It is with great pleasure and satisfaction that we lend our support to the collection of papers in this Special Issue of Health Policy which draws on the body of evidence gathered in the COVID-19 Health Systems Response Monitor (HSRM) and its network of international experts. The HSRM is a joint undertaking of the WHO Regional Office for Europe, the European Commission, and the European Observatory on Health Systems and Policies. The richness of the papers lies in the fact that they aim to identify important lessons from the COVID-19 response across five main health system dimensions (preventing transmission; providing health services effectively; ensuring sufficient infrastructure and workforce capacity; paying for services; and governance) as well as through dedicated cross-country comparisons covering all European Union and a large portion of WHO European Region Member States as well as Canada and the United States.
This body of work could not have been possible without the hard work and commitment of all the COVID-19 HSRM network members. This Special Issue builds on and complements an ever growing range of network outputs, including the HSRM Monitor platform itself as well as policy briefs and snapshots, a major study on health system resilience, three issues of Eurohealth and a series of webinars, to name a few. And while the academic papers published here are aimed at the research community, the analyses are essentially powered by the conviction to be as policy-relevant as possible for the wider constituencies of policy advisors and senior government officials, who will undoubtedly find valuable information to add to their arsenal of policy tools to meet the forthcoming challenges that await our health systems.
For this reason, our gratitude to the institutions and individuals who make up the HSRM, to the journal Health Policy, to the editors of this Special Issue and to all of the contributing authors is redoubled. The varied evidence and analyses contained here are not only important for the valuable lessons learned but also as concrete contributions to the efforts now underway to rebuild and strengthen our health systems as we emerge and recover from the pandemic. While the COVID-19 pandemic has been a severe health system shock it is by no means an isolated one. Previous shocks such as the global financial crisis and potential new ones around the corner, like the Ukrainian refugee crisis, all serve to highlight how the resilience of health systems may be tested, often to limits that are difficult to bounce back from. The COVID-19 pandemic uncovered a number of well-known chronic vulnerabilities and deficiencies in our health systems that need to be addressed. In terms of its policy legacy, this crisis provides a window of opportunity to examine and learn which actions can contribute to stronger, better performing health systems. A good overview and some key messages for resilience and recovery can be found in the European Commission co-funded project ‘State of health in the EU’, with its 29 Country health profiles and Companion report published in December 2021. Let's not forget that the last stage of a shock cycle is ‘recovery and learning’, but this is not a one way street; rather the feedback loop between the two are what makes the pandemic a powerful agent of transformative change.
Looking to the future we'd like to offer two final considerations that could provide some guidance on forging necessary change. Firstly, as the lessons emerging from this Special Issue make clear, the emphasis now should be on transformation and implementation. Many of the examples of best practices and innovations collected here are not new in themselves. What is new is the newfound capacity to govern, and transform health systems to implement reforms in key areas such as primary health care, financing, the health workforce or digital health. In other words, key areas of focus now should be on how to harness innovations and rethink their implementation.
Secondly, we should always remain mindful that viruses are not the only things that cross borders – effectively countering many other potential threats to health and health systems, be they economic, environmental, social or epidemiological, requires European and/or international co-operation. The public good that results from such co-operation may require some pooling of national decision-making in policy-making in order to tackle common threats, but as demonstrated by the co-operation in producing and purchasing effective vaccines, the pay-offs can be enormous. Let us all strive to learn from the pandemic and strengthen our health systems to be more resilient to future health system shocks.