The COVID-19 pandemic has posed substantial ethical challenges for research ethics committees (RECs), which must balance the urgent review of COVID-19 studies with careful assessment of potential risks and benefits. In Africa, these challenges are compounded by historical mistrust of research, concerns about equitable participation in COVID-19 studies, and the need to ensure fair access to treatments and vaccines. In South Africa, the prolonged absence of a National Health Research Ethics Council (NHREC) left RECs without national guidance for much of the pandemic. This study aimed to explore the experiences and perspectives of South African RECs regarding the ethical issues arising from COVID-19 research. We conducted a qualitative descriptive study using in-depth interviews with 21 REC members or chairpersons from seven major academic health institutions in South Africa that actively reviewed COVID-19 research between January and April 2021. Interviews were conducted remotely via Zoom, lasting 60–125 minutes, in English, and guided by a semi-structured interview protocol. Data collection continued until saturation was reached. Audio recordings were transcribed verbatim, supplemented with field notes, and systematically coded line by line. An inductive thematic analysis approach was employed to identify and organize key themes and sub-themes. Analysis revealed five primary themes: the rapidly shifting ethics landscape for research, heightened vulnerability of participants, distinct challenges in obtaining informed consent, difficulties in community engagement during the pandemic, and the intersection of research ethics with public health equity considerations. Each theme encompassed multiple sub-themes. South African REC members reported numerous and complex ethical challenges in reviewing COVID-19 research, with reviewer fatigue and workload pressures emerging as significant concerns. The findings underscore the importance of enhanced ethics education, particularly in informed consent, and the urgent need for national guidance for research ethics during public health emergencies. Additionally, cross-country comparative studies are warranted to enrich understanding of African RECs’ experiences and ethical considerations in pandemic-related research.
