Hybrid threats require hybrid solutions: A roadmap for healthcare security

Health systems are increasingly disrupted by hybrid threats, which include scientific espionage, sabotage of healthcare infrastructure, disinformation campaigns, and cyberattacks. These threats undermine not only patient safety, service continuity, workforce trust and public confidence, but also national security. As a result, attacks on healthcare have emerged as a new instrument of geopolitical power. In an era defined by whole-of-society disruption, a roadmap is required to strengthen healthcare resilience through an integrated approach emerging from health security ecosystems. Building effective health security ecosystems requires action across four interdependent priorities (STEP framework): (a) Security awareness and medical intelligence (MEDINT) that provide indications and warnings of hybrid disruptions; (b) Technology integration to provide an operational edge; (c) Education and upskilling of the health workforce to function under conditions of sustained disruption; and (d) Partnerships across public, private, and academic sectors. Embedding the STEP framework in policymaking, clinical practice, and research can mitigate hybrid threats and address critical health system vulnerabilities.