Indigenous knowledge systems and pandemic health resilience.

INTRODUCTION: Indigenous Knowledge Systems (IKS) have played important roles in community-based health responses across the Global South, yet they remain marginalized in formal health policy during global health crises. This study examined how IKS were mobilized to support respiratory and immune health during the COVID-19 pandemic across BRICS (Brazil, Russia, India, China, South Africa) and Southern African Development Community (SADC) countries. METHODS: A qualitative exploratory research design was employed across Zimbabwe, South Africa, and China involving 38 participants. Data were collected through semi-structured interviews (n = 22), digital questionnaires (n = 10), and WhatsApp voice narratives (n = 6). Purposive and criterion-based sampling ensured representation across age, gender, geography, and familiarity with IKS. Data were analysed using Braun and Clarke's six-phase thematic analysis with inter-rater reliability verification (Cohen's κ = 0.82). Member checking was conducted through community advisory boards, and ethical approval was obtained from institutional review boards in each participating country. RESULTS: Participants reported using 27 distinct herbal remedies, primarily derived from locally available plants, including Lippia javanica, Artemisia afra, Psidium guajava, and commonly used spices, with perceived improvements in respiratory symptoms and overall well-being. Four major themes emerged: (1) variation in institutional support, with China and India formally integrating traditional medicine while SADC countries relied largely on informal community practices; (2) differences in knowledge documentation, characterized by codified systems in China and India compared with predominantly oral transmission in SADC countries; (3) barriers to integration, including epistemic hierarchies, regulatory limitations, and policy marginalization; and (4) community resilience and adaptability despite limited formal recognition and support. DISCUSSION: The findings suggest that IKS can complement biomedical approaches in strengthening health system resilience during public health emergencies. Integrating IKS into pandemic preparedness and response requires policies that recognize epistemological diversity, protect intellectual property, promote equitable benefit-sharing, and strengthen community knowledge sovereignty within planetary health frameworks.