Federalism and the challenge of a swift public response to COVID-19
By: Alberto Diaz-Cayeros
Tags: Covid 19, Mexico, Federalism, Italy, Public Health

Like many residents in California, I am living through the COVID-19 epidemic, learning as we go along on how to best protect ourselves and our communities. We are also concerned about how to protect strangers, outside our friends and neighbors, whom we may be putting at risk by spreading the disease. My University took swift action, moving to an online learning model, avoiding travel, promoting simple guidelines of personal hygiene, and practicing social distancing. Our School District, instead, followed CDC and County protocols, keeping our children attending school for two weeks, on the grounds that they were not susceptible to the same risks as other members of our community. My public schools have only announced today their closing for a month. The rationale is compelling: Santa Clara County currently has 66 confirmed cases and one death, and the epidemic is growing at an exponential rate. Shouldn’t there be a more unified response to the crisis, shared by Universities, Schools and other social spaces of potential contagion?

Confirmed cases of COVID-19 follow an exponential curve as noted by the blue dots denoting a hypothetical doubling of cases every 4 days after February 27.

More broadly, what is the proper response to a new epidemic in a democratic nation? Measures taken in China are probably not a good guide to how the US or other democratic countries should respond to this crisis. But the way things are going, at least in California, we unfortunately might heading towards a scenario like Italy’s, where COVID-19 has overrun the capacity of highly sophisticated and developed health system.

The problem with making a case for aggressive measures that may arrest contagion is that there are still many unknowns regarding the future of the disease, notwithstanding the sophisticated models simulated by epidemiologists. We do not know how or why children are less susceptible to the disease. We are barely beginning to understand whether warm weather may reduce the rate of infection in the coming months. It is still quite unclear what the actual death rate is. But in addition to the crucial evidence that science is providing to chart a course of action, the US has a structural challenge in facing this epidemic, emerging from its form of government, namely federalism.

Federal systems of government have the peculiarity of being less capable of acting in unison for a threat such as a pandemic. Federalism protects diverse interests creating veto points that empower local actors. But in so doing, it is also less able to transmit centralized decisions to subnational levels of government. There is quite a bit of evidence suggesting that for those same reasons, countries organized along federal lines are more unequal than unitary systems. The national State in federal regimes has less capacity to compensate and equalize when local and state actors block efforts at redistribution. Of course some federal systems are more unequal than others, with the US and the Latin American federations being more unequal than the European ones. But the general point is that in federal systems it is harder to shift resources to where they are most needed or to create solidarity among various territorial units, because of an in built feature in the arrangement that leads towards uncoordinated decision making.

Therefore, one of the complications in the response to COVID-19 in the US, and presumably in other federal systems, is that national strategic responses are harder to put together. This may be one of the elements that explains why Italy, though not strictly federal but characterized by a highly decentralized system of government, could not react in the same way as Taiwan or Japan did. The Italian regions are analogous to the US in their response to the COVID-19 crisis, because they initially were characterized by uncoordinated responses, particularly in what regarded aggressive testing. The Veneto region, as seen below, tested almost 5 per 1000 inhabitants, while Emilia Romagna only a third of that rate. Positive confirmed cases depended on the prevalence of testing, but there might have been an important insight in the authorities of some regions that may have been more able to prevent deaths by slowing down the spread in their jurisdictions.

Prevalence of testing by Italian region. Information from Dipartimento della Protezione Civile (March 12, 2020)

Provincial level data from Italy provide some additional insight, although it is very important to clarify that any claims regarding causal chains or an explanation are invalid with the information we have thus far. There is, however, a greater prevalence of cases in places where there is more jurisdictional fragmentation. The scatterplot is by no means a “smoking gun”, in the sense of providing definitive evidence, but it is suggestive, and a cross sectional regression model shows that the positive correlation is a statistically significant (a slope different from zero) positive one. The provinces in Italy also show what may be a climatic North — South gradient, although it is too soon to know whether this might be a consequence of temperature (we do not yet know how susceptible the virus is to those environmental conditions) or simply a confounding factor related to the way contagion progressed over the Italian territory.