Health system resilience and pandemic response: a comparative analysis of China, Singapore, the U.S., and the U.K.

IntroductionInfectious disease outbreaks have imprinted unprecedentedly on global economies, societies, politics, and healthcare systems. The COVID-19 pandemic underscored critical challenges in global healthcare delivery, necessitating the translation of lessons into actionable strategies for strengthening health system resilience against future outbreaks.MethodsThis paper divides resilience into two dimensions: resilience from scale and resilience from structure. The former pertains to the overall resilience of the “state-society” system, while the latter refers to resilience rooted in the system's internal structure. Expert consultation method is used to assess the potential and actual levels of two types of resilience. The case study and time slicing approach are used to analyze the anti-epidemic policies in four countries.ResultsThere are significant differences in the potential and actual levels of resilience from scale and resilience from structure in the event of infectious disease outbreaks in China, Singapore, the U.S., and the U.K., as a result of a combination of political and non-political factors. Based on the original perspective of two types of resilience, this study reveals that differences in anti-epidemic policies among these countries stem from variations in the resilience from scale and resilience from structure.ConclusionThis paper elucidates the divergent global responses to the same virus from the original perspective of two types of resilience. Furthermore, the study presents a practice-oriented framework that links health system scale and structure to anti-epidemic policies, thereby moving beyond existing indices like the Global Health Security Index. The findings deliver concrete lessons for improving managerial practices, enhancing preparedness, and informing future healthcare delivery innovations, directly contributing to translating pandemic experience into implementable best practices for strengthening health systems against infectious disease threats.