Temporality shaping lessons learned from COVID-19 - Follow-up study of Finnish pandemic governance

BACKGROUND: Public health crises require and offer unique opportunities for learning. Despite abundant “lessons learned” -literature on the COVID-19, follow-up research designs are scarce. To fill in this gap we analyse how key national level decision-makers in Finland discuss the lessons from COVID-19 at its’ different stages, since they are in key positions to develop health system preparedness and crises response policies based on lessons from past shocks. METHODS: The qualitative interview study includes unique follow-up data on Finnish national-level decision-makers’ interpretations of the lessons learned from COVID-19. The interviewees represent key ministries, other governmental organisations with responsibilities in pandemic governance, expert organisations and authorities responsible for preparedness. The data were collected from the same informants 1) at the acute stage of the epidemic in Finland (2021, n = 21) and 2) after the vaccination coverage was at high level and the acute stage of the epidemic had passed (2022-2023, n = 16). Analyses included abductive and thematical content analyses. RESULTS: The lessons learned from COVID-19 were defined differently at different stages of the pandemic. In addition, the possibilities to assess or implement the lessons or reform the system were hampered by scarce resources and the political agenda already shifting to other crises and challenges. Results further showed the short-term nature of many of the crisis measures taken during the acute stage. CONCLUSIONS: The follow-up design enabled analysis of the nature of the lessons learned during and after the acute stage of COVID-19. Temporal framing of data illustrated the changing and emergent nature of the lessons learned, highlighting the need for broad ranging analyses across multiple time spots and crisis cycles in the future. Scarce human and financial resources in the health system compel to focus on most topical issues, hampering long-term development. KEY MESSAGES: • Preparation for future crises requires practical measures during normal times. • Comprehensive analyses of lessons learned beyond a single crisis cycle supports continuity of crisis preparedness and management.