Pandemic Response and Preparedness Through Stakeholder Lenses: A Mixed-methods Study from Türkiye

The COVID-19 pandemic tested preparedness, prevention, and response (PPPR) systems globally. Türkiye, as a upper-middle-income country at the European–Western Asian health governance interface, offers a valuable case for examining pandemic lessons and preparedness. This NUS-Lancet PRIME Commission country case study explored Türkiye’s PPPR landscape through the perspectives of key stakeholders including frontline health workers. A mixed-methods study was conducted including review of policy documents and grey literature; 22 in-depth interviews across 12 sectors; 2 focus group discussions with 20 healthcare workers; social network analysis mapping collaboration between national/international actors. The study examined structural drivers of resilience, experience of healthcare workers, whole-of-society coordination, current preparedness, and multi-level governance. Türkiye’s rapid health infrastructure mobilization, centralized management of the pandemic, its national guidelines, and digital health systems emerged as notable strengths. Simultaneously, stakeholders identified areas for improvement including cross-sectoral collaboration, polycrisis planning, localization of preparedness, social protection for disproportionately affected communities including healthcare workforce wellbeing. Earthquake preparedness emerged as a high priority for many stakeholders. Future prevention and preparedness needs centered on One Health operationalization, improved public health literacy, sustainable financing. Türkiye’s experience demonstrates both achievements and opportunities for strengthening equitable PPPR. Key priorities include building on existing vaccine production capacity, formalizing whole-of-society governance structures, investing in healthcare workforce protection, embedding community co-creation in preparedness planning. These lessons, reflecting both strengths and needs offer transferable insights for middle-income countries strengthening pandemic governance.

Key messages

• Türkiye demonstrated significant health system resilience during COVID-19 while revealing opportunities to strengthen cross-sectoral coordination and polycrisis preparedness.

• Stakeholders identified more vaccine development capacity, community co-creation, whole-of-society governance, and health workforce protection as priorities for future preparedness.