Public Health System Resilience: Reflections from the COVID-19 Pandemic Response

Introduction: The COVID-19 pandemic had profound impacts across society, including strain on public health and health system resources globally. Given the increasing threat of public health emergencies, it is important to illuminate understandings of public health system resilience. The study objective was to explore public health practitioners’ experiences of the COVID-19 pandemic to better understand factors that contribute to public health system resilience. Methods: The qualitative design included key informant interviews and focus groups conducted at five public health organizations in provinces across Canada at varying sub-national levels. Practitioners in roles related to public health emergency management were recruited to participate. Data were collected from February 2023 to June 2024. Reflexive thematic analysis was then completed to generate descriptive themes. Results: A sample of N = 70 participants was captured across the focus groups, and N = 34 interviews were completed across the organizations. Analysis identified five themes related to public health system resilience: 1) Prioritize staff wellness as an essential component of a resilient workforce; 2) Identify and map staff assets (strengths, skills, and knowledge) to support purposeful redeployment for future responses; 3) Prioritize and maintain diverse partnerships through proactive engagement to enhance communication and collaboration; 4) Ensure accountability to implement ‘lessons learned’ to support evaluation and future planning and preparedness activities; and 5) Nimble investment and training is essential to diversify and maintain preparedness for future threats. Conclusion: Public health threats are becoming increasingly frequent and complex for systems to manage. Considering strategies that support system resilience is essential to preparedness. The results of this study demonstrate that workforce capacity, collaboration, learning, and resourcing remain crucial aspects of resilience based on COVID-19 experiences. Future work can integrate COVID-19 pandemic learnings with pre-pandemic perspectives to inform future-oriented resilience strategies.