In recent years, health security has become one of the defining priorities of European policymaking. Yet the concept is still understood differently across Europe.

For many countries in Western and Southern Europe, health security is primarily associated with preparedness for future pandemics and public health emergencies. In Eastern Europe, however, Russia's war against Ukraine has fundamentally broadened this understanding. Health security is increasingly viewed as an essential component of national security and societal resilience.

Academic research is moving in the same direction, recognising health not merely as a medical issue but as a cornerstone of national resilience, economic stability and human security.

Whatever perspective we take, one conclusion is clear: resilient health systems cannot be built during a crisis—they must exist before one begins.

To achieve genuine health security, policymakers need to think across three interconnected levels: resilient national health systems, effective crisis preparedness, and strong European coordination. Each level reinforces the others, and neglecting any one of them weakens the entire system.

Strong health systems: the foundation of health security

The first and most important pillar of health security is a resilient healthcare system.

The COVID-19 pandemic demonstrated that emergency funding alone cannot compensate for years of underinvestment. Countries with stronger, better-funded health systems generally experienced lower mortality, greater flexibility and were able to maintain essential healthcare services throughout the crisis. Conversely, countries with structurally weaker systems faced greater challenges despite mobilising substantial emergency resources.

Latvia illustrates this well. As one of the lowest spenders on healthcare in the European Union, it experienced one of Europe's highest COVID-19 mortality rates during the autumn 2021 wave, despite substantial emergency funding. The crisis highlighted how years of structural underinvestment, together with delayed access to care and lower health literacy, can significantly weaken a health system's resilience.

The same principle applies to military crises. War places extraordinary pressure on healthcare systems, not only because of direct casualties but also because it increases the burden of chronic diseases, disrupts continuity of care and creates long-term mental health consequences. During prolonged crises, health systems must continue managing non-communicable diseases, ensuring that patients receive timely care outside hospitals whenever possible and preserving hospital capacity for acute needs.

But the role of health systems extends far beyond healthcare delivery. Population health directly influences a country's ability to withstand and recover from conflict. It shapes the resilience of critical institutions, the capacity of society to endure prolonged crises and, ultimately, national defence itself. A healthier population means greater workforce resilience, continuity of essential services and stronger social cohesion. It also directly affects military readiness by determining the pool of people fit for mobilisation, the ability to sustain military personnel over time and the capacity to rehabilitate those who are injured.

Medicines are a critical part of this equation. Access to medicines is therefore not only a matter of healthcare or social policy - it is a matter of national security. Keeping people with chronic diseases healthy reduces avoidable complications during crises, prevents sudden surges in demand for hospital care and preserves scarce healthcare capacity. A population whose conditions are well managed is better able to continue working, supporting critical infrastructure and contributing to national resilience. Likewise, robust reimbursement systems encourage treatment continuity long before emergencies occur, reducing the risk that a military or humanitarian crisis is accompanied by a parallel health crisis.

Sustainable investment in access to medicines and innovation should therefore be recognised not simply as healthcare expenditure but as an investment in national resilience.

Crisis preparedness: planning for the unexpected

Strong health systems alone are not enough. Governments also need comprehensive preparedness plans covering hospital resilience, emergency procurement, medicines supply, proportionate stockpiling (including contingency stocks) measures, where justified, and operational coordination.

Across Europe, significant progress has been made in strengthening institutional preparedness. Most health authorities and hospitals today have contingency plans for future crises. Yet one important vulnerability often receives far less attention: coordination beyond government institutions.

Health emergencies are never managed by governments alone. Patient organisations, healthcare professionals, industry, wholesalers, pharmacies, humanitarian organisations and other civil society actors all become part of the response. However, these stakeholders are rarely fully integrated into preparedness planning before a crisis occurs.

This creates uncertainty precisely when clarity is needed most. Who communicates with patients if medicine shortages occur? Which organisations are responsible for supporting vulnerable patient groups? How will information be shared between regulators, healthcare providers and manufacturers? These questions should not be answered during a crisis - they should already be embedded in preparedness plans.

Preparedness therefore extends beyond logistics and stockpiles. It requires clearly defined roles, regular joint exercises and trusted partnerships between public authorities and external stakeholders. Countries that invest in these relationships before emergencies occur will be significantly better prepared when the next crisis inevitably arrives.

However, preparedness plans cannot compensate for structurally weak health systems. Emergency protocols become effective only when they are built upon strong healthcare infrastructure, sufficient workforce capacity and sustainable healthcare financing. 

European coordination: health security through smart dependency

The third pillar of health security extends beyond national borders. While healthcare remains primarily a national competence, health security cannot. The COVID-19 pandemic, medicine shortages and Russia's war against Ukraine have all demonstrated that no Member State can build resilience in isolation.

As resilience expert Karl Blanchet argues, "Resilience is not self-sufficiency. Crises do not respect geopolitical boundaries and resilience therefore requires thoughtful interconnectedness, or what we call 'smart dependency'." This principle is particularly relevant for European health policy. The objective should not be for every country to become entirely self-sufficient, but for Member States to become more resilient through stronger European cooperation.

The European Union has already taken important steps in this direction through initiatives such as HERA and the proposed Critical Medicines Act. These initiatives recognise that safeguarding access to medicines is no longer simply a health policy objective but a strategic priority for Europe. 

However, this should be only the beginning. Health security should become a guiding principle across European pharmaceutical policymaking. Every major policy initiative affecting medicines - from pharmaceutical legislation to industrial policy and supply chain regulation - should be assessed for its long-term implications for Europe's health security.

Building on existing initiatives, the European Union should strengthen coordination of proportionate strategic reserves for critical medicines where vulnerabilities justify them, diversify global supply chains, improve demand forecasting, enable greater transparency and data sharing across Member States, and establish mechanisms that allow medicines to be rapidly redistributed where shortages emerge. Such measures should be coordinated at European level and designed to avoid unnecessary or duplicative national stockpiling (and contingency stock) requirements that could themselves put pressure on supply. These measures would strengthen the resilience of the entire European health system while reducing unnecessary duplication of national efforts. 

European coordination must also recognise that pharmaceutical competitiveness is itself a health security issue. Europe cannot strengthen medicine security while simultaneously weakening the environment for pharmaceutical innovation and manufacturing. Predictable regulation, sustainable incentives for research and development, timely patient access and stable healthcare funding create the conditions in which innovative medicines continue to be discovered, manufactured and supplied across Europe. These conditions determine not only whether patients receive new treatments during peacetime, but also whether medicines remain available when future crises occur. 

Ultimately, Europe's health security will depend not on how independent each Member State becomes, but on how effectively countries combine strong national health systems with smart European interdependence.

The way we think about health security matters because it shapes the policies we prioritise.

If we see health security only as preparedness for the next emergency, we will continue focusing on the response. If we broaden our understanding of health security, healthcare, access to medicines and European cooperation are no longer separate policy agendas -they become investments in resilience.

Health security is built long before a crisis begins. The policy choices we make today will determine how well we protect patients when the next crisis comes.