Pope Leo XIV entered the hospital on Oct. 13 to undergo surgery to remove a lung nodule. The Vatican has said his recovery in the hospital will take at least a week and the pope’s appointments are canceled through Oct. 20.
An extended hospital stay for one of the most important leaders in the world may raise the question: Who exactly runs the Vatican wh
en 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 EWTN News in 2025 after then-Pope Francis was hospitalized that in such cases, “the machinery of state tends to keep functioning.”
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 apprised 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.
Pope Leo is expected to be hospitalized for just a week. But in some cases, popes have addressed the possible need for resignations in the event of serious health crises.
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 had signed his resignation and given 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 late pope joked at the time.)
In his biography published in 2024, Francis said he considered 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.
The Vatican said on Oct. 13 that the pope’s surgery was completed successfully. Yet in the event of a pope’s death, Bunson said, much of the immediate administration of the Vatican falls to the camerlengo of the Holy Roman Church — one of the few officials of the Vatican who does not immediately lose his job upon a pope’s death.
The camerlengo’s roles include certifying the pope’s death and overseeing the functions of the interregnum.
“It’s his job to certify the death of the reigning pope and to make sure the wishes of the pope are respected,” Bunson explained. “Then the cardinals are summoned to Rome,” after which a new pope is eventually elected.
Also retaining his title in the event of a pope’s death is the head of the Apostolic Penitentiary, the dicastery for which the chief role is the forgiveness of sins.
That official “always keeps his job,” Bunson said, “because there must always be the opportunity for God’s loving mercy.”
A second key official is the almoner of his holiness, the cardinal in charge of papal charity and care for the poor. It was Pope Francis who decreed that the almoner should keep his post, a reflection of Francis’ concern for the forgotten and most vulnerable.
This story was first published on Feb. 26, 2025, and was updated on Oct. 13, 2026.