South Africa's heavy reliance on coal-fired power plants for electricity generation has long been a double-edged sword: providing much-needed energy while unleashing invisible toxins into the air that silently erode public health. A groundbreaking new report, Unmasked: The Health and Economic Cost of Delaying Coal Phase-Out in South Africa, lays bare the stark human price of prolonging this dependence. Published on April 22, 2026, by the Centre for Research on Energy and Clean Air (CREA), Greenpeace Africa, and GroundWork, the study projects up to 32,000 additional premature deaths between 2026 and 2050 if the government sticks to the delayed decommissioning timeline outlined in the Integrated Resource Plan (IRP) 2025. This figure starkly contrasts with the original IRP 2019 schedule, highlighting how policy shifts could avert a public health catastrophe.

The report's health impact assessment (HIA) uses advanced air quality modeling to simulate pollution dispersion from ten key Eskom-operated coal plants. These facilities, concentrated in Mpumalanga (31.3 gigawatts or GW), Limpopo (8.8 GW), and the Free State (3.7 GW), emit fine particulate matter (PM2.5), sulfur dioxide (SO2), and nitrogen dioxide (NO2). These pollutants travel hundreds of kilometers, infiltrating lungs and bloodstreams, triggering respiratory diseases, cardiovascular issues, and even developmental problems in children.

Transboundary Pollution: Gauteng's Invisible Threat

Gauteng, South Africa's economic powerhouse encompassing Johannesburg and Pretoria, emerges as the epicenter of this crisis despite lacking major Eskom coal plants. The study attributes 15,200 additional deaths—or nearly half the national total—to transboundary pollution wafting over 300 kilometers from Mpumalanga's behemoths like Medupi. Winds carry PM2.5 particles, which linger for one to two weeks, accumulating in the Highveld region's stable atmosphere.

This phenomenon underscores a critical gap in local air quality management. Residents in densely populated townships like Soweto and Alexandra report chronic coughing, dizziness, and exacerbated asthma during winter inversions, when cold air traps pollutants close to the ground. The report warns that Gauteng's 15 million inhabitants, many in low-income areas, face heightened vulnerability, with pollution hotspots exceeding World Health Organization (WHO) guidelines by factors of ten or more.

Breaking Down the Health Toll on Vulnerable Populations

Beyond mortality, the delayed scenario forecasts 41,000 extra preterm births, 17,000 new childhood asthma cases, and 370 under-five deaths. PM2.5 penetrates deep into lungs, causing inflammation and impaired lung growth in infants, while NO2 and SO2 aggravate chronic conditions like ischemic heart disease and stroke. Children under five and seniors over 60 suffer disproportionately, as their developing or weakened systems offer little defense.

The methodology employs concentration-response functions from global epidemiological data, calibrated for South Africa's demographics. For instance, a 10 micrograms per cubic meter (μg/m³) rise in PM2.5 correlates with a 6-8% increase in mortality risk, validated against local monitoring stations. These projections build on prior work, including a 2025 SAMRC study linking proximity to coal plants with a 6% higher death rate.

The Steep Economic Price Tag

The human cost translates to a staggering ZAR 721 billion (USD 38 billion) in economic losses from 2026-2050 under the delayed path. This encompasses 27 million lost workdays, healthcare strains, and productivity dips. Public hospitals, already overburdened, could see admissions for respiratory illnesses surge, diverting funds from other priorities. In contrast, adhering to IRP 2019 would cap total coal-related costs at ZAR 1.5 trillion, saving billions for renewable investments.

For Gauteng, the economic ripple effects amplify: reduced workforce participation in its GDP-dominant economy could hinder growth, exacerbating inequality. The report urges valuing these 'externalities' in policy, akin to how Europe prices carbon.

Photo by Mayukh Karmakar on Unsplash

Eskom's Coal Fleet and Policy Shift: IRP 2019 vs 2025

Eskom, South Africa's state utility, operates over 40 GW of coal capacity, fueling 80% of electricity but chronic breakdowns have triggered load-shedding blackouts. IRP 2019 targeted decommissioning by 2030 to align with Nationally Determined Contributions (NDCs) capping emissions at 350-420 MtCO₂e by 2030. However, IRP 2025, approved October 2025, extends ten plants' lives by up to a decade to avert shortages, formalizing delays.

Specific plants like Komati (decommissioned early as pilot) contrast with others slated for extension, prioritizing reliability over health. Critics argue renewables—220 GW pipeline of wind, solar, storage—could replace coal by mid-2030s without gaps.

Higher Education Leading Air Quality Research: Spotlight on Wits University

South African universities are at the forefront, bridging research and action. The University of the Witwatersrand (Wits) launched a pioneering real-time coal pollution app in April 2026, targeting Johannesburg's crisis. Led by Professor Bruce Mellado from Wits' Institute for Collider Particle Physics and School of Public Health experts like Prof. Mary Kawonga, the app deploys low-cost laser sensors (US$100 each) in townships, streaming PM2.5/PM10 data every five minutes via AI akin to CERN tech.

It forecasts hotspots, sends alerts, and empowers advocacy—directly addressing the 'Unmasked' report's Gauteng warnings. With 5,300 annual Johannesburg deaths from pollution (part of 30,000 nationally), this tool exemplifies how academia translates data into community resilience. Plans expand to 500 Gauteng sensors by mid-2026.

UCT and SAMRC: Mapping Pollution and Quantifying Risks

The University of Cape Town (UCT) complements this with high-resolution air pollution maps, revealing 40% of Capetonians at severe risk—insights applicable nationwide. Meanwhile, the South African Medical Research Council (SAMRC), collaborating with universities, found coal-proximate districts have 6% higher mortality, with under-fives facing pneumonia spikes.

These efforts, including Wits' School of Public Health studies on respiratory burdens, underscore higher education's role in evidence-based policy. Researchers advocate integrating such data into IRP revisions for health-inclusive planning.

Towards a Just Energy Transition: University-Led Solutions

A just energy transition (JET)—balancing decarbonization with jobs, equity—features prominently in university research. UCT's studies on climate finance for coal phase-out emphasize retraining miners for renewables. Wits and Stellenbosch explore community co-design for smart cities powered by solar/wind.

The JET Partnership (JETP), backed by USD 8.5 billion internationally, funds diversification in Mpumalanga. Academics stress worker reskilling (e.g., via TVET colleges linked to universities), economic hubs, and inclusive governance to mitigate 100,000+ job losses.

Photo by Roma Durkin on Unsplash

Stakeholder Views: From Communities to Policymakers

GroundWork's community voices from eMalahleni highlight lived realities: 'rotten-egg' sulfur smells, chronic illnesses. Government cites energy security amid blackouts, but NGOs urge renewables acceleration. Universities like Wits bridge divides, validating claims with data.

Experts like Prof. Kawonga call for pollution controls on remaining plants, echoing global successes in China/India.

Future Outlook: Renewables Pipeline and Research Imperative

South Africa's 50-60 GW renewables by 2030 outpace coal retirements, promising cleaner air. Yet, IRP adherence is key. Higher education must scale interdisciplinary research—public health, engineering, policy—for resilient transitions.

Actionable insights: Expand sensor networks, fund JET scholarships, integrate HIA into planning. By prioritizing health, South Africa can power progress sustainably.