1 Introduction

On 12 March 2020, Norway was shut down. Like the rest of the world, Norway was not prepared to handle a pandemic that affected all of society. Overall, the pandemic was well managed. Nevertheless, health emergency preparedness must be strengthened to ensure that we are better prepared to prevent and respond to future crises.

In this Report, the Norwegian Government provides the political and strategic direction for Norwegian health emergency preparedness. We have been through three years of a pandemic and are now facing more complex and challenging threats. This means that prevention and emergency preparedness must be given greater priority. The Norwegian Government will ensure a resilient health emergency preparedness with the aim of safeguarding and protecting lives and health. The Norwegian Government is focused on organising health emergency preparedness in a manner that protects the most vulnerable groups in society. Equitable services must be provided for the entire population regardless of place of residence and income.

One strength of Norwegian society is the high level of trust we have in one another, and the strong sense of community that unites us. Trust and openness were key factors in Norway’s successful management of the COVID-19 pandemic. Adhering to these values is essential for our resilience and our ability to manage future crises. Knowledge, competence and awareness at all levels of society create a robust and resilient society that can weather crises.

Norway has a good health emergency preparedness system. The health and care sector is the country’s largest emergency preparedness resource. Essential cornerstones are legislation, plans, personnel, emergency services, hospitals, municipalities and the health administration. Over time, this sector has displayed the capacity and willingness to mobilise to protect lives and health in the population in times of crises and disasters.

The Coronavirus Commission’s reports, parts 1 and 2, and the Coronavirus Special Committee outline important lessons learned. The Defence Commission and the Total Preparedness Commission have also made recommendations of relevance to health emergency preparedness. This Report is part of the follow-up of the recommendations concerning health emergency preparedness. The Norwegian Government will submit a Report to the Storting on total preparedness and a long-term plan for the defence sector in 2024. There, the Norwegian Government’s comprehensive work on security and emergency preparedness will be presented.

A more challenging threat environment

A number of developments are setting the premises for future health emergency preparedness. We are now in the midst of the most serious security situation since the Second World War. There is war in Europe. Nuclear emergency preparedness is higher on the agenda. Democracy and human rights are under pressure. The rule-based international order that has benefitted Norway and Norwegian interests since the Second World War is being challenged. Threats against critical infrastructure are increasing. The same applies to hybrid threats. States and actors are seeking to exploit vulnerabilities in Norway for their own gain. Malicious cyber activity, disinformation and human influence are systematically employed.

Climate change is increasingly impacting health emergency preparedness. Globally, climate change will cause more extreme weather. This will, in turn, affect global food production, which could lead to food shortages and affect access to water, conflict levels, migration flows and the spread of communicable diseases. Norway must be prepared to handle crises as a result of climate change. The northern regions of Norway are particularly vulnerable to climate change.

Norway is facing major demographic changes in the coming years. Changes in the composition of the population and settlement will pose significant challenges for health and care services and will affect health emergency preparedness.

Society is characterised by an increasing degree of dependencies. This applies both between and within sectors. Norway is a highly digitised country. Supply chains are long and partially unclear. This requires a strong awareness of the values and functions that must remain intact, as well as a high degree of adaptability. This means that the health and care sector must consider dependencies, complexity, criticality and totality to a greater extent than before. In order to be able to provide good health and care services, the sector is dependent on a number of individual elements. This includes safe water and food supplies, ICT services and a functioning electrical and electronic communications infrastructure.

A new model for health emergency preparedness

The organisation of health emergency preparedness is the constitutional responsibility of the Minister of Health and Care Services. A well-functioning health emergency preparedness is based on defined roles and responsibilities. The foundation for sound crisis management is laid through what is done on a daily basis.. Plans for good health emergency preparedness are essential in order to be prepared for likely and less likely incidents and crises. However, it is not possible to have plans for every eventuality. Flexibility and adaptation are key factors for the health sector’s ability to handle various crises, which the management of the COVID-19 pandemic clearly demonstrated.

A common understanding of risk and vulnerability is an important starting point for health emergency preparedness. By understanding risk and threats and identifying vulnerabilities, we can strengthen our emergency preparedness. This provides a basis for implementing preventive measures and preparing overall scenarios that may result in common prerequisites for local, regional and national plans.

The pandemic showed us that crises can have consequences for all of society, particularly if broad societal measures must be implemented. All sectors must be prepared for health crises and their consequences. They must also be prepared to be part of the measures that society must implement to protect lives and health, while also protecting the economy.

There is a need for strengthened cross-sector cooperation both prior to and during crises. The Norwegian Government is focused on developing the capacity to collaborate across sectors. For health emergency preparedness, it is particularly important to understand and be prepared for cross-sectoral consequences of measures implemented during a health crisis. This means that the sectors must cooperate well on a daily basis..

To strengthen health emergency preparedness, the Norwegian Government will establish a new model for health emergency preparedness. This model includes work on health emergency preparedness in the health and care sector and clarifies roles and responsibilities. The model involves the establishment of a Health Emergency Preparedness Council, which unifies the sector and is chaired by the Ministry of Health and Care Services, six committees at the agency level and an advisory Expert Committee for health crises. This will ensure a better basis for strategic emergency preparedness work through clearer management, prioritisation and coordination of the health sector both on a daily basis and in crises.

A resilient health emergency preparedness – at local, national, European and global level

The purpose of health emergency preparedness is to protect lives and health in crisis and war. A resilient society increases health emergency preparedness and the ability to manage undesirable events and changes in a sustainable and democratic manner.

Public resources and efforts are at the heart of health emergency preparedness. There are approximately 430,000 employees in the health and care services in Norway.1 Our common health service and health administration form the basis for a robust and resilient health emergency preparedness. The Norwegian Government will facilitate greater flexibility and adaptability of our common health service. This involves prioritisations, an overview of human resources, and the reallocation and mobilisation of resources. Good public health work and appropriately organised health and care services contribute to greater safety and security for the population and make Norway better equipped to face future health crises.

The private sector, civil society, local communities and individuals are important contributors to resilient health emergency preparedness and response. The Norwegian Government is focused on strengthening cooperation across sectors and facilitating closer cooperation with the civil society and private sector. The Norwegian Government will therefore ensure increased involvement and dialogue with the civil society and private sector in the efforts on health emergency preparedness and response. This is about utilising society’s total resources. We are stronger together.

National emergency preparedness is important, but we rely on international cooperation to solve a number of health crises. In this sense, the pandemic was a wake-up call. It revealed that Norway was more vulnerable than we thought. A virus originating in China resulted in the shutting down of society. Markets for personal protective equipment collapsed. There were no pharmaceuticals or vaccines available to protect the population. However, despite this grim situation, the world managed to manufacture safe and effective vaccines in record time.

It was by no means a foregone conclusion that Norway would succeed in securing early access to vaccines for the population. Several vaccine candidates were evaluated, but Norway was not in a position to ensure access to effective vaccines. The only real option to provide the Norwegian population with early access to vaccines was via the EU. In order to manage future health threats, it is in Norway’s interest to have a binding agreement with the EU to ensure that we are covered by the European Union’s health emergency preparedness and response.

The evaluation report on pandemic management, the Defence Commission and the Total Preparedness Commission all note the need to strengthen international cooperation.2 This is essential if we are to manage future health crises. The Norwegian Government will therefore strengthen international cooperation on health emergency preparedness at the Nordic, European and global levels.

Four key measures for strengthened health emergency preparedness and response

The Norwegian Government will strengthen health emergency preparedness through four main measures. First, the Norwegian Government will establish a model for the work on health emergency preparedness that clarifies roles and responsibilities, which is crucial for a well-functioning health emergency preparedness system. Through systematic work on risks and vulnerabilities, planning and exercises, the health sector must be as prepared as possible to manage incidents throughout the crisis spectrum. Second, the Norwegian Government is taking action to improve our health service’s ability to adapt and flexibility to face future crises. This requires prioritisation, an overview of human resources, and the reallocation and mobilisation of resources. In order to successfully manage a crisis, it is important to train for such incidents. Third, the Norwegian Government is strengthening cooperation across sectors and cooperation with the civil society and private sector. This is about utilising society’s total resources. Together we are strong. And fourth, the Norwegian Government is strengthening international cooperation on health emergency preparedness. The pandemic showed us how vulnerable Norway is on its own. In order to better equip Norway to face future crises, the Norwegian Government is working to ensure Norwegian participation in the EU’s strengthened cooperation on health emergency preparedness. The Norwegian Government will further develop the Nordic cooperation on civil-military collaboration on health emergency preparedness and be a driving force behind investments in global public goods for health emergency preparedness.

Structure of the Report

Chapter 2 addresses strengthening the system for health emergency preparedness.

Chapter 3 discusses key elements of a resilient health emergency preparedness. In the event of a health crisis, the aim is to reduce vulnerability and limit the adverse impacts on society and the population as much as possible. The following elements are of particular importance:

• flexible health and care services

• trust and competence within the population

• strong civil society and private sector

• European and global resilience

Chapter 4 highlights six risk areas that require special attention in the coming years to reduce the probability and/or reduce the adverse consequences of incidents:

• hybrid threats and war

• cyber threats and vulnerabilities

• security of supply with an emphasis on access to medical countermeasures

• pandemic and infection control

• secure supply of safe drinking water

• nuclear incidents that threaten lives and health

In Chapter 5, the Norwegian Government concludes that a more challenging threat and risk situation means that emergency preparedness in society must be given a higher priority going forward. This also applies to health emergency preparedness. With more restrictive economic circumstances in the years to come, it is crucial that emergency preparedness be integrated into all parts of the health and care sector. By standing together, and with knowledge of our vulnerabilities, we will be better equipped to face future crises.