps and virtual therapy tools may have a significant impact in 2025.

The global mHealth market, expected to surpass $269 billion by 2032, is transforming mental healthcare delivery through mobile health solutions, which allow individuals to track health and manage well-being conveniently, especially as busy lifestyles and preferences for minimal in-person visits grow.

Emerging technologies, such as AI chatbots and virtual reality (VR) therapy sessions, are reshaping how mental health services are delivered. Patients have reported that virtual therapy, whether via an immersive VR or AR environment, helps create a sense of presence and engagement, even remotely.

The chatbots offer 24/7 support for those experiencing stress, anxiety, or depression, with studies showing a 64% greater reduction in depression symptoms for users compared to those who don't use these tools.  On the clinician side, automated systems for risk assessment are also being developed, which will enable clinicians to focus more on direct patient care.

While these innovations hold great promise for tackling stigma, addressing resource shortages, and improving accessibility, the rapid growth of consumer apps offering therapeutic services has created a "Wild West" landscape in mental health technology. Calls for stricter regulation are growing, and as we look to 2025, ethical and legal challenges surrounding these technologies are expected to remain a key focus in the mental health space.

Wearables are now available to monitor vital signs like blood glucose levels, oxygen saturation, and heart rate, empowering users to proactively manage health while providing doctors with continuous data for personalised care.

This capability is particularly beneficial in managing chronic conditions like diabetes and hypertension. However, adoption isn't without challenges: the accuracy of consumer-grade devices, battery limitations, and usability issues for older populations remain concerns. The future of wearables will hinge on addressing these pitfalls.

Enhanced data quality, interoperability across devices, and equitable access are crucial for sustained adoption. Integrating artificial intelligence with wearables promises to overcome data overload by identifying meaningful trends and supporting clinical decision-making.

Beyond individual care, wearables appear to offer the potential to reduce healthcare inequities. For instance, they could revolutionise maternal health, where 80% of morbidity cases are preventable, or facilitate broader participation in clinical trials among underserved populations.

With the big health insurers' Discovery, and more recently, Momentum Health driving the adoption of these technologies in an effort to reduce healthcare costs through the promotion of healthy lifestyles and early disease detection, there is no doubt that 2025 will see exponential growth in the adoption of wearables in South Africa.

In 2024, significant progress was made in the HIV space, with lenacapavir—a novel twice-yearly injectable —being named Science's Breakthrough of the Year 2024 for its transformative potential in HIV management. In October, Gilead Sciences, the developer of lenacapavir, announced its intention to work with the South African government to expedite the local registration of this groundbreaking product.

South Africa's 95-81-91 treatment targets were met by the end of 2023: 95% of people with HIV knew their status, 81% of those with a positive status were on ART, and 91% achieved viral suppression. For 2025, these targets have been raised to 95-95-95. Whether this is achievable and whether it will help meet the UN Sustainable Development goal of a 90% reduction in new HIV infections by 2030 remains to be seen.

At the same time, the WHO released its report in October 2024, indicating that TB is once again the world's top infectious disease killer. We can expect to see increased activity in including coordinated, multisectoral action to tackle these broad issues and substantial investments in TB research, including vaccine development.   

Antimicrobial resistance (AMR) will continue to be a grave concern, not only for sub-Saharan Africa but for the entire continent.Globally, drug-resistant infections currently claim around 700,000 lives annually, and this figure is projected to rise to 10 million by 2050 if left unchecked, with Africa potentially accounting for 4.5 million of those deaths.

With that in mind, we predict 2025 will be the year that vaccine development takes centre stage for the prevention of infectious diseases and the reduction of AMR.

In line with the World Health Organization's October report, which highlighted the importance of vaccines in preventing AMR and reducing mortality, vaccines targeting just 24 key pathogens could reduce global antibiotic use by 22%, equivalent to 2.5 billion defined daily doses annually—significantly contributing to AMR efforts.

Vaccine equity, however, will remain a contentious issue, and we expect much more debate around this topic in the year ahead.

Finally, the WHO's ongoing efforts to unite countries in pandemic preparedness strategies will continue.
Ensuring health systems in sub-Saharan Africa are better equipped to respond to future health crises and minimise their impact will remain a priority for public health officials.

 

Even as we write this, the Universal Healthcare Access Coalition (UHAC), representing the majority of South Africa's healthcare professional associations, has presented an alternative proposal to President Cyril Ramaphosa. You can read more on that story here.

Adding to the complexity, Business Unity South Africa's feedback on the NHI proposal—expected by Oct 30—remains pending. Meanwhile, the Democratic Alliance (DA) has hinted at plans to propose legislation allowing healthcare professionals to do community service and internships in private hospitals, further murking the waters.

These developments underscore the high stakes and divergent visions surrounding universal healthcare reform. With multiple stakeholders vying for influence, the NHI is poised to dominate public discourse in the coming year, shaping the future of equitable healthcare delivery in South Africa. The path forward will require collaboration, compromise, and a commitment to addressing the pressing needs of the country's healthcare system.