The best time to prepare for a crisis is before it arrives. The hardest time to prepare is when everything feels fine. Norwegian health leaders learned both truths on March 12, 2020, when the country entered lockdown to address the COVID-19 pandemic and faced an impossible question: how do you protect an entire nation’s health care workers when the world has run out of protective equipment?
When the Supply Chain Collapsed
At a conference in Barcelona celebrating the 100th anniversary of the Harkness Fellowship, hosted by the Commonwealth Fund and supported by the Financial Times, Dr. Cathrine Marie Lofthus shared a story that captures everything essential about crisis leadership. As CEO of the largest health region in Norway in 2020, responsible for approximately 80,000 health care workers, she faced an unprecedented challenge when international supply chains collapsed that March.
As the crisis unfolded, Dr. Lofthus made one of the most exceptional decisions of her career. On the evening of March 18, 2020, she decided to charter planes to transport personal protective equipment (PPE). A rapidly assembled team, including a deputy CEO, the country’s largest airport operator, the Minister of Foreign Affairs, and the Chief Information Officer, was in place by the morning of March 19. Four days later, on March 22, the first shipment arrived. Norway would go on to supply its entire health care system with the protection workers desperately needed.
“A leader in a crisis like the COVID-19 pandemic must be willing to think outside of the box,” Dr. Lofthus said. “Plans and preparation are important and can provide the confidence to make such unusual decisions in [a] crisis.” This is particularly relevant for health services researchers, who can inform rapid decision-making during emergencies when they have established data systems and research infrastructure in advance, allowing for quick pivots to address urgent health care delivery questions.
Innovation Under Pressure
That first plane was only the beginning. What followed was an extraordinary display of innovation under pressure. Within weeks, plastic office folders became makeshift eye protection, which were then refined into full face shields. Digital patient follow-up systems were rolled out at record speed. Norway used its infection control and health preparedness laws to link data registers—covering everything from mobile data movement to laboratory results and ICU statistics—enabling real-time monitoring and adjustment of public health measures.
In the early phase of a crisis, when established solutions don’t exist, health care systems depend completely on innovation and research. The rapid development of mRNA vaccines is a powerful example. The pandemic was a wake-up call: innovation and research must work together when everything is at stake.
The Six Pillars of Preparedness
So, how do health care systems prepare for crises they cannot predict? Dr. Lofthus proposed a framework built on six pillars:
Civil-military health preparedness
Nuclear safety
Supply security for pharmaceuticals and medical equipment
Digital security
Water supply preparedness
These areas demand constant attention, regularly updated scenarios, and cross-sector collaboration—with a particular focus on protecting vulnerable groups and ensuring equitable access. Critically, these pillars depend on continuous research, evaluation, and evidence from the health services research field to remain effective and responsive to evolving threats.
Health care systems can also prepare for a crisis by building resilient populations. “Public health—mental and physical health—is good preparedness,” they argued. A healthier population is better able to prepare individually and endure the psychological strain that crisis measures impose. Investing in population health isn’t just about outcomes; it builds the social and psychological backbone that keeps a society functioning when everything else is under pressure.
Trust and Transparency
All of this rests on trust. Without it, Dr. Lofthus stressed, their pandemic response would have been impossible. Trust depends on transparency, especially when it comes to the most challenging aspect of preparedness: prioritization. When a crisis creates scarcity, leaders must openly share how and why they make difficult choices.
Norway’s approach is anchored in four preparedness principles:
Responsibility (do not change who is accountable in a crisis),
Similarity (manage crises as close to normal operations as possible),
Proximity (respond as close to the event as possible), and
Cooperation is especially critical. The public sector understands the needs, regulations, and has access to data. The private sector brings speed, technology, and commercial know-how. Together, these strengths can develop solutions with major impact on sustainable health care.
People First, Always
Dr. Lofthus emphasized that the health care workforce remain health care’s most important resource. Preparedness requires plans for mobilizing staff, deploying them flexibly, and investing in strong leadership. Leaders must understand their field, make hard calls, and care for their teams. None of this can be achieved in isolation. International cooperation and fair data sharing are essential for managing future pandemics. The WHO has now reached consensus on guidance for how countries should collaborate to prevent and strengthen preparedness, so we do not repeat the inequitable data sharing seen during COVID-19.
The Work Ahead
The session closed with a clear set of imperatives: invest in research and innovation in ordinary times to build strength for extraordinary times. Invest in public health to build population resilience. Develop plans and scenarios that reveal gaps and opportunities. Invest in leaders equipped to make entirely new kinds of decisions. And invest in convenings where we can discuss global challenges together.
This work aligns closely with AcademyHealth's priorities, particularly the organization's recognition that learning from other country contexts—like Norway's crisis response capabilities—can provide valuable insights for improving the US health care system.
The chartered plane was not just about logistics. It symbolized a system ready to act decisively when it mattered most. Dr. Lofthus, who later served as permanent Secretary General in the Ministry of Health and Care Services of Norway and is now Director General of Health in Norway and the first Vice Chair of the Executive Board of WHO, exemplifies the kind of leadership needed for tomorrow’s challenges. As the Harkness Fellowship enters its second century of preparing leaders for change and shaping solutions to global challenges, the lesson feels more urgent than ever: the next crisis is coming. The question is whether we’ll have done the work now to be ready then.