Strengthening pandemic preparedness in Peru: a qualitative study of high-level leaders involved in the COVID-19 response.

Introduction: The COVID-19 pandemic exposed critical gaps in Peru's preparedness and response, including the absence of sustainable, intersectoral strategies to address systemic vulnerabilities and improve resilience. Through interviews with national leaders, we sought to identify key issues and actionable strategies for sustainable mechanisms that could improve preparedness and response for future pandemics. Methods: We conducted in-depth, semistructured key-informant interviews using snowball sampling to recruit 14 high-level leaders who were engaged in the COVID-19 pandemic response. Participants informed decision-making in Peru within health and other sectors, and within government, private sector, academia, multilateral agencies and non-governmental organisations. Data were analysed thematically. Results: Participants highlighted key challenges and opportunities in Peru's pandemic response. Two overarching themes emerged: (1) contextualising Peru's response, which explores the structural, cultural and systemic factors shaping the pandemic response, and (2) coordinating intersectoral mechanisms, which highlights the dynamics of collaboration, leadership and resource sharing across sectors. Participants emphasised the need to improve healthcare and emergency response systems, foster transparent and culturally sensitive communication, and institutionalise multisectoral collaboration. They also highlighted the importance of involving communities in planning and ensuring financial readiness for future emergencies. Conclusions: Findings emphasise the urgent need for a cohesive, sustainable approach to pandemic preparedness in Peru, emphasising robust multisectoral collaboration, equitable resource distribution and transparency. These recommendations provide a pathway to strengthen Peru's resilience and offer insights applicable to other low- and middle-income countries facing similar challenges.