This chapter examines the governance of health technologies during the COVID-19 pandemic and reflects on three interrelated challenges that need to be addressed in future assessment approaches for achieving systemic resilience: problems of scale, trust and politics. The chapter focuses on digital surveillance technologies and vaccines, two cornerstones in the efforts to mitigate the spread of SARS-CoV-2 around the globe. Tracing apps were introduced in many countries, but their effectiveness has been constrained by issues of data privacy, insufficient interoperability and digital inequalities. In parallel, a global research race enabled the development of different vaccines with unprecedented speed, building on innovative biotechnologies. However, vaccination worldwide was marked by disparities in access and controversy. We conclude that governance and assessment should be built around strong international coordination and cooperation, without limiting local experimental learning and innovation. Further, public trust should be considered as a necessary condition for the success of any technological innovation in the health context. As trust in policymakers, academia and industry is strongly context-specific, global governance should also be sensitive to the diversity of social and cultural contexts. Finally, to improve overall systemic resilience, global power imbalances should be addressed in all phases of the innovation process.