VATICAN CITY — As Pope Leo XIV faces a period of serious medical uncertainty, the Vatican’s ability to function hinges on the balance of power between the papal household — including his secretaries, Father Edgar and Father Marco Belleri, and the Pope’s inner circle — and the Secretariat of State, based in the Third Loggia of the Apostolic Palace.

Across the Tiber, the time has come for what Buckingham Palace calls “the Firm”: a shadow government ready to keep the institution running through a crisis.

“The ‘deep state’ is at work, but it does not include every head of a Vatican department,” said Father Filippo Di Giacomo, a canon lawyer. “It consists of Secretary of State Pietro Parolin, Archbishop Paolo Rudelli, the Substitute for General Affairs, and officials responsible for finances and foreign affairs, including Giordano Piccinotti and Paul Gallagher.”

“It is a ‘war room’ with full powers, operating around the clock even during a vacancy of the Holy See or other emergencies, despite the fact that the apostolic constitution Praedicate Evangelium attempted to undermine it by reforming the Roman Curia six years ago in a way that made it worse,” he said.

“In every emergency, when the holder of sovereign power is absent, the ‘deep state’ continues to operate without difficulty. In the Church, nobody is more dead than a dead pope. Even in the most tragic circumstances, the structures that must temporarily replace the pope remain active. Anything can happen, but the Church endures. The institution may slow its pace, but it does not stumble; it keeps moving under its own power.”

As St. John Bosco taught, Di Giacomo added, the traditional cry is not “Long live Pope Pius,” but simply “Long live the pope,” whoever he may be. Leo’s participation in a procession in Lourdes while ill, two weeks ago, offers a powerful reminder, he said, that all the baptized are equal before God.

The current camerlengo, the cardinal responsible for administering the Holy See during a vacancy, is Kevin Joseph Farrell.

“The simplicity with which Leo has shared his illness reflects the deeply human character of his ministry,” said Father Giulio Albanese, an adviser to the Secretariat of State. “Even those who sustain the faith of so many people need support themselves. The shepherd, too, draws strength from the affection of his flock. This reciprocity reveals the beauty of the Church as a family that gathers around those facing hardship.”

“Confidence in the expertise of doctors goes hand in hand with solidarity with those in hospital wards who, often alone, await a diagnosis, an operation or relief,” he added.

In the days surrounding his surgery at Gemelli Hospital, Leo moved to reinforce the Vatican’s leadership, appointing Cardinal Luis Tagle dean of the College of Cardinals and Archbishop Vittorio Viola Vicar General for Vatican City. Both positions remain in place during a vacancy of the Holy See.

Tagle, who was considered a possible successor to Leo at the last conclave, will stand in for the Pope at a Mass marking the 10th anniversary of the apostolic exhortation Amoris Laetitia. Prayers will be offered for Prevost’s recovery.

The canonical rules are clear: The papal office becomes vacant only upon the pope’s death or a valid resignation, not simply because he has been hospitalized. Admission to a hospital does not suspend the prerogatives of the bishop of Rome or automatically transfer his powers to another Church authority. Even when undergoing surgery or facing an extended hospital stay, the Pope remains in office and can continue to exercise his authority to the extent permitted by his health.

In practice, however, precedent may prove more influential than the letter of the law.

The model is John Paul II’s recovery after the 1981 assassination attempt, which offers a precedent for informal coordination beyond the provisions explicitly set out in canon law. Vatican officials are now preparing to follow a similar approach, drawing on the arrangements through which senior figures — above all Cardinal Agostino Casaroli, in a complex relationship with the Pope’s Private Secretary, Stanisław Dziwisz — helped manage the Church during the early years of John Paul II’s pontificate.

That, too, was a pope whose leadership was interrupted by a serious setback, only for him to return to the full exercise of his office. His suffering also became a powerful testimony, reaching beyond the Church to remind the world’s most powerful leaders of human vulnerability and the need to stand by those facing illness.

“We do not know how serious the situation is, but Prevost has brought order to the institution, in keeping with his style,” said sociologist Massimo Introvigne. “Francis had created a ‘Bergoglio-centric’ Vatican, in which personal charisma took precedence over the institution.”

Leo’s Curia, Introvigne said, “is much more institutional and therefore better equipped, if necessary, to function during a prolonged absence of the pontiff. The appointments made just hours before the announcement of his hospitalization confirm Leo’s determination to put the institution at the center.”

Prevost’s message is clear: “Don’t look at me; look at the Church.”

That approach reflects a different sensibility from his predecessor’s and could encourage a more coordinated, team-based response, allowing the pope’s commitment to multilateral diplomacy to continue even during a period of uncertainty.

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