The COVID-19 pandemic was not a surprise test of health system resilience. It was the test that health systems had been warned about for years. Most failed it anyway.
What the Pandemic Revealed
The COVID-19 pandemic did not reveal unexpected vulnerabilities in health systems. It exposed vulnerabilities that had been documented in advance — the inadequacy of surge capacity in health systems optimised for normal operating conditions, the fragility of just-in-time medical supply chains that had eliminated the inventory buffers that surge conditions require, the weakness of disease surveillance systems that could identify but not rapidly characterise novel pathogens, and the absence of institutional coordination mechanisms that pandemic response requires. Each of these vulnerabilities had been identified in prior pandemic preparedness assessments. Each had been the subject of recommendations for investment and policy change. Each remained unaddressed when the pandemic arrived, primarily because the investment and policy changes required were politically difficult to prioritise in the absence of the immediate urgency that the hypothetical pandemic scenario could not provide.
Health system resilience is built in the periods of normalcy that make it feel unnecessary. The pandemic that overwhelms a health system was not unforeseen — it was foreseen and not prepared for. That is a governance failure whose cost is measured in the people the system could not treat when it was overwhelmed.
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