The rapid development and deployment of vaccines was an important contributor to pandemic management. The deployment of COVID‑19 vaccines in situations of severe vaccine shortages required countries to prioritise their vulnerable populations. Alongside ensuring sufficient vaccine supply, other challenges included a shortage of equipment and staffing, logistics, managing several different vaccines, and the spread of mis- and disinformation. Adjustments were required, which included changes in eligible age according to the type of vaccination, the time interval between doses, recommendations for those infected previously with SARS‑CoV‑2, and new variants of concern. Countries adopted varying prioritisation strategies, depending on the main objective of their vaccination programmes. The elderly, health care workers and adults with co-morbidities were prioritised most commonly (ECDC, 2020[1]).

Consultations with doctors are the most frequent contact most people have with health services and provide an entry point for subsequent medical treatment. Consultations can take place in different settings and are increasingly online. COVID‑19 has had a substantial impact on how people consult doctors. Stay-at-home orders and the suspension of non-urgent care contributed to fewer in-person doctor consultations, which was partly offset by increased teleconsultations.

A resilient health system is able to generate a robust increase in essential services. When a pandemic, epidemic or other infectious disease occurs, identifying, containing and controlling it requires the scale up of laboratory services. This was evident during the COVID‑19 pandemic, with diagnostic testing and genomic sequencing services under stress at the beginning of the pandemic. Genomic surveillance of SARS‑CoV‑2 (the virus that causes COVID‑19) allows detection, monitoring and assessment of new virus variants (ECDC, 2021[1]). When it replicates, SARS‑CoV‑2 can manifest changes in its genome. Scaled up capacity is especially important when mutations are associated with changes in transmissibility or the effectiveness of countermeasures such as vaccines. The cost of sequencing has fallen over time but still requires substantial investment in staff, equipment and bioinformatics infrastructure.

The pandemic placed enormous strain on intensive and critical care resources. It was more intense in some regions and periods than others, for example in Lombardy (Italy) during March/April 2020. The pandemic resulted in intensive care demands exceeding the ability of critical care facilities to serve their communities. If critical care is not accessible when required, morbidity and mortality increase. Increasing occupancy of intensive care has been associated with increasing mortality (Bravata et al., 2021[1]).

Health care that is safe, effective, timely, efficient and patient-centred relies on the right information reaching the right person (or organisation) at the right time. A digitalised information infrastructure that ensures timely and reliable sharing of clinical and other information can improve health outcomes and efficiency, and can create valuable data for researchers and system managers (OECD, 2017[1]). The pandemic demonstrated the importance of contemporary information in Electronic Medical Records (EMR), guiding decision-making during a crisis and targeting resources to those who benefit the most.

Investments in health care facilities, diagnostic and therapeutic equipment, and information and communications technology, affect the capacity to respond to population needs. There are no guidelines or international benchmarks regarding the optimal level of capital investment in the health sector. Nonetheless, it is of critical importance for countries to maintain spare capacity to deal with surges – too little investment will over-stretch service provision, undermining health system resilience.

Over 80% of health spending in the EU is financed out of public sources, such that the size and growth in health and long-term care expenditure raises questions about a country’s ongoing budgetary position, as noted in Chapter 5 (see indicator “Financing of health expenditure”). Ageing populations will continue to exert pressures on health and long-term care spending while reducing the size of the working-age population able to finance such expenditure, raising concerns around the fiscal sustainability of health and long-term care systems. Another important driver of health and long-term care spending is technological progress. The type of technological development and how it is implemented may put upward or downward pressures on expenditure.