“Too many times in health or public health or in public life we tend to dismantle and try and rebuild.”
As the COVID-19 pandemic stretched health systems across the globe, Dr. Mike Ryan of the World Health Organization emerged as one of the most visible voices in emergency response. On January 22, 2021, during a WHO COVID-19 press briefing, he reflected on a familiar reflex in politics and public health: when systems fail or fall short, the instinct is often to tear them down and start again. His observation was not just about the pandemic, but about how societies handle crisis, complexity, and the urge for quick fixes when people are afraid or frustrated.
Ryan’s point speaks to a core tension in health policy. Health systems are intricate networks of clinics, hospitals, laboratories, supply chains, and people—especially the workers who keep services running. Dismantling those systems in moments of stress can disrupt care for millions, from routine vaccinations to emergency surgeries. Instead of scrapping what exists, Ryan argued for evolving, strengthening, and better coordinating current structures. The goal is not endless reform for its own sake, but practical improvements that make care more accessible, more resilient, and more equitable, particularly for vulnerable populations who are usually hit hardest when systems falter.
The quote also challenges how leaders frame accountability. When something goes wrong, it can be politically attractive to promise a total reset: closing agencies, replacing leadership, or creating entirely new institutions. Yet genuine accountability often means investing in training, data systems, local capacity, and long-term planning, rather than sweeping away decades of built experience. In health, this might look like reinforcing primary care, supporting community health workers, or modernizing surveillance systems—changes that are less dramatic on a podium but far more powerful in practice.
Beyond the pandemic, Ryan’s words resonate with other health challenges such as climate-related emergencies, chronic disease, and mental health. Each requires sustained, coordinated action rather than episodic overhauls. The quote is ultimately a reminder that building stronger health systems is slow, detailed work: learning from failure without discarding what already functions, valuing collaboration over disruption, and recognizing that the most effective reforms often grow from within. In urging the world not just to rebuild, but to evolve, Ryan captured a principle that will shape public health far beyond the crisis that prompted his remarks.
On January 22, 2021, during a World Health Organization (WHO) COVID-19 press briefing, Dr. Mike Ryan, Executive Director of the WHO Health Emergencies Programme, reflected on how countries respond under pressure. He warned that “too many times in health or public health or in public life we tend to dismantle and try and rebuild” when systems appear to struggle or fall short in a crisis.
Ryan’s comment came at a moment when governments were facing intense scrutiny over their pandemic responses. Rather than calling for the wholesale tearing down of institutions, he urged leaders to strengthen and evolve existing health systems. His message emphasized that resilient systems are built through sustained investment, learning, and adaptation, not through repeated cycles of destruction and reinvention.
In practical terms, Ryan’s quote highlights the risks of reacting to health crises with sweeping institutional overhauls. Health systems are complex networks of primary care clinics, hospitals, laboratories, supply chains, and public health agencies. Rapid “dismantling” can disrupt routine vaccinations, chronic disease management, and emergency care, often harming the very communities reforms aim to protect.
Applying his principle means identifying weak points and reinforcing them instead of starting from scratch. That could involve better data systems for tracking outbreaks, stronger support for health workers, or clearer coordination between national and local authorities. The focus is on incremental, evidence-based improvements that preserve functioning parts of the system while addressing gaps revealed by crises.
Ryan’s caution against “dismantle and rebuild” approaches does not deny the need for deep reform. Critics of existing systems argue that some structures are so underfunded, fragmented, or inequitable that modest adjustments are not enough. They point to persistent gaps in access, quality, and preparedness as evidence that more radical redesign is sometimes necessary.
The ongoing debate centers on how to balance transformation with continuity. Ryan’s quote is often read as a call to avoid politically appealing but destabilizing resets in favor of measured, sustained change. Its relevance extends beyond COVID-19 to other challenges—such as climate-related health shocks, mental health crises, and aging populations—where durable progress depends on strengthening institutions rather than repeatedly replacing them.
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