In this stream we will highlight and reference work dealing with building a shift from a dominant health systems ‘efficiency’ paradigm to complex, dynamic, adaptive systems. If anything emerges as painful awareness from this crisis, it is the hampered levels of adaptivity of many health care systems, even (or maybe notably) in the richer parts of the world. For decades, an ‘efficiency’ paradigm has reigned at the detriment of more investment in ‘(local) contextuality’, ‘flexibility’, ‘adaptivity’. We need to rethink urgently how health systems around the world could be reconfigured as dynamic adaptive systems. Even in this emergency phase this is already on top of the agenda in most countries, now we see that systems cannot handle ‘surges’. But also beyond the immediate demands, suggestions of adaptation/adaptivity have emerged in many settings for a while, and not should be taken to the next level.