The threat picture is no longer hypothetical

Two developments make preparedness urgent for European health systems. First, the medicine supply chain is concentrated and brittle. The active pharmaceutical ingredients behind most medicines are made in a few countries: China accounts for an estimated 40% of global production, and India, the largest supplier of generic medicines, sources almost 70% of its ingredients from China. A single failure spreads widely. A 2017 factory fire in China caused a global shortage of the antibiotic combination piperacillin / tazobactam. The COVID-19 pandemic and the war in Ukraine have already interrupted access to essential products, and OECD analysis identifies the geographic concentration of manufacturing as a standing vulnerability. Second, heightened geopolitical tension increases the chance that such disruptions coincide with losses of energy, transport, or communications. The probability of any single catastrophic scenario is uncertain; the underlying fragility is documented.

Resilience must be designed in, not bolted on

A health system is resilient when it can prepare for and absorb a shock, keep core functions running during it, and reorganise afterwards. That capacity is not summoned during a crisis; it is built beforehand, through decisions about stockholding, supplier diversity, surge capacity, and the physical protection of facilities. Hospitals depend on uninterrupted power, water, telecommunications, and medical gases. A peer-reviewed review of facility-safety assessments shows that structural integrity and these internal systems determine whether a hospital keeps working when its surroundings fail; the WHO Hospital Safety Index evaluates exactly these structural, non-structural, and management dimensions. Few European facilities have been hardened against sustained loss of these inputs, or against blast and contamination. Resilience should also be honest about its costs: the term is often used loosely, and the aim is targeted preparedness for identified risks, not open-ended spending.

How we support preparedness and resilience by design

We help provider and payer organisations rethink delivery so that continuity of care survives disruption, with analysis grounded in peer-reviewed evidence. Typical engagements include:

• Mapping single points of failure across the medicine and consumables supply chain, and designing supplier diversity, buffer stock, and substitution protocols against identified risks.
• Assessing facilities against recognised safety indices and prioritising the hardening of power, water, communications, and medical-gas continuity.
• Designing surge and continuity plans (staffing, triage, care pathways) that hold under loss of supply, utilities, or access.
• Building the measurement and rehearsal (exercises and drills) that confirm plans work before they are needed.

Preparedness for private shelters and bunkers

We also advise private individuals on the health dimension of personal preparedness. Switzerland maintains near-universal shelter coverage, more than one protected place per resident across roughly 370,000 public and private shelters, under the long-standing principle of one protected place for every inhabitant. Yet a shelter's structure is only half the matter: its occupants' health depends on what is planned for inside it. Interruption of routine medication during disasters measurably worsens chronic conditions, and ordinary prescribing leaves little in reserve. We help individuals and families plan the medical contents and health logistics of a shelter, appropriate first-aid and medicine reserves, continuity of treatment for chronic conditions, provision for elderly and paediatric members, and attention to ventilation, water, sanitation, and mental wellbeing during confinement, so that the protected space supports health, not merely physical safety.