Introduction

COVID-19 pandemic has disrupted the political, economic and healthcare systems of most, if not all countries across the globe. As such, the COVID-19 pandemic represents another global health catastrophe similar to the Spanish influenza (1918–1920), H1N1 swine influenza (2009–2010) and West African Ebola (2014–2016) with high mortalities. Current public health measures aimed at subduing the spread of COVID-19 virus seem to be working but are not extensive enough to prevent ongoing infections and death.1 There is a need for leadership at the systems level, necessary because COVID-19 represents a complex problem, of a type commonly characterised as (volatile, uncertain, complex ambiguous (VUCA) unlikely to be effectively addressed by a single agency or person.2 In the context of COVID-19, leadership of the system encompasses politicians, scientific experts, civil servants and front-line practitioners, where leadership is shaped by the system in which it is enacted, and its historical, political and national characteristics.3 4 We discuss systems level leadership to address the COVID-19 outbreak,5–7 with concern for recovering from COVID-19.

As our first aim, we outline three themes related to how systems level leadership might influence recovery from the COVID-19 pandemic. Second, we provide comparative international descriptors that we critically evaluate against these three systems level leadership themes. We draw on observations of the way systems level leadership is enacted across England, Australia, India and in the Caribbean (Aruba), thus drawing on lessons from both OECD nations and low-income and middle-income countries (LMICs), and small as well as large countries, in our analysis. Following which, in our conclusion, we set out prescriptions for systems level leadership in the context of considerable VUCA.2