Who’s in charge of the Vatican while Pope Francis is hospitalized?

Pope Francis entered the hospital for treatment of bronchitis on Feb. 14. Almost two weeks later, doctors say the pope – who contracted a case of double pneumonia while at Rome’s Gemelli Hospital and experienced a “respiratory crisis” on Saturday – will remain in the facility while recovering due to his “complex” medical situation.

An extended hospital stay for one of the most important international figures in the world may raise the question: Who exactly runs the Vatican when a pope is hospitalized or unable to perform his normal duties?

Matthew Bunson, vice president and editorial director of EWTN News and the author of numerous books on Catholicism including “Encyclopedia of Catholic History,” told CNA that although Pope Francis has been in the hospital for almost two weeks, he has continued at least some oversight of Vatican affairs.

Bunson pointed to coverage by ACI Stampa, CNA’s Italian-language news partner, which reported that the pope earlier this week met with his secretaries at Gemelli while recovering from his illness.

“So he’s clearly still in touch with the Vatican and is still making decisions,” Bunson said. 

In such cases, he said, “the machinery of state tends to keep functioning until such time as we enter into an interregnum” – the period in between popes. 

Andreas Widmer, an associate professor of practice in entrepreneurship at The Catholic University of America’s Busch School of Business and former Swiss Guard at the Vatican, likewise said much of the Vatican’s administration continues even when the pope is sick. 

“Things keep going. He is kept appraised by (Vatican officials),” said Widmer, who served as a Swiss Guard under Pope John Paul II in the 1980s and who regularly returns to the Vatican to work with the guard.

“From what I understand, the pope is still lucid and working,” Widmer said of Francis’ current hospitalization. “Maybe he doesn’t put in his 12-hour days, but he’s putting in work and meeting with people.”

In some cases, popes have addressed the possible need for resignations ahead of time. Pope Paul VI in 1965 wrote a letter to the dean of the College of Cardinals stating that, in the event of his incapacitation while in office, he should be considered resigned. (Pope Paul ultimately lived another 13 years and died while in office.)

In 2022, Pope Francis revealed that in the first year of his pontificate he signed his resignation and gave it to then-Vatican Secretary of State Cardinal Tarcisio Bertone to be invoked if he was medically incapacitated and unable to carry out his duties. (“I don’t know who Cardinal Bertone gave it to, but I gave it to him when he was secretary of state,” the pope joked at the time.)

However, in his biography last year, the pope said he considers the Petrine ministry to be “for life” and saw no conditions for resignation, barring serious physical impairment.

Widmer argued that popes are not given to leaving such matters unresolved one way or the other. “A pope is not going to leave this to chance. They take their responsibility very seriously,” he said. 

Bunson noted the recent similar scenario in which St. John Paul II declined in health toward the end of his pontificate; during that period, he said, it was clear that preparations were being made for a possible interregnum.

“Clearly we’re not in that position yet, so the Roman Curia continues to function” as normal, he said.