Purpose This study proposes a problem-solving framework grounded in Total Quality Management (TQM) to enhance preparedness for future pandemics. By comparing COVID-19 responses in Japan, United States, Taiwan, and India, it examines how TQM principles can strengthen adaptive governance and public health resilience. Design/methodology/approach A comparative analysis of infection trajectories, policies, and behavioral responses was conducted across four countries/regions with different governance structures. TQM principles, particularly process integration and preventive design, were applied to explain variations in infection and mortality rates, and to systematize quality elements and risk governance frameworks in daily social processes. Findings Timely, science-aligned leadership, and structured social processes were essential for effective pandemic response. Taiwan’s early cross-sectoral coordination fostered trust and compliance. In Japan, bureaucratic decision-making delayed timely actions, while in United States, fragmented federal-state leadership hindered policy consistency. India’s socio-economic constraints limited process control. These cross-national contrasts demonstrate that institutional maturity, advanced healthcare infrastructure, and abundant public resources alone do not guarantee effective crisis management. Rather, TQM principles – science-based leadership, process assurance, digital risk communication, and protection of high-risk populations – are key to ensuring coherent governance and behavioral compliance under uncertainty. Originality/value This paper reconceptualizes pandemic preparedness as a quality assurance challenge. By integrating TQM with digital governance and risk stratification, it presents a structured, feedback-driven model for minimizing risk, promoting equity, and reinforcing resilience in public health systems.
Kazuyuki Suzuki (2026) studied this question.