Health leaders must take action to prevent contagion The world has faced a shortage of medical workforce for decades.1 Failure to tackle problems of recruitment and retention, accelerated by the covid-19 pandemic, is now manifesting in the closure of urgent and emergency services, and even whole hospitals, across high income countries. Closures and mergers of rural and remote hospitals are nothing new and have long been a feature of the centralisation agenda internationally.2 The current closures are different, being driven either by insufficient medical or nursing staff to keep services open or indirectly by high locum bills that send organisations into bankruptcy.3 Closures are also occurring in places that were previously immune, such as major towns and peripheral urban areas.4 The speed of change varies across jurisdictions. The Netherlands, for example, is taking a proactive approach through planned national reconfiguration over the next few years.5 Closures elsewhere are happenin