Individual patients’ safety and public health were compromised by critical drug shortages, substandard medications, and extremely restricted access to personal protective equipment during the COVID-19 pandemic. As health organizations and workers struggled to meet demands posed by unprecedented patient numbers and illness acuity, our complex global health ecosystem with long-standing upstream supply chain vulnerabilities failed to meet emergent downstream demand in several ways. First, material procurement and ingredient sourcing were inadequate. Second, operations lacking transparency made stopping propagation of substandard or falsified medications ineffective, inefficient, or impossible. Finally, logistical obfuscation made environmental consequences of waste management hard to assess and steward responsibly. Policy makers, health care organizations, regulators, manufacturers, and distributors each have roles in building and maintaining global medical supply chain security. This theme issue investigates how these and other agents’ failures to cultivate public health capacity, nourish sustainable production processes, and carefully maintain systemic supply chain resiliency are neither accidental nor simply unfortunate, but unjust.