National Governance of Public Health Responses in a Pandemic?

The world is currently facing the worst pandemic in a century and we were caught unprepared. COVID-19 has proven highly contagious and with severe consequences that are still unfolding. As of 16 April 2020, there were over 2 million confirmed cases and over 136,000 related deaths reported worldwide.Footnote1 Over 1 million of those confirmed cases were in the preceding 14 days, with the USA accounting for nearly half of those. Furthermore, the International Monetary Fund (IMF) is now warning that the world is about to suffer the worst economic recession since the Great Depression in the 1920s.Footnote2 However, although the World Health Organization (WHO) provides scientific expertise globally and some other examples of limited centralisation exist (eg the European Union (EU) provides for minimum quality standards regarding medical products or food), public health is primarily governed at a national level or regional level (within the nation state). Consequently, despite some overlap in mechanisms such as contact tracing and social distancing, responses have varied considerably in objectives, timing and degree – even within the EU or across the USA. This raises the fundamental question of whether national decision-making is effective or indeed appropriate in the context of the COVID-19 or similar future pandemics,Footnote3 or whether a supranational or international approach would be more appropriate. In order to address this question, the nature of COVID-19 and the policy responses are analysed through the lens of subsidiarity