There has been unprecedented progress in vaccine development against SARS-CoV-2, the virus that causes COVID-19. However, given the huge demand for a limited supply of efficacious vaccines, there has been global, regional and local outcry regarding the lack of access to vaccines and the equity of distribution. Over 319 million vaccine doses have been administered (at the time of writing), with the majority in high-income countries.1,2 In contrast, by mid-January 2021, Guinea was the sole low-income country to have administered vaccines, but to only 25 individuals.3 Early in February 2021, South Africa (SA) received one million doses of the AstraZeneca vaccine; however, shortly thereafter, data reflected disappointing results on the efficacy of this vaccine on the predominant strain in the country (the 501Y.V2 variant), prompting the country to reverse the decision to utilise these in the national roll-out. With ample agility, on 17 February 2021 SA launched an early-access programme through a phase 3B open-label study using the Johnson & Johnson vaccine candidate, rapidly deploying the first tranche of 80 000 vaccines within hours of the vaccines touching down on SA soil. Despite global surveillance efforts and the promise of numerous vaccine candidates, ongoing public health challenges to fully understand the impact of the COVID-19 pandemic remain a major concern. COVID-19 testing data have become a key metric that informs public health decision-making. However, epidemiological indicators can be flawed, as they may be influenced by insufficient testing capacity, limited access to healthcare facilities and testing bias, as individuals with severe symptoms are more likely to be tested than asymptomatic individuals.4,5 While African countries have reported low COVID-19 case numbers relative to other regions, this may not be indicative of low prevalence or spread containment, but rather low surveillance.6