This chapter situates the COVID-19 pandemic and responses to it within global public health systems. As a mixture of public health and social measures were implemented globally to slow the spread of the virus, economies and social interactions were curtailed to huge social and economic cost. Reinforcing existing and deeply entrenched social inequalities, the crisis highlighted the incapacity of health systems around the world to address inequality and highlighted the need for a radical rethink of the neoliberal institutions – including health systems – that underpin modern life. Building systems through a lens of social justice requires better focus on local, national, and global coordination and an explicit focus on addressing social and health inequalities.