A crucial argument put forward by our eminent colleagues (Frank et al. 2022) in their paper on public health practices and pandemics in the 21st century is that our common discipline has developed a unique and critical understanding of some of the greatest threats we face in our societies and around the world. Their vision is to make use of the experience gained during the current health crisis – without forgetting the errors and the shortcomings – to fully engage in the resolution of those major problems, which happen to share many characteristics with a “classic” pandemic. This is a commendable objective built on a strong scientific foundation. Where the approach may be less convincing, however, is that it does not pay much attention to institutional factors and policy processes.