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Path-breaking transformative change is needed in human-environment relations to move towards more sustainable development trajectories at local, national and global scales. Crises may trigger transformative change and learning in the short and in the long term. However, in particular, a short-term response to crises may also be reactive, strengthening established unsustainable practices and further perpetuating vulnerability and inequality rather than supporting transformative change towards a more sustainable path. To understand the nature and response to a crisis in the context of sustainability transformations, this paper elaborates on the following aspects of a crisis: What are the characteristics of a crisis? What and who shapes the narrative(s) of a crisis? What and who shapes the nature of the response to a crisis? Do responses to crises trigger higher levels of learning? Conceptual synthesis is complemented with an exploratory comparative analysis of the Cape Town water crisis and of the COVID-19 pandemic in South Africa. To this end the paper analyzes the interplay between mobilizing individual, collective and relational agency and navigating and transforming power relations to challenge and profit from already weakened unsustainable structures. This approach proves to be promising to understand the role of crises in catalysing and supporting transformative learning to eventually replace unsustainable structures. ● During and immediately after crises, it is important to identify opportunities for policy change to address persistent governance failures. ● To support transformative change towards sustainability, governments typically should adopt a network governance style and act more as a convenor for deliberative processes in the later phase of the response to a crisis. ● Formation of innovation platforms bringing together actors from different levels and different roles (e.g. pioneering innovators, investors, scientists, policymakers, regulators) could support the scaling up of local initiatives and innovative approaches that have been developed during crises. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has posed challenges to the conduct of clinical trials. Strategies for overcoming common challenges to non-COVID-19 trial continuation have been reported, but this literature is limited to pharmacological intervention trials from high-income settings. The purpose of this paper is to expand the literature to include a low- and middle-income country perspective. We describe the challenges posed by COVID-19 for a randomised feasibility trial of a psychological intervention for adolescents in Cape Town, South Africa, and lessons learned when implementing strategies to facilitate trial continuation in this context. We used a Plan-Do-Study-Act cycle method to explore whether our adaptations were having the desired effect on trial accrual and retention. We found that stakeholder engagement, trial coordination and team communication need to be intensified while testing these procedural changes. We learned that strategies found to be effective in high-income countries required significant adaptation to our resource-constrained setting. The detailed documentation of extraneous influences, procedural changes and trial process information was essential to guiding decisions about which adaptations to retain. This information will be used to examine the potential impact of these changes on study outcomes. We hope that these reflections will be helpful to other trialists from low- and middle-income countries grappling with how to minimise the impact of public health emergencies on their research. TRIAL REGISTRATION: The trial is registered with the Pan African Clinical Trials Registry (PACTR20200352214510). Registered 28 February 2020.   https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9795 . [ABSTRACT FROM AUTHOR]