Abstract
Introduction: European health security has undergone substantial post-pandemic reform, with new arrangements for surveillance, crisis coordination, medical countermeasures, workforce mobilisation, civil protection, cybersecurity and preparedness assessment. At the same time, the threat environment has expanded beyond conventional public health emergencies to include deliberate biological events, cyber disruption, information manipulation and interacting cross-sector failures. However, the existence of preparedness strategies, institutions and resources does not necessarily demonstrate that these capabilities can be activated, scaled, sustained and adapted under crisis conditions. This study examined the extent to which the emerging European Union/European Economic Area (EU/EEA) health preparedness architecture is supported by documented operational readiness. Methods: A structured qualitative policy analysis and capability-based Framework Method were applied to 33 primary sources published between 1 January 2024 and 17 September 2026. The analysis generated 185 document–capability observations across eight operational-readiness domains. Evidence was differentiated between policy commitments, established mechanisms, operational functionality, completed exercise-based validation and real-world use, without constructing a composite readiness score. Results: The analysis identified extensive preparedness architecture but uneven translation into demonstrable operational capability. Documented preparedness–readiness gaps were present in 74 observations and clustered around operational formalisation, interoperability and situational visibility, workforce and supply scalability, exercise-based validation, corrective-action closure and cross-border integration. Operational evidence was stronger for selected capabilities, including laboratory surge, deployable public-health expertise, medical-countermeasure mechanisms and cross-border patient transfer. By contrast, evidence for digital interoperability, information integrity and system-wide responses to hybrid, compound and cascading disruption remained less developed. Conclusions: The principal preparedness–readiness challenge is not simply the absence of capability, but discontinuities between formal architecture and scalable, interoperable, validated and adaptive operational performance. Operational readiness should therefore be understood as a dynamic and conditional system property shaped by capability, activation, scalability, critical dependencies, validation and learning rather than inferred from preparedness structures alone.