Expert perspectives on priorities for supporting health security in the Pacific region through health systems strengthening.

The COVID-19 pandemic has reiterated the interdependence of health security and health systems, and the need for resilient health systems to prevent large-scale impacts of infectious disease outbreaks and other acute public health events. Three years into the COVID-19 pandemic has led to discussions on how to "build back better", making it important to identify lessons to strengthen health systems and prevent future shocks from health security threats. Limited data exist on effective implementable initiatives, especially for the Pacific region. We explored the perceptions of a selection of experts with field experience in the Pacific region to identify and prioritise areas for future health system investments that strengthen health security. We conducted a qualitative cross-sectional study, collecting data using four focus group discussions. We analysed the data using a content analysis of notes recorded from each of the sessions. There were 24 participants, representing 15 research and academic institutions, nongovernment agencies, UN agencies and government as well as independent consultants. All were health sector stakeholders with field experience in the Pacific region and expertise in either health systems or health security. The analysis revealed four areas to prioritise future efforts, namely workforce development, risk communication, public health surveillance and laboratory capacity. A fifth theme, localisation, was identified as a cross cutting theme that should be applied to implementation of other identified priority areas. These findings provide a starting point to apply in practice this relatively new concept, of targeted health systems strengthening for health security development, in the Pacific. Evaluation of these initiatives will strengthen knowledge on the value of integrating these two concepts.