American Federal Systems and COVID-19: Responses to a Complex Intergovernmental Problem 9781801171663, 9781801171656, 9781801171670, 1801171661

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AMERICAN FEDERAL SYSTEMS AND COVID-19

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AMERICAN FEDERAL SYSTEMS AND COVID-19 Responses to a Complex Intergovernmental Problem EDITED BY

B. GUY PETERS

University of Pittsburgh, USA

EDUARDO GRIN

Fundação Getulio Vargas, Brazil And

FERNANDO LUIZ ABRUCIO Fundação Getulio Vargas, Brazil

United Kingdom – North America – Japan – India Malaysia – China

Emerald Publishing Limited Howard House, Wagon Lane, Bingley BD16 1WA, UK First edition 2021 Editorial matter and selection © 2021 B. Guy Peters, Eduardo Grin and Fernando Luiz Abrucio. Published under exclusive licence by Emerald Publishing Limited. Individual chapters © 2021 the authors. Published under exclusive licence by Emerald Publishing Limited. Reprints and permissions service Contact: [email protected] No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. Any opinions expressed in the chapters are those of the authors. Whilst Emerald makes every effort to ensure the quality and accuracy of its content, Emerald makes no representation implied or otherwise, as to the chapters’ suitability and application and disclaims any warranties, express or implied, to their use. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-80117-166-3 (Print) ISBN: 978-1-80117-165-6 (Online) ISBN: 978-1-80117-167-0 (Epub)

CONTENTS

About the Editors

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About the Contributors

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Introduction B. Guy Peters, Eduardo Grin, and Fernando Luiz Abrucio

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1. Federal Systems: Institutional Design and Political Agency B. Guy Peters, Eduardo Grin, and Fernando Luiz Abrucio

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2. American Federalism in the Pandemic B. Guy Peters

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3. Argentine Federalism in COVID-19 Pandemic Daniel Alberto Cravacuore

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4. Brazilian Federalism in the Pandemic Fernando Luiz Abrucio, Eduardo Grin, and Catarina Ianni Segatto

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5. Canadian Federalism in the Pandemic ´ Catarina Ianni Segatto, Daniel Beland, and Shannon Dinan

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6. Mexican Federalism in the Pandemic ´ Edgar E. Ramírez de la Cruz and D. Pavel Gomez Granados

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7. Conclusions Eduardo Grin, B. Guy Peters, and Fernando Luiz Abrucio

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Index

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ABOUT THE EDITORS

B. Guy Peters is a Maurice Falk Professor of Government at the University of Pittsburgh. He was founding president of the International Public Policy Association and is now editor of the International Review of Public Policy. His recent publications include Administrative Traditions (Oxford University Press), Democratic Backsliding and Public Administration (Cambridge University Press), and The Advanced Introduction to Public Policy, 2nd ed. (Edward Elgar). Eduardo Grin, PhD in Public Administration and Government, is Professor and Researcher at Fundação Getulio Vargas/São Paulo, Brazil, where he teaches on local government, federalism, and public policies. He has carried out research supported by institutions such as UNESCO, the British Embassy in Brazil, the Global Initiative for Fiscal Transparency, World Bank, and the Latin American Development Center for Administration. Currently he is a member of a research team from eight Latin American Universities dedicated to building the Regional Development Index (IDERE). Eduardo’s major publications include Intermunicipal Cooperation in Metropolitan Regions in Brazil and Mexico – Does federalism matter? (Urban Affairs Review) and The Transaction Costs of Government Responses to the COVID-19 Emergency in Latin America (Public Administration Review). Fernando Luiz Abrucio, PhD in Political Science, is Professor at São Paulo School of Business Administration/Fundação Getulio Vargas, Brasil, where he teaches Public Administration, Federalism, and Public Policies, especially Education Policy. Winner of the Moinho Santista Award as the best young Brazilian political scientist, Fernando was a visiting researcher at Massachusetts Institute of Technology (MIT). He has had research projects supported by the Ford Foundation, World Bank, UNESCO, World Wildlife Fund (WWF), Inter-American Development Bank, and United Nations of Development Program (UNDP). He has also participated in international consulting programs in Latin America and Africa. Fernando’s major publications include Federalism and Democratic Transitions: The New Politics of the Governors of

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Brazil (Publius) and Intermunicipal Cooperation in Metropolitan Regions in Brazil and Mexico – Does federalism matter? (Urban Affairs Review). He is ˆ also a political columnist for the Valor Economico newspaper.

ABOUT THE CONTRIBUTORS

Daniel B´eland is Director of the McGill Institute for the Study of Canada and the James McGill Professor in the Department of Political Science at McGill University. He has held visiting academic positions at Harvard University, the University of Bremen, the University of Nagoya, the University of Southern Denmark, and the Woodrow Wilson International Center for Scholars. Professor B´eland currently serves as Editor (French) of the Canadian Journal of Sociology and President of the Research Committee 19 (Poverty, Social Welfare, and Social Policy) of the International Sociological Association. A student of social and fiscal policy, he has published more than 160 peer-reviewed journal articles and 20 books, including Fiscal Federalism and Equalization Policy in Canada: Political and Economic Dimensions (2017; with Andr´e Lecours, Gregory P. Marchildon, Haizhen Mou, and Rose Olfert) and Universality and Social Policy in Canada (2019; edited with Gregory P. Marchildon and Michael J. Prince). Daniel Alberto Cravacuore, PhD, is Professor of Local Government and Director of the Centre for Territorial Development, National University of Quilmes, Argentina. He has been the Director of the Ibero-American Network of Municipalist Academic Centres since 2016. He serves on numerous editorial boards and as an advisor to many of Latin America’s national municipal associations. He is an Advisory Committee Member of the Latin American Federation of Cities, Municipalities and Associations, as well as Visiting Scholar at universities in Chile (University of Valparaiso), Colombia (University of Valley), Spain (Autonomous University of Madrid and University of Jaen), and the United States (Florida International University). He has carried out many international projects for the UNDP, UNICEF, ILO, EU, UCLG, and various national agencies (AECID, AMEXID, IDRC, SKL). He was the Former Editor of the Ibero-American Journal of Municipal Studies. He is also President of the International Foundation for Local Development (FINDEL). Shannon Dinan is an Associate Professor in Public Finance in the Department of Political Science at Universit´e Laval. As a public policy scholar, Professor Dinan’s research interests include the comparative welfare state and labor ix

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market policy. She obtained her PhD from the Universit´e de Montr´eal and was also a student fellow at the Centre d’´etudes europ´eennes et de politique compar´ee at Science Po Paris, the Department of Business and Politics at the Copenhagen Business School, and the Policy Network in London as part of her doctoral research. ´ D. Pavel Gomez Granados is a PhD Candidate and Research Assistant in the Public Administration Division at the Center for Research and Teaching in Economics (CIDE) in Mexico City. He is currently a doctoral candidate in ´ urbanism at Universidad Autonoma de M´exico (UNAM). His main interests are: urban sustainability, growth management, land use regulations, public management, and policy networks, as well as local governments, public services, and metropolitan governance. Edgar E. Ramírez de la Cruz is Professor and Department Chair in the Public Administration Division at the Center for Research and Teaching in Economics (CIDE) in Mexico City. He earned his PhD in Public Administration and Policy from the Askew School at Florida State University (FSU). His main interests are: urban sustainability, growth management, land use regulations, public management, and policy networks. Dr Ramírez is also a consultant for public, nonprofit, and private organizations in Mexico and the United States. Edgar Ramírez has published in academic outlets such as American Journal of Political Science, Public Administration Review (PAR), Urban Affairs Review, International Review of Public Administration, International Journal of Public Administration, and Housing Policy Debate. His most recent book on private capitalization of public goods was published last year in Mexico by CIDE. He ´ y Política Publica ´ is the Editor in Chief of Gestion and an Associate Editor of PAR. He was awarded in 2019 the International Public Administration Award by the American Society for Public Administration. Catarina Ianni Segatto is a researcher at the Center for Metropolitan Studies and Professor of the Graduate Program in Public Policy at the Federal University of ABC. She was a postdoctoral researcher at Johnson Shoyama Graduate School of Public Policy, University of Regina, and obtained her PhD in Public Administration and Government from the Getulio Vargas Foundation and was a visiting scholar at the University of Kent. Her research interests include discussing federalism, intergovernmental relations, and bureaucracy in social policies, especially education and health care.

INTRODUCTION B. Guy Peters, Eduardo Grin, and Fernando Luiz Abrucio

The upsurge of COVID-19 pandemic suddenly struck countries all over the world. The national responses to mitigate the disease and confront the multidimensional effects of the pandemic have been varied. However, regardless of the type or efficacy of these answers, this is a global problem since the virus spread without respecting territorial boundaries. Every country must consider the encompassing features of this problem when designing its intervention in public policies. In federal countries, their institutional and political characteristics make providing the public goods – in health, economic policy, education, and other policies – a much more complex issue (Bednar, 2009; Dardanelli, Kincaid, Fenna, Kaiser, Lecours, & Singh, 2018). This book addresses how five “democratic federal political systems” (Behnke & Mueller, 2017, p. 512) – Argentina, Brazil, Canada, Mexico, and United States – have been responding to a complex intergovernmental problem (CIP) (Paquet & Schertzer, 2020) such as the COVID-19 pandemic. Federal systems are composed of by formal and informal institutions that organize authority relationships among government’s spheres. Federal institutions seek to build the context through which different orders of government can relate among themselves in a more stable manner for the distribution of political authority and responsibilities. Understanding trajectories of changes within federations requires to take into account: (a) constitutional landmarks (if the relationships among territorial entities are based on defined responsibilities and powers, as well as whether federative bonds are more centralized or decentralized); and (b) intergovernmental relations systems (whether an institutionalized model or not, and how symmetrical or asymmetrical is the interchange among federal and subnational governments). In effect, developing a way how federations organize the possibilities of solving problems that affect all orders of government is very challenging for federations (Loughlin, Kincaid, & Sweden, 2013).

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The social and economic complexity of the contemporary societies, the expansion of international and national integration of the countries, as well as the expansion of welfare state influenced the growing state intervention in many public policies, especially since the second half of twentieth century (Obinger, Leibfried, & Castles, 2005). In federal countries, due to the existence of autonomous levels of government that formulate and implement public policies, intergovernmental coordination is one of the most challenging issues for this kind of territorial organization of the national state. Politically, federal arrangements are pact agreements which involve dividing powers among many territorial governments. Public policies require split responsibilities in each sector in which more than one government is involved. Since federal politics and public policies are a continuous issue of intergovernmental disputes, the struggle over the balance of power between national and subnational government usually is continuous (Bakvis & Brown, 2010; Bakvis & Juilet, 2004). If scale is an important dimension of public policy problems, in federal countries this issue is even more relevant. Some policy problems must be thought of as large scale, requiring interventions that “solve” it in its entirety, or which address them across the country (Peters, 2018; Schulman, 1980). Other problems are small scale which are handled better if decentralized and delivered locally. And many policy problems have aspects of both the largeand small-scale problems and, therefore, require matching with the size of delivery units. Complexity of issues is another dimension of a policy problem that must be considered when designing policies. Complexity has several dimensions that should be considered. One is political complexity (number and strength of contending interests involved in the policy). Few, if any, policies are entirely consensual, but some are more politically complex than others. For example, an economic development project is likely to pit economic interests against environmental interests, both of which would be capable of exerting political pressure. Another dimension is substantive complexity. For some policies, cause and effect can be identified readily, and, therefore, interventions can be planned effectively. Likewise, for some policies, the relationship between cause and effect are linear and stable, usually producing small changes, and remaining constant across a wide range of values of those variables. However, for a complex (Cairney & Geyer, 2015) or “wicked” (Rittel & Webber, 1973; Peters, 2017) problem, a small increase in the independent variable(s) may produce very large, or perhaps no change in the dependent variable. Further there may be tipping points at which a small increase in

Introduction

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the variable will have very large effects, notwithstanding a linear relationship for much of its range. The problems presented to policymakers by wicked problems may be confounded because the cause and effect relationships are, in general, unclear, and there may be no agreement even among experts about policy designs to deal with them. And for many of these complex problems such as climate change, time is running out, and unless some effective intervention is made, the effects will not be redressed (Levin, Cashore, Bernstein, & Auld, 2012). Finally, substantively complex policy problems tend to be politically complex once they affect large swathes of the society. So, what can government do when confronted before a problem such as this? The COVID-19 pandemic is a policy problem and more generally a governance problem (Knill & Tosun, 2020). However, this kind of problem “requires intergovernmental coordination and cooperation for effective policy responses” (Paquet & Schertzer, 2020, p. 1). But, as substantial evidence is demonstrating, the success rates of different countries in this struggle with the disease have been markedly different. The book analyzes five federations, where territorial dynamics are a key issue as for coordination of public policies. Because of that, in federative countries, the fight against COVID-19 becomes a CIP. Thus, the main question that guides the understanding of empirical cases is: how structures and institutions of federative systems and political leadership may affect their actions to face the COVID-19 as a CIP (Paquet & Schertzer, 2020)? To answer this question, this ‘book’ is organized as follows. First, the theoretical approach and analytical issues to compare the five national cases based on the federalist literature are proposed. The second to sixth section will discuss each national case. In the conclusions, we will return to the main goal to present main findings and questions for future research.

REFERENCES Bakvis, H., & Brown, D. (2010). Policy coordination in federal systems: Comparing intergovernmental processes and outcomes in Canada and the United States. Publius: The Journal of Federalism, 40(3), 484–507. doi: 10.1093/publius/pjq011 Bakvis, H., & Juillet, L. (2004). The horizontal challenge: Line departments, central agencies and leadership. Ottawa, ON: Canada School of Public Services.

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Bednar, J. (2009). The robust federation. Principles of design. Cambridge: Cambridge University Press. Behnke, N., & Mueller, S. (2017). The purpose of intergovernmental councils: A framework for analysis and comparison. Regional & Federal Studies, 27(95), 507–527. doi:10.1080/13597566.2017.1367668 Cairney, P., & Geyer, R. (2015). Introduction. In R. Geyer & P. Cairney (Eds.), Handbook on complexity and public policy. Cheltenham: Edward Elgar. Dardanelli, P., Kincaid, J., Fenna, A., Kaiser, A., Lecours, A., & Singh, A. K. (2018). Conceptualizing, measuring, and theorizing dynamic de/ centralization in federations. Publius: The Journal of Federalism, 49(1), 1–29. doi:10.1093/publius/pjy036 Knill, C., & Tosun, J. (2020). Public policy: A new introduction. London: Red Globe Press. Levin, K., Cashore, B., Bernstein, S., & Auld, G. (2012). Overcoming the tragedy of super wicked problems: Constraining our future selves to ameliorate global climate change. Policy Sciences, 45(2), 123–152. Loughlin, J., Kincaid, J., & Sweden, W. (2013). Handbook of regionalism and federalism. London and New York, NY: Routledge Taylor and Francis Group. Obinger, H., Leibfried, S., & Castles, F. G. (2005). Federalism and the welfare state: New world and European experiences. Cambridge: Cambridge University Press. Paquet, M., & Schertzer, R. (2020). COVID-19 as a complex intergovernmental problem. Canadian Journal of Political Science, 53(4), 343–347. doi:10.1017/S0008423920000281 Peters, B. G. (2017). Policy problems and policy design. Cheltenham: Edward Elgar. Peters, B. G. (2018). Institutional theory in political science: The new instiutionalism (4th ed.). Cheltenham: Edward Elgar. Rittel, H. W. J., & Webber, M. M. (1973). Dilemmas in a general theory of planning. Policy Sciences, 4, 155–169. Schulman, P. R. (1980). Large-scale policymaking. Greenwood, CT: Praeger.

1 FEDERAL SYSTEMS: INSTITUTIONAL DESIGN AND POLITICAL AGENCY B. Guy Peters, Eduardo Grin, and Fernando Luiz Abrucio

ABSTRACT If intergovernmental relations are necessary in normal times, it should be even more required to face complex intergovernmental problem (CIP) as the COVID-19 pandemic. However, collaboration between governments depends on institutional rules as well as on political will. To discuss this issue, the analytical model is based on two dimensions: institutional design and political agency. As for the first dimension, since COVID-19 pandemic is considered as a CIP, three aspects are relevant when discussing how federations can organize the coordination between different levels of government: autonomy of subnational governments, mechanisms of coordination, and policy portfolio. As for political agency, the performance of political leadership (national presidents and governors) will be analyzed. The possibility of sharing collective goals across the federation is also a consequence of the political agency that takes place within the institutional systems of each federation. In short, it seeks to analyze the relationship between institutional design and political agency to deal with this CIP in five American federations. Keywords: Political agency; subnational autonomy; policy portfolio; mechanisms of coordination; complex intergovernmental problem; intergovernmental relations

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FEDERAL SYSTEMS: INSTITUTIONAL DESIGN AND ITS CONSTITUTIVE DIMENSIONS One of the classic distinctions in comparative politics is that between federal and unitary systems. As is true of other such institutional variations (Peters, 2018), there are both advantages and disadvantages for each of those forms of government. Uniformity and the capacity of a unitary regime to deal with larger scale problems can be weighed against the capacity to match local needs and preferences in a federal one. Federalism is based on the shared rule and self-rule formula (Elazar, 1987), and the power sharing is its crucial issue (Dardanelli et al., 2018, p. 1). Perhaps most importantly, subnational governments can be the “laboratories of democracy,” as stated by Mr. Justice Brandeis1 concerning the United States, and they can provide opportunities for innovation and experimentation. Federations tend to offer more opportunities for participation whereas in unitary countries the efficiency side normally is more salient in decisionmaking. This trade-off between more democracy or more efficiency is also used to compare levels of decentralization and centralization in federations (Philipmore, 2013). Federalism should provide policymakers with a greater capacity to match the scale of action with the scale of the problem being addressed than other means of organizing territorial governance. Large-scale national problems can be addressed by the central government, while smaller scale delivery problems can be addressed more effectively through subnational governments.2 There will be problems of vertical coordination (Adam, Hurka, Knill, Peters, & Steinebach, 2019) within a federal system, and the multilevel nature of governance for any significant policy issue will require cooperation across level through of a more flexible and polycentric governance platform. The federalism constitutes a complex institutional context of divided powers exerted in different spheres as well as a setting of rules, practices, and norms accrued from intergovernmental interactions. Thus, three are the main bonds among institutional arenas: (1) vertical differentiation of authority between territorial governments; (2) horizontal relationships among subnational governments; (3) intergovernmental arenas that reinforce the federal system itself (Benz & Broschek, 2013).

1 Contained in New State Ice Co. V. Liebmann 285 U.S. 262 (1932). 2 Federal systems vary in the degree of autonomy permitted to local and state governments.

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The examples of success and failure in dealing with the pandemic above mentioned contain both federal and unitary political systems. So, we need to consider the nature of federalism more precisely and attempt to determine what it is about different forms of federalism that may affect their capacity to cope with the COVID-19 pandemic, and indeed any other large scale and complex crisis. The alternative hypothesis is that the major determinant of success or failure is not the characteristics of the systems, but rather the individuals who occupy positions of political leadership within those governments both at national or subnational level. The theoretical model includes both hypotheses, as we seek to analyze how institutional design can function as a federalist safeguard (Bednar, 2009; Bolleyer, 2009) against individual shortcomings, and how political leadership of presidents, prime ministers, or governors can overcome individual failings. We will analyze the features of federal institutional resilience (Bednar, 2009) and the behavior and profile of political leaders (Dardanelli et al., 2018) to understand national responses to deal with pandemic. In effect, the analysis of tackling with the COVID-19 as a complex intergovernmental problem (CIP) should consider the federal design as well as the role of the political leaders to understand the implemented actions in each country. The national cases that will be analyzed can be featured through federal struggles that feature good or bad behaviors by leaders, and better or worse functioning of their federal institutions. The nature of this CIP is focused on how governance systems and political actors (Paquet & Schertzer, 2020, p. 1) adapt to tackle with the pandemic as a huge external shock over federal institutions. So, we address two main questions: What factors within federal systems could be related to the success or failure of their attempts to face this crisis? How political leaders have been acting in federative arena along with subnational levels of government? The analytical model is based on two dimensions: institutional design and political agency. As for the first dimension, there is a long list of possible answers about what factors matter (Bednar, 2009; Dardanelli et al., 2018; Hueglin & Fenna, 2015). In this book, considering the COVID-19 pandemic as a CIP, we think that three aspects are relevant: autonomy of subnational governments, mechanisms of coordination, and policy portfolio. As for political agency, we will analyze the performance of political leadership (national presidents and governors). We analyze the matching between institutional design and the political agency to deal with this CIP in five American federations.

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Subnational Autonomy Although autonomy is not an easy concept to define, the development of the modern self-government in Western countries since the nineteenth century had had as one of the main goals to limit national governments intrusion into local matters. Subnational units were established as legal orders of government, albeit never totally free from a national steering. Their status generated political, economic, and legal barriers against more arbitrary intervention from upper levels. They would be free to deal with most local problems, albeit not free from national interference in national policy matters. This conception positively grounded the construction of autonomy as core characteristic to analyze intergovernmental relationships, especially in contexts of decentralization or/and federalism (Agranoff, 2004). Therefore, the first factor in the analysis is the degree of autonomy of the states, provinces, or even municipalities.3 The constitutional base of the power division between, at least two levels of government, is a core issue as it defines the features of authority exerted by national and subnational spheres. Political conflicts and disputes on policy jurisdiction are central to the territorial politics in federations. It is often unclear whether autonomy is a fixed characteristics in time since federal dynamics moves according to “patterns of continuity and change” (Benz & Broschek, 2013). Taking ideal types of federations, the dualistic ones like United Stated and Canada should be more decentralized, Mexico would be more centralized, and Argentina and Brazil would be intermediate cases. Considering intergovernmental cooperation, the reduction and/or lack of federal support may affect states and municipalities both in their own public policies and programs as well as those ones came from national government. Both the excess or the absence of federal government are problematic options. The role of federal coordination is essential to implement national public policies. In opposition to the dualist model, for the cooperative federalism shared authority is the best way for both subnational autonomy and national coordination (Elazar, 1987, 1994). For this conception, federations are not formed by state and local governments acting independently from each other since this kind of territorial split power needs collaboration and coordination among national and local governments. Subnational autonomy can be better analyzed as a historic trajectory that generates institutionalized rules that order the relations among governments. 3 Subnational autonomy usually is analyzed through three dimensions: political, administrative, and financial.

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In other words, federations have a meaningful temporal and spatial variance of institutional resources in their territorial governments which affect the way how they build mutual relationships (Benz & Broschek, 2013). For instance, path dependence could explain the characteristics of these intergovernmental links. Thus, if one federation has a more integrative or decentralized profile, this has to do with its history (Broschek, 2011). In some federations (e.g. Belgium), there is very little capacity of the central government to control the decisions from regional governments, while in others such as Australia, the states have little autonomy to make their own decisions. In the United States, the legislative division of powers represents the model of dualistic federalism. In Germany, legislation jointly designed by ¨ national government and the Lander (Hueglin & Fenna, 2015), but each level has some autonomous legislative powers which require vertical coordination (Adam et al., 2019). The level of autonomy and the distribution of authority can be a constitutional bedrock, and to comply, it is a duty for all governments and political leaders, besides useful to analyze federative robustness (Bednar, 2009). Constitutional autonomy uses to be based on exclusive, common, or competitive liabilities among different levels of government. This design is a safeguard for preserving territorial distributional authority as well as to avoid opportunistic behaviors. For example, if central governmental actions go beyond state authority, it could be considered encroachment. However, if subnational governments do not obey federal rules, as well as if they cannot implement their own responsibilities within federal system, they probably will engage in shirking. Finally, if a State A has the purpose of discharging the weight of a public policy over the State B, it will be involved in burden shifting. Too much encroachment, shirking, or burden shifting is responsible for creating intergovernmental strains that threaten the functioning of federal system (Bednar, 2009, p. 9). The three situations are affected by the scope of subnational autonomy, even if each of them can produce different political behaviors and effects. While encroaching represents an excess and expansion in the national actions, shirking and burden shifting usually depend on a more autonomous attitudes of local government. Similarly, the rationale of the opportunistic federalism or gaming (Philipmore, 2013) through which governmental actors in all levels game one another order to get policies goals regardless the limits in the split power among them. All governments seek their own interests with little concerns about collective consequences (Conlan, 2006). However, if the constitutional structure of shared rule and self-government loses support may increase the likelihood of placing “individual political and

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jurisdictional interests above common goals” (Conlan, 2006, p. 667). Another form of weakening autonomy is through preemption when national government enacts laws reducing the scope of statutory states authority (Agranoff & McGuire, 2001). Another approach that can also be used to analyze the kind of intergovernmental relations (IGR) is based on the unilateralism of federal government. The concentration of decisional power in the national level conveys to a more centralized stance and can threaten the federal system if this model deepens to the point that the constitutive units become agents of national government. This centralization usually happens when federal government unilaterally settle political and public policy issues which affect issues both for in national as well as subnational jurisdictions. Since federal governments are the main guarantors of national unity, and because they generally have more revenue than subnational entities, they seek to find encompassing solutions covering all national territory. Because of that, on one hand, federal government can decide to enact its own solutions or even impose measures over state and local governments in the name of the national interest. On the other hand, the federal government may not comply with a political solution agreed with the constitutive entities (Schnabel, 2020, pp. 10–11). All kinds of unilateralism, of different manners, reduce the subnational autonomy. Even in normal times, federal struggles can be a tug of war between all levels of government. But when governments must face CIP (Paquet & Schertzer, 2020), as the COVID-19 pandemic, two questions become relevant. The first is whether subnational constitutional autonomy could be eroded. Second, whether this autonomy has been strengthened in response to an opportunistic national political agency or because intergovernmental institutions are not performing well.

Policy Por tfolios Different federal systems allocate policies to different levels of government. Generally, defense and monetary policies are national, while education is often state/provincial or local (Bednar, 2009). In contemporary federalism, levels of government tend to share liabilities in all policy domains (Cameron & Simeon, 2002). Health policy, the core policy for this book, tends to involve all levels of government, although their responsibilities vary. This variation derives from different schemes for sharing expenditures or intergovernmental committees to define national rules. Some countries have

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only one national health system (Brazil), other have states systems (Canada and Argentina), and in Mexico, there are stratified systems according to segmented lines of corporatism. The United States also has state insurance programs under the Affordable Care Act and Medicaid, national programs like Medicare, and extensive private insurance. The institutional design of public policies, especially those focused on welfare state, such as health sector, depends on many aspects. Firstly, policy portfolios and their institutional structure follow a sequence of events in which earlier decisions strongly influence their further development (Skocpol, 2002). The impact of the federalism on this process is contingent in each historical phase of a public policy (formulation, expansion, or reduction, for instance). Public policy environments result from this mutual influence between federal institutions and other factors that characterize their historical path such as: split power in intergovernmental arenas, sharing of responsibilities between different national and subnational spheres, financial mechanisms and rules for making decision involving or not federal, state and municipal government (Abrucio & Grin, 2015; Benz & Broschek, 2013; Philipmore, 2013). History and the sequence of events in a public policy condition its institutional model since there is a cause and effect relationship in the temporal horizon of the analysis (Obinger, Leibfried, & Castles, 2005; Pierson, 1993). The distribution of authority in each public policy gives more autonomy or shared responsibilities in management, formulation, implementation, and funding. Also, rules historically adopted according to institutional paths influence different kinds of veto power to national or subnational levels of government as for the way on how public policy portfolios are organized. Secondly, policy portfolios depend on the level of conflict between national and subnational governments which, in turn, is influenced by the differential political relevance conferred to each sector. For instance, policies for disabled people tend to be less salient than health policies (Bolleyer, 2009) as they are easier to define policy portfolios involving distribution of responsibilities. On the contrary, how public health policy has more social impact in the federal conflict is a more common situation. In effect, federal disputes vary depending on the political priority defined for each government about different policy areas. Third, policy portfolios are also aligned with the formalization of rules; in areas in which national institutionalization is weaker, it is more probable that subnational governments are more responsible for larger activities. In this vein, who regulates (policy decision-making) and those who executes (policymaking) public policies (Arretche, 2012) should be considered. At this

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level, there are issues like constructing coalitions of political players between spheres of government based on the institutional design in each policy arena, such as levels of political and administrative autonomy and funding rules. Among other aspects, the federal process includes partnerships that are negotiated both on the design of policy portfolios and the agreements that such bargaining will generate, or at the very least preserving the integrity and autonomy of the subnational governments (Agranoff, 2001; Elazar, 1987, 1994). Fourth, policy portfolios also depend on the distribution of managerial and technical skills between different orders of government. State capacity has four dimensions: (1) administrative capacity: organizational efficiency to carry out essential government functions such as the provision of public services; (2) institutional capacity: to define the “rules of the game” that condition the behavior of social and public actors; (3) technical capacity: skills for formulating and managing policies; (4) political capacity: channels to deal with conflicts and social demands that depend on responsible political and administrative leadership (Cingolani, 2013; Grindle, 1996; Hanson & Sigman, 2020). A fifth element that defines the distribution of competences between the levels of government is the extent to which the federal government works, in each federation, to reduce territorial inequalities (Arretche, 2012; Banting, 2006). The existence of strong inequalities between states and municipalities is a fact in some federal countries – in the Americas, only Canada would be out of this situation. However, the Union only assumes this role when there is a political construction around this ideal. In this case, the United States would not have this question as something that would structure its model, whereas in the three Latin-American countries, this is a fundamental issue. The pandemic increased territorial inequality, to a greater or lesser extent, in all federations. The analysis of how this affected the federative game has become important for assessing intergovernmental performance. In sum, federal politics and the characteristics of the constitutional design, as well as the historical path of each public policy mutually influence the policy portfolio. This process depends on the historical evolution of the federalism in each country in which not only the distribution of power and authority between national and subnational governments is defined. In other words, federal dynamics, historical public policy path matters, defined rules on the distribution of authority between national and subnational levels, resources of state capacity to formulate and implement public policies, and the role of the federal government in combating territorial inequalities combine to shape policy responses to a crisis like COVID-19.

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Mechanisms for Coordination Federal systems may or may not build in mechanisms for coordination in their IGR. In general, negotiations among the different governments are necessary for policy coordination (Hueglin & Fenna, 2015). IGR can be more institutionalized or even work in ad hoc ways depending on the historical path of each federation (Bolleyer, 2006, 2009). Furthermore, pressing demands (e.g. natural disasters or pandemics like the current COVID-19) generating spillover effects may incentivize more cooperative arrangements. According to Poirier & Saunders (2015), IGR is influenced by policy demands, political disputes, kinds of public policies, economic context, and institutional channels to deal with conflicts and collaboration. There are a lot of contextual factors that play a pivotal role for understanding how the intergovernmental interactions among political actors can function both in federal as well as unitary countries. IGR are reciprocal activities and interdependent choices based on interests and preferences of involved political actors considering financial, political, and public policies issues. This interaction generates institutional and political arrangements with varying scopes of discretion for each level of government or functional body. Balancing these aspects can induce different instruments of collaboration (Krane & Wright, 2000). However, it is also relevant to identify relationship patterns that can be established both between governments as well as in each public policy arena (Krane & Leach, 2007). IGR deal with crucial relationships among governments which imply always issues on politics, public policies, fiscal and managerial that are related to the functioning of federal system. As such, IGR are “vehicles of political negotiation that produce patterns capable to place groups with less political power in confrontation with others, each of them fighting for leveraging their position” (Souza, 2002, pp. 433–434). Since these bonds involve spheres of authority and power regarding territorial politics, the kind of resulting arrangement can induce more negotiation, bargain, and cooperation to seek mutual benefits or, on the contrary, incentive conflicts around more vertical or hierarchical relationships (Agranoff, 2001; Agranoff & McGuire, 2001; Falletti, 2010). The more formal are arenas of IGR, the stronger will be the coordination between different governments, and they become a safeguard for the federation (Behnke & Mueller, 2017; Bolleyer, 2006; Schnabel, 2015) preserving autonomy (self-rule) while bringing together federal and subnational governments (share rule). The balance achieved in these poles of the equation may indicate the likelihood of greater coordination or conflict with implications for

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federal robustness (Bednar, 2009; Braun, Ruiz-Palmeiro, & Schnabel, 2017; Burgess, 2006). The kind of federal IGR also is path dependent and “can be either weakly or strongly institutionalized” (Broschek, 2011, p. 667). Federations featuring dual allocation of powers usually are weaker systems whereas more cooperative ones use them to build participatory arenas, or at least agreements among different governments. The probability for achieving cooperation indicates the “ability of national and sub-national governments […] to work together to address public policy problems” (Inwood, Johns, & O’Reily, 2011, p. 14). This goal is still more challenging when the problems require high levels of coordination and collaboration as is the case with the COVID-19 pandemic which claims that different governments work together and share responsibilities (Paquet & Schertzer, 2020, p. 2). The complexity and novelty of this problem, considering its spillover effects, defies federations to develop new intergovernmental policy capacities (Inwood, Johns, & O’Reily, 2011). For instance, in United States, there are almost no formal mechanisms for coordination, although within each policy domain there are close policy connections. In Brazil, there are different intergovernmental arenas, but the health sector is the most striking and institutionalized example of a national system based on federative coordination involving the three levels of government (Grin & Abrucio, 2019). In Canada, there are regular meetings between the federal prime minister and the premiers of the provinces as well as more policy-specific connections among ministers and bureaucrats. Thus, subnational autonomy coupled with strong mechanisms for coordination may be a means of gaining benefits of both centralization and decentralization. An external shock as the pandemic can provoke different IGR answers considering the variety of federalisms (Benz & Broschek, 2013). There may be countries where regularized or institutional councils or committees (Bolleyer, 2006, 2009) exist and perform well to rally intergovernmental efforts (Canada). In other countries, these arenas have not been working as a cushion against conflict, or preemption coming from national government (Brazil). Also, most informal IGR has been the available option to deal with this CIP (United States). Finally, countries where the federal dispute either induced ad hoc IGR arrangements to counter the pandemics (Argentina), or not even this type of informal agreement was put in place (Mexico). COVID-19 is a CIP that requires cooperation between government’s spheres (Paquet & Schertzer, 2020) so that it is essential to understand the intersection between IGR systems and national policy responses. Analyzing these five cases might help to know national pathways to create, reinforce, or

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even weaken their IGR. Moreover, we can identify different responses ranging from centralized to more decentralized ones, or those underpinned in coercion, participation, or agreement (Hueglin & Fenna, 2015). Finally, one could analyze different but complementary IGR systems (vertical, horizontal, or sectoral) (Philipmore, 2013) as routes to deal with this CIP. The asymmetry of power between national and subnational government can be a characteristic of IGR. Therefore, one needs to investigate whether IGR can be dominated by national sphere instead of the subnational governments, and if this process will vary between different policy sector and over time (Trench, 2006). As for horizontal IGR, they can adopt many designs and involve some or all constitutive unities. In this line, intergovernmental arrangements, cooperative forums, and independent agencies are common instruments for IGR to deal with public policy issues (Poirier & Saunders, 2015). Another way to analyze IGR is to consider it as a self-coordination process: “it is not hierarchical and in federal system is usual mainly in sectors where subnational governments have guarantee and right to decide autonomously” (Bolleyer, 2013, p. 321). By definition, this kind of participation depends especially on political will at each level of government (Bolleyer, 2013). The cooperation process deals with a set of institutional arrangements and decisional rules which consider territorial interests. These institutional designs vary according to the veto power available to subnational governments because what is at stake are issues such as allocation of responsibilities in public policies among different levels of government. This context refers to both as for production, implementation, and financing of public policies (Obinger et al., 2005). However, we need to distinguish “federalism as a multidimensional driving force and federation as its institutional, structural and systemic counterpart” (Burgess, 2006, p. 47). The main question consists in identifying, if not all, at least some pathways that formalize, in the federative functioning, how links among governmental spheres could be institutionalized. In this case, it is possible to think about instruments to organize intergovernmental forums. The assignment of responsibilities to different levels of government requires vertical and even horizontal coordination because decisions taken by one level can generate consequences over citizens from another one. (Schnabel, 2020). Are there any kinds of institutional governmental forum gathers political leaders and senior civil servants to deal with common problems? Taking this issue into account, two analytical questions are important: (1) the direction of the interaction between involved actors – upward, downward, or horizontal – and if there is a hierarchy among them; (2) motivation for the installation of

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these IGR forums: to influence other federal entities, preserve jurisdictional autonomy from external interferences, coordinate actions, interchange information, and knowledge-sharing (Behnke & Mueller, 2017). To avoid that governments unilaterally sought to solve problems affecting many federal actors, intergovernmental forums can contribute to safeguarding federalism as well as the federal stability (Schnabel, 2020). Taken together, these factors help to describe how multilevel governance ¨ and interjurisdictional performance (Fenna & Knupling, 2015) can function within different federal systems to tackle with COVID-19. But to understand how federalism deals with this CIP, we need to examine some real cases.

FEDERAL SYSTEMS: THE ROLE OF POLITICAL AGENCY The analysis of complex IGR should also consider the role of political agency in federal countries to understand their robustness (Bednar, 2009). IGR involves both cooperation and conflict, but its politicization can be a side effect especially in periods of crises when the need for coordination is higher. In a nutshell, if political leaders pursue their political objectives (Hueglin & Fenna, 2015), it is unlikely that it will be possible to set shared goals to be achieved among different levels of government. Furthermore, especially national political leaders can opt for more unilateral decision-making (Schnabel, 2020) or a more coercive stance in the IGR arena (Kincaid, 2015). Certainly, the more institutionalized the federal safeguards are, the less likely there will be an opportunistic federalism, especially with unilateral decisions by the central sphere (Bolleyer, 2009; Nugent, 2009). Thus, there are three main ways to characterize the stance of political leaders – cooperative, opportunistic, and coercive or unilateralist – as for the role performed in IGR arena. Anyway, problems of political agency can be an effect from institutional design (for example, more dualist federation) and/or the way how political leaders behave especially before CIPs. Thus, it is not possible to take for granted that the more severe the public problem, the larger would be the policy coordination even if federal systems require any kind of IGR (Bakvis & Brown, 2010). The way how political battles and cooperation work in difficult times can say too much about the propensity of a federal system to build, reinforce, or weaken its IGR. So, the combination of political agency and the design of IGR can explain national responses to face challenging situations. Opportunistic and unilateralist stances of political leaders as presidents, governors, and mayors can represent “the opposite side of the cooperation as

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it featured by actors pursuing their immediate interests with little regard for the institutional or collective consequences” (Conlan, 2006, p. 667). Policy preemptions or political confrontations are examples that can be even more prominent in critical situations. It would be a na¨ıve assumption to assert that more serious social problem result in higher probabilities for cooperation among different governments. Unlike the cooperative model, opportunism can broaden either more centralized and nationalizing policies or more autonomous subnational logics without considering larger effects on the federation. As the federal role expands in the national government, the intergovernmental capacities to manage policies in a shared way is increasingly pressured by coercive and/or opportunistic federalism. In this context, all levels of government are increasingly engaged in “opportunistic federalism” and attempt to use each other to achieve a particular policy regardless of traditional boundaries and distributions of authority (Posner & Conlan, 2008). This approach is similar to the debate about coercive federalism through mandates issued by the central government. Mandates are political actions with centralizing and coercive effects. Federal goals expanded into new fields of intergovernmental services formerly controlled by states and localities. This nationalization and centralization in public policy areas is responsible for amplifying IGR tensions (Posner, 2008). Coercive federalism has some characteristics such as: (1) rules attached to federal grants and public policies that require complying by the states; (2) increased national mandates over state and local governments; (3) restrictions on loans and state and local tax powers; (4) the disappearance and/or loss of relevance of intergovernmental institutions; (5) the decline of intergovernmental cooperation in policy formulation (Kincaid, 2015). Both opportunistic political behaviors from national or subnational governments and political leaders as well as more coercive stance of central government can harm the IGR process, especially when conjoint efforts should still be more intensified. As it will be analyzed, this CIP has been characterizing the federative landscape addressed in this book. Also, political leaders can be prone to incentivize or reinforce cooperative IGR devices when facing CIPs. Federations commonly have more than one level of government operating in the same sector. This interdependence demands IGR what makes this system more complex when it comes to obtaining collaboration between the bodies. The methodological path to identifying this growth and change in the quality of IGR lies in trying to reconstruct relevant policy and intergovernmental management themes (Agranoff, 2001). If the split power in federation is harder to balance the role

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and stance of political leaders, it should be still more relevant to build agreements favorable for both national and subnational governments.

CONCLUSION If IGR are necessary in normal times, it should be even more required to face CIP as the COVID-19 pandemic. However, collaboration between governments depends on institutional rules as well as on political will. The possibility of sharing collective goals across the federation is also a consequence of political agency. Of course, agency of political actors takes place within institutional systems of each federation. Constitutional rules or even informal norms make up the set of opportunities and constraints for political actors and could be thought as structural conditions shaping their more cooperative or opportunistic behaviors (Dardanelli et al., 2018). However, even if political actors do not act in an institutional vacuum, agency in the IGR context could also be a relevant way to understand possibilities for getting more intergovernmental cooperation or, on the contrary, increase intergovernmental conflicts. The three elements of contemporary IGR described here have all played a significant role in the handling of the COVID-19 pandemic in the five federal systems in the Americas. Each country has had, and will continue to have, its own version of federalism, but the strains placed on governance during the pandemic have displayed the strengths and the weaknesses of these five models. These strains have also helped to understand federalism, more generally, and its capacity to provide effective and democratic government.

REFERENCES Abrucio, F. L., & Grin, E. J. (2015). From decentralization to federative coordination: The recent path of intergovernmental relations in Brazil. Paper presented at the II International Conference on Public Policy, Milan, Italy. Adam, C., Hurka, S., Knill, C., Peters, B. G., & Steinebach, Y. (2019). Introducing vertical policy coordination to comparative policy analysis: The missing link between policy production and implementation. Journal of Comparative Policy Analysis, 21, 499–517. doi:10.1080/ 13876988.2019.1599161

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Agranoff, R. (2001). Managing within the matrix: Do collaborative intergovernmental relations exist? Publius: The Journal of Federalism, 31(2), 31–56. doi:10.1093/oxfordjournals.pubjof.a004895 Agranoff, R. (2004). Autonomy, devolution and intergovernmental relations. Regional & Federal Studies, 14(1), 26–65. doi:10.1080/ 1359756042000245160 Agranoff, R. & McGuire, M. (2001). Big questions in public network management research. Journal of Public Administration Research and Theory, 11(3), 295–326. doi:10.1093/oxfordjournals.jpart.a003504 Arretche, M. T. (2012). Democracia, federalismo e centralização no Brasil. Rio de Janeiro: Editora FGV/Editora Fiocruz. Bakvis, H., & Brown, D. (2010). Policy coordination in federal systems: Comparing intergovernmental processes and outcomes in Canada and the United States. Publius: The Journal of Federalism, 40(3), 484–507. doi: 10.1093/publius/pjq011 Banting, K. (2006). Social citizenship and federalism: Is a federal state a contradiction in terms? In S. Greer (Ed.), Territory, democracy, and justice. Regionalism and federalism in western democracies (pp. 44–66). London: Palgrave Macmillan. Bednar, J. (2009). The robust federation. Principles of design. Cambridge: Cambridge University Press. Behnke, N., & Mueller, S. (2017). The purpose of intergovernmental councils: A framework for analysis and comparison. Regional & Federal Studies, 27(95), 507–527. doi:10.1080/13597566.2017.1367668 Benz, A., & Broschek, J. (2013). Federal dynamics continuity, change, and the varieties of federalism. Oxford: Oxford University Press. Bolleyer, N. (2006). Federal dynamics in Canada, the United States, and Switzerland: How substates’ internal organization affects intergovernmental relations. Publius: The Journal of Federalism, 36(4), 471–502. doi: 10.1093/ publius/pjl003 Bolleyer, N. (2009). Intergovernmental cooperation: Rational choices in federal systems and beyond. Oxford: Oxford University Press: EPCR. Bolleyer, N. (2013). Paradoxes of self-coordination in federal regimes. In A. Benz & J. Broschek (Eds.), Federal dynamics continuity, change, and the varieties of federalism (pp. 321–342). Oxford: Oxford University Press.

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Braun, D., Ruiz-Palmero, C., & Schabell, J. (2017). Consolidation policies in federal states: Conflicts and solutions. Oxfordshire: Routledge. Broschek, J. (2011). Historical institutionalism and the varieties of federalism in Germany and Canada. Publius: The Journal of Federalism, 42(4), 662–687. doi:10.1093/publius/pjr040 Burgess, M. (2006). Comparative federalism: Theory and practice. London and New York, NY: Rouledge. Cameron, D. & Simeon, R. (2002). Intergovernmental relations in Canada: The emergence of collaborative federalism. Publius: The Journal of Federalism, 32(2), 49–72. doi:10.1093/ oxfordjournals.pubjof.a004947 Cingolani, L. (2013). The state of state capacity: A review of concepts, evidence and measures. Working Paper Series on Institutions and Economic Growth: IPD WP13. Maastricht Graduate School of Governance (MGSoG), Maastricht, The Netherlands. Conlan, T. (2006). From cooperative to opportunistic federalism: Reflections on the half-century anniversary of the commission on intergovernmental relations. Public Administration Review, 66(5), 663–676. doi:10.1111/ j.1540-6210.2006.00631.x Dardanelli, P., Kincaid, J., Fenna, A., Kaiser, A., Lecours, A., & Singh, A. K. (2018). Conceptualizing, measuring, and theorizing dynamic de/ centralization in federations. Publius: The Journal of Federalism, 49(1), 1–29. doi:10.1093/publius/pjy036 Elazar, D. J. (1987). Exploring federalism. Toscallosa, AL: University of Alabama Press. Elazar, D. J. (1994). Federalism and the way to peace. Reflections Paper n. 13. Institute of Intergovernmental Relations, Kingston, ON. Falletti, T. (2010). Decentralization and subnational politics in Latin America. Cambridge: University Press. ¨ Fenna, A., & Knupling, F. (2015). Benchmarking as a new mode of coordination in federal systems. In F. Palermo & E. Alber (Eds.), Federalism as decision-making: Changes in structures, procedures and policies (pp. 315–338). Leiden: Brill. Grin, E. J., & Abrucio, F. L. (2019). The co-evolutionary policy style of Brazil: Structure and functioning. In M. Howlett & J. Tosun (Eds.), Policy

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styles and policy-making (pp. 115–136). London and New York, NY: Routledge Taylor and Francis Group. Grindlee, M. S. (1996). Challenging the state: Crisis and innovation in Latin America and Africa. Cambridge: Cambridge University Press. Hanson, J. K., & Sigman, R. (2020). Leviathan’s latent dimensions: Measuring state capacity for comparative political research. Retrieved from https://calhoun.nps.edu/bitstream/handle/10945/64717/HansonSigman_Leviathans_Latent%20Dimension.pdf?sequence51&isAllowed5y Hueglin, T. O., & Fenna, A. (2015). Comparative federalism: A systematic inquiry. Toronto, ON: University of Toronto Press. Inwoods, G. J., Johns, C. M., & O’Reily, P. (2011). Intergovernmental policy capacity in Canada. Inside the worlds of finance, environment, trade, and health. Montreal, QC: McGill-Queens’s University Press. Kincaid, J. (2015). Policy coercion and administrative cooperation in American federalism. In F. Palermo & E. Alber (Eds.), Federalism as decision-making: Changes in structures, procedures and policies (pp. 62–76). Leiden: Koninklijke Brill. Krane, D., & Leach, R. H. (2007). Federalism and intergovernmental relations: Theories, ideas, and concepts. In J. Rabin, W. Bartley, & G. J. Miller (Eds.), Handbook of public administration (pp. 481–500). London and New York, NY: CRC. Krane, D., & Wright, D. (2000). Intergovernmental relations. In J. Shafritiz (Ed.), Defining public administration: Selections from the international encyclopedia of public policy and administration (pp. 83–101). Boulder, CO: Westview Press. Nugent, J. D. (2009). Safeguard federals: How states protect their interests in national policymaking. Norman, OK: University of Oklahoma Press. Obinger, H., Leibfried, S., & Castles, F. G. (2005). Federalism and the welfare state: New world and European experiences. Cambridge: Cambridge University Press. Paquet, M., & Schertzer, R. (2020). COVID-19 as a complex intergovernmental problem. Canadian Journal of Political Science, 53(4), 343–347. doi:10.1017/S0008423920000281 Peters, B. G. (2018). Institutional theory in political science: The new institutionalism (4th ed.). Cheltenham: Edward Elgar.

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Philipmore, J. (2013). Understanding intergovernmental relations: Key features and trends. Australian Journal of Public Administration, 72(3), 228–238.doi:10.1111/1467-8500.12025 Pierson, P. (1993). When the effect becomes cause: Policy feedback and political change. World Politics, 45(4), 595–628. doi:10.2307/2950710 Poirier, J., & Saunders, C. (2015). Comparing intergovernmental relations in federal systems: An introduction. In J. Poirier, C. Saunders, & J. Kincaid (Eds.), Intergovernmental relations in federal systems: Comparative structures and dynamics (pp. 1–13). North York, ON: Oxford University Press. Posner, P. (2008). Mandates: The politics of coercive federalism. In T. J. Conlan & P. L. Posner (Eds.), Intergovernmental management for the 21st century (pp. 286–309). Washington, DC: The Brookings Institute. Posner, P., & Conlan, T. J. (2008). Conclusion: Managing complex problem in a compound republic. In T. J. Conlan & P. L. Posner (Eds.), Intergovernmental management for the 21st century (pp. 338–352). Washington, DC: The Brookings Institute. Schnabel, J. (2015, August 26–29). The intergovernmental safeguard’s capacity to prevent opportunism: Evidence from eight federation. In ECPR general conference, University of Montreal, Montreal. Schnabel, J. (2020). Managing interdependencies in federal systems: Intergovernmental councils and the making of public policy. Cham: Palgrave Macmillan. Skocpol, T. (2002). Bringing the state back in: Strategies of analysis in current research. In P. B. Evans, D. Rueschmeyer, & T. Skcopol (Eds.), Bringing the state back in (pp. 3–43). Cambridge: Cambridge University Press. Souza, C. (2002). Governos e sociedades locais em contextos de ´ Coletiva, 7(3), 431–442. desigualdades e de descentralização. Ciˆencia Saude doi:10.1590/S1413-81232002000300004 Trench, A. (2006). Intergovernmental relations: In search of a theory. In S. L. Greer (Ed.), Territory, democracy and justice: Regionalism and federalism in western democracies (pp. 224–256). New York, NY: Palgrave MacMillan.

2 AMERICAN FEDERALISM IN THE PANDEMIC B. Guy Peters

ABSTRACT American federalism permits the states a good deal of latitude for action, and, at the same time, the federal government can exercise control through both mandates and the use of its financial powers. During the COVID-19 pandemic, the federal relationship was strained not only because of the sheer magnitude of the crisis but also because of political conflicts between the federal government and some of the states. During the Trump administration, the federal government initially denied the importance of the pandemic, and then (except for encouraging the development of vaccines) did little to support the states or citizens in fighting the virus. The Biden administration, on the other hand, was active in distributing the vaccine and in supporting other responses to the pandemic. The pandemic also exposed the underlying weaknesses in the public health system of the United States and the extent to which years of conflict between levels of government have reduced effective cooperation, even in times of crisis. Keywords: Federalism; crisis management; public health; political conflict; Donald Trump; Joe Biden

INTRODUCTION There are several stories of American federalism during the pandemic. First, there is the marked difference in addressing the pandemic during two

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presidencies. The two presidents not only handled the scientific and political aspects of the pandemic differently but also managed their relationships with the states differently. The two presidencies also roughly correspond to two stages in this health crisis, with the first focusing more on public health measures to control the spread of infections, as well as the development of vaccines, and the second focusing more on the distribution of the vaccines and preventing the spread by creating immunity. These two periods represent two different styles of federalism, reflecting political choices as well as the underlying constitutional nature of federalism. In the first stage, the federal government was engaged in a great deal of loadshedding and denial, trying to push the management of the pandemic off to the states or deny its existence entirely. This behavior was in part blame avoidance and in part reflected the incompetence in the Trump administration. The second stage of the process returned to a somewhat more cooperative style of federalism, or at least the conflicts were not so over. There are still points of contention between the two levels of government, based in large part on partisan differences, but the governments have been able to work together effectively to vaccinate the population and to attempt to return the country to something approaching normalcy. These two periods also reflect success and failure in dealing with the pandemic. During the first period, the “pandemic denial” of many officials in the Trump administration led to the United States having the worst results of any country in the world (Lasco, 2020). Rates of infection and death far surpassed most other wealthy, democratic political systems. The second period has been one of the significant successes in delivering the vaccine and getting it into people’s arms. President Biden first pledged that there would be 100 million vaccinations in the first 100 days of his administration, and was soon able to increase that to a pledge of 200 million (Stolberg, 2021). Indeed, by the Spring of 2021, the major impediment to reaching herd immunity in the United States was the reluctance of some citizens to be vaccinated, rather than the capacity of governments and the private sector to deliver the vaccine (Axelrod, 2021). Even with the success in vaccination, however, the death rate from COVD19 remains high in the United States. This high death rate reflects some of the continuing influence of the last months of the Trump administration, when little emphasis was placed on public health measures to control the disease. It also reflects the reluctance of some state governments to continue the needed public health measures now that vaccinations have become more readily available. Somewhat paradoxically, the Trump administration invested a great deal of effort and money into developing vaccines – Project Warp Speed – but

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did not match that effort with any great interest in actually vaccinating the population (Kenen & McGraw, 2021). This disjuncture meant that President Biden could appear extremely effective once he took office, but it also meant that a number of people contracted, and died from, the virus while waiting for vaccinations to become available. This chapter will discuss the formal aspects of American federalism as they have affected the struggle against COVID-19, but those formal aspects of governing have to be understood within the context of both the historical development of federalism and the contemporary politics within the United States. Those politics are not only about the polarization of the two political parties and their supporters but are also about the way in which that polarization affects the relationships between Washington and state capitols. Governing the United States has never been easy, but it is perhaps more difficult in the present period than in any time in the postwar era.

THE STRUCTURE OF FEDERALISM The Constitution of the United States does not contain the word “healthcare,” or any other social policies, but since it does not the federal government had been involved rather little in health policy for much of its existence. The one area of major concern for the federal government in health policy was the control of infectious diseases. The federal government established marine hospitals for sailors in the late eighteenth century and then created the public health service in 1870. The federal government had at times imposed quarantines, and those powers became solidified in the late nineteenth century and then even more institutionalized following the outbreak of “Spanish flu” just at the end of World War I (Hatchett, Mecher, & Lipsitch, 2017). With the passage of the Public Health Act in 1944 and the creation of the Department of Health, Education, and Welfare1, in 1953 the federal government assumed a stronger position in health policy, but it continued to work heavily in cooperation (and sometimes in competition) with the state and local governments. Although the federal government is now a major player in health care, its role is primarily as an insurer (Medicare), funder (Medicaid), or regulator (Food and Drug Administration), rather than as a provider of health

1 Now the Department of Health and Human Services after the Department of Education was created during the Carter administration, and its functions were separated from health and social services.

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services in communities. The federal government does supply health services directly to Native Americans, veterans, and the military and their families, but not to the general public. This policy portfolio, therefore, involves both federal and state governments, but often without clear boundaries as to who is responsible for what aspects of the portfolio. The pandemic, or any other major public health event, then requires the health agencies in the federal government to engage directly with their partners at the state and local level. But some of the problems that have emerged in the federal response to the pandemic is that other federal agencies are also involved in a health emergency, and, therefore, a great deal of coordination is required at the federal level, even before dealing with the states. For example, the Federal Emergency Management Agency (FEMA, a part of the Department of Homeland Security) becomes involved in any significant emergency, including the pandemic. Once policies that affect economic activity, e.g. lockdowns, became a part of the response, the Departments of Commerce, Labor, and the Treasury become involved, along with independent executive agencies such as the Small Business Administration. This list of organizations involved in responding to an emergency could be extended, but the fundamental point is that the federal government does not act as a single entity but rather as a number of more of less autonomous, and often feuding, organizations. For this pandemic or any other major outbreak of infectious disease, there are three major players at the federal level. The first is the Centers for Disease Control and Prevention (CDC). As the name implies, this organization is vested with responsibility for identifying outbreaks of disease and working with their partners in the public and private sectors to control them – much of the advice about wearing masks and social distancing has come from the CDC. The second organization is the National Institutes of Health, and particularly the National Institute of Allergy and Infectious Diseases, now headed by Dr Anthony Fauci. This organization does research on COVID-19 and other infectious diseases, and helped to move research on vaccines forward. And, finally, there is the Food and Drug Administration which licenses vaccines and other drugs. While this powerful triumvirate provides most of the scientific information, it is still up to state governments to implement the measures to control a pandemic. The states have been the principal players in health policy for much of the history of the United States and remain major players even after the passage of legislation such as Medicare and Medicaid, and then the Affordable Care Act, at the federal level. The states regulate health care, including licensing doctors and health facilities, they provide a range of services, including hospital

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services in some states, and they provide health insurance through Children’s Health Insurance Program (CHIP)2 and Medicaid. Most importantly in the context of the pandemic, state governments have significant responsibilities in controlling infectious diseases and are meant to have the capacity for contact tracing for people who have contracted a disease.3 Unlike states or provinces in some federal systems, the American states have considerable autonomy in taxing and spending. They can collect as much tax as the political climate will allow, and they can spend that money in any way they see fit. The federal government may attempt to encourage the states to spend in certain ways by providing matching money and other incentives, but there is little way in which Washington can command or prohibit expenditures or taxes. The states also have the “police powers” of defending the health, safety, and welfare of their citizens, and may impose their own constraints on individual actions unless that violates federal law (see below). Finally, although local governments are the “creatures of the state” and can be controlled by state governments, they also have significant roles to play in health policy. Local health departments implement many of the programs of the state governments, including contact tracing, as well as managing a wide range of public health measures. And, again, some local governments also manage their own hospitals and other health facilities, most of which tend to serve less-affluent members of the community. In the pandemic localities, especially large cities have found themselves at odds with their state governments and have attempted to make their own rules about masks and curfews. In particular, cities, such as Austin, which are more liberal than the rest of the state of Texas, have sought to impose more stringent controls on behavior, only to be blocked by the state (Martinez, 2021). It is also important to remember that there are 3,141 county governments in the United States. These range from populous urban counties, e.g. Cook County, Illinois, containing Chicago, to small rural counties (one with 88 inhabitants) with very small and highly dispersed populations, and limited medical resources. In Texas, for example, there are 166 counties with no intensive care unit (ICU) beds, and some of these counties have no hospital and only a handful of medical practitioners. Many counties in rural areas have no health departments. Therefore, depending on a decentralized solution to the pandemic, as welcome as it might be to many Americans, is not really viable.

2 Children’s Health Insurance Program. 3 This contact tracing has been used primarily for tuberculosis and for sexually transmitted diseases.

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The political dynamics of federalism in the United States have focused more on guaranteeing the autonomy of action for the constituent units than they have on ensuring coordination among the levels of government. Unlike federalism in Germany or Austria, they are few explicit coordinative devices in intergovernmental relations in the United States. Further, to the extent that those coordinative devices do exist, they tend to be hierarchical direction from the federal government, rather than more collaborative means of reaching agreed solutions. Further, to the extent there are such attempts at collaboration and coordination, they tend to be bilateral and ad hoc. Those sporadic federal attempts at coordination are generally regarded negatively by the states, especially when the state government and the federal government are controlled by different political parties. A final preliminary comment is that during the pandemic American federalism was functioning in a political environment that was heavily influenced by populism, and the associated rejection of the authority of government and expertise (Brubaker, 2020; Moynihan, 2021). While much of the negative perspective on government was directed against the “swamp” in Washington, state governments were also targeted, although they tended to be more trusted than the federal government. The distrust associated with populism extended to experts, including the medical experts attempting to control the pandemic. The general rejection of institutions and authority by segments of the population has made the already daunting task of confronting the pandemic all the more challenging for governments.

FEDERALISM IN ACTION – THE COVID-19 PANDEMIC The problems with the American response to the pandemic, as well as to earlier disasters such as Hurricane Katrina (see Birkland & Waterman, 2008), can be seen in light of the particular style of “opportunistic federalism” (Conlan, 2006). There is an interesting academic tradition of characterizing periods of federalism in the United States (Bolling & Pickerill, 2013; Wright, 1988), but the period after World War II can be seen as one of the gradual accretions of federal power, despite several attempts to reduce that centralizing effect of the money and power held by Washington. This trend toward centralization and coercion has not been without conflict (see Peters, 2019), and the contemporary style of federalism may be more opportunistic, meaning that the actors involved tend to pursue their own goals and their own opportunities with little consideration of the needs of other actors involved in

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the federal system. One of the numerous opportunistic elements revealed by the failure to cope adequately with the pandemic was the large reduction in federal funding for state and local public health programs, leaving these programs incapable of coping with testing and contact tracing (Altman, 2020). The opportunistic elements of federalism, during the pandemic and at other times as well, are not confined to policy choices. They can also be political. Especially during the first stages of the pandemic, governors and some mayors of big cities sought to score political points at the expense of President Trump by demonstrating that they were willing to exercise more leadership than the president in coping with the crisis. While the president denied the importance of masks, governors (especially Democratic governors) imposed mask mandates, as well as lockdowns. In the period since the inauguration of President Biden, Republican governors have been attempting to score their own political points by opening up businesses and eliminating mask mandates. The pandemic has revealed that the cleavages in American government may not be so much among the levels of government as between different political parties and even factions within parties (Kettl, 2020). When given the autonomy to make decisions on their own, the states were far from uniform in how they reacted, and some chose paths that have led to significantly worse outcomes than would have occurred if other policies had been selected. The differences mirror choices made with respect to other policies, such as expanding Medicaid under the Affordable Care Act (Meyer-Gutbrod, 2018). Somewhat paradoxically, the absence of federal leadership, with greater autonomy for the states, has made the importance of some central direction within the system all the more evident. When it became clear in February and early March of 2020 that there was a major viral threat to the population of the United States, the various governments began to respond in their own ways, and those initial reactions then shaped the first wave of the pandemic. Those responses by government were made individually, but they were also shaped in part by federalism, and the differing responsibilities and resources of the levels of government. These initial responses, thus, set the stage for the disastrous effects of COVID-19 on the population of the United States. The Trump administration took an initial position that the virus was not really a threat. The stated position of the administration was that this virus was no worse than ordinary seasonal flu, and that existing health processes and procedures were more than capable of dealing with the disease. This denial of science and the reality becoming apparent in hospitals and nursing homes all across the country meant that little federal effort was placed into

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procuring and distributing protective equipment for health-care workers around the country. Likewise, the administration continued to be more concerned about the economic impacts of the pandemic than about the public health impacts.

Strategies in Oppor tunistic Federalism The events of the pandemic revealed the use of a number of strategies by governments, especially by the federal government, to attempt to improve their positions within the conflict. For the states, this abdication of federal leadership had rather devastating consequences. Although the states do have resources of their own, and political legitimacy of their own, they have come to depend on the federal government setting the agenda for major policy issues, and also providing resources when they are confronted with major emergencies such as hurricanes or earthquakes. Whenever one of those natural disasters occurred, the FEMA, along with other federal agencies, would appear and play a major role in restoring public services and helping individual citizens harmed by the events. Power Grabs: Both the federal government and the state governments at various times tried to take control of the manner in which the pandemic was handled and to exclude the other. This was especially apparent for President Trump who early in the crisis said that he was in control. He likened himself to a “wartime president” who would control centrally the actions of government (Karni, Haberman, & Epstein, 2020). Actually, he asserted he was in control not only in terms of the federal government taking responsibility for the pandemic, but also that he and his associates could control the pandemic (Wallach & Myers, 2020). This position taken by the administration tended to denigrate the role of the states in fighting the pandemic, even when the burden of fighting the disease was being borne primarily at the state and local level. When it became clear that the federal government was not really in control of the situation, and when the president backed off from his claims of control, the states and localities became more activated and began to assert their own capacities to govern in the emergency. Although they may not have had the sweeping powers the federal government could have exercised, the states were able to assert enough power to be able to at least appear as if they had supplanted the federal government as the major actors. Given the sluggishness of the Trump administration, that image of power being exercised through state governments was perhaps reasonable.

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Load-shedding: The response to the pandemic from the federal government was somewhat contradictory. While at sometimes claiming full control, at other times it denied, or at least minimized, its involvement in the fight. One of the common strategies during the pandemic, especially in the early days, was for governments to shed the burdens of coping with the pandemic and pass that load on to other governments. This was most evident in the early days of the pandemic, when President Trump basically told the state governors (and the citizens) that they were on their own. There were instruments available to the federal government, such as the Defense Production Act, which were invoked only sparingly (Solomon, Wynia, & Gostin, 2020). Full use of the Act would have enabled the president to increase production of necessary equipment and distribute it to the states, but that act was never utilized to an extent that significantly influenced the availability of protective equipment or ventilators. One somewhat less obvious form of load-shedding was to move the responsibility for making decisions about closings, mask mandates, and lockdowns to state and local governments. These were difficult decisions from both an ideological and an economic perspective, and the federal government was very happy to let governors and mayors make those difficult decisions. The ideology of the Trump administration obviously emphasized minimal government interference, but this was also a means of not bearing the political burden of making unpopular decisions. Even in the Biden administration, however, there has been a reluctance to make any sweeping policies about closing businesses, relying on suggestions and guidelines rather than more direct intervention.4 Hoarding: Regrettable as it may be, hoarding is a common behavior in times of crisis. While this is usually a behavior of individuals, it can also be true for governments, and was during the COVID-19 pandemic. In particular, the Trump administration created a confusing systems for distributing ventilators and personal protective equipment that to the states and individual hospitals appeared to be hoarding (Kanno-Youngs & Nicas, 2020). Whether intentionally or through incompetence, the Trump administration created the image of holding on to the equipment they had, although the purpose of that hoarding was not clear. To some extent, the same image, albeit perhaps less of the reality, emerged when the vaccines for COVID-19 became available in later 2020. Very few 4 In fairness, this “soft law” approach may be necessary given the lack of a clear legal foundation for the federal government to enact sweeping economic actions, such as forcing businesses to close.

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doses were distributed during the waning days of the Trump administration, even though there was a great demand for its distribution. The administration appeared to have help develop the vaccine with Operation Warp Speed with little thought about how to actually get it to the public once it was developed.

Blame Game In any crisis, governments may attempt to shift blame for failures (Hood, 2013), and pandemic in the United States was no different. For the Trump administration, the major object of the blame game was China. By trying to blame China for, among other things, inventing the virus, failing to notify other countries and the World Health Organization, and misleading other countries about the severity of the disease, the administration attempted to minimize its own culpability for failures to deal with the virus effectively, and further to improve its own status internally by blaming an adversary in international political and economic contests (Dionne & Turkmen, 2020). China was not alone, however, and the Trump administration also tried to shed some blame onto the World Health Organization for being ineffective in managing the health crisis (McNeil & Jacobs, 2020). The blame game was not, however, confined to actors outside the United States. Early in the pandemic, President Trump and others in his administration blamed the poor response to the pandemic on the states, and especially on Governor Andrew Cuomo of New York. When Cuomo complained about the small number of ventilators received from the federal government, Trump said he should have bought more himself, rather than spending money on “a lottery and death panels” (Blake, 2020). The thought that the federal government would step away from what were perceived to be its responsibilities for coping with a major health and economic crisis was surprising and somewhat unnerving for the states. This was true even though the states often were engaged in conflicts with the federal government. Still, the idea that the states would be left with the federal government playing a “backup” role during the pandemic was extremely disconcerting to state governments, as well as to many citizens who had expected the federal government to assume the leadership (see Yen & Woodward, 2020). As the pandemic continued, the federal government did begin to react more positively, albeit still again in its own way. The most positive of the actions of the federal government was to begin the development of vaccines, under the name of Operation Warp Speed. But even after beginning to take some action

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to address the pandemic, the federal government or, at least, the President and his staff did not stress the public health measures such as wearing masks and maintaining social distance. Indeed, many members of the staff continued to denigrate those measures and appeared in public not wearing masks or distancing. Having the same partisan allegiances is not, however, a guarantee of an absence of tensions between the federal and state governments. Republican governors tended to hew to the line of the Trump administration, but Democratic governors have been less likely to always follow the preferences of the Biden administration. For example, Governor Gretchen Whitmer of Michigan when faced with rapidly increasing cases of the virus in April 2021 did not shut down the state’s economy as Washington wanted, but instead continued to plead for more vaccines as the means of controlling the surge (Weiland & Smith, 2021). Some of the conflicts between state and federal governments during the pandemic have been more constitutional than about health policy per se. In particular, the guarantee of the free exercise of religion in the first amendment to the constitution has come into conflict with state actions attempting to limit in-person religious services to limit the spread of the virus. These issues have arisen in a number of states, with the federal courts, especially the Supreme Court dominated by conservatives, tending to side with the churches and synagogues that want to remain open for in-person services (Liptak, 2020).

WHAT HAVE WE LEARNED ABOUT AMERICAN FEDERALISM FROM THE PANDEMIC? There is little doubt that the existence of federalism has affected the manner in which the United States has addressed the COVID-19 pandemic. It is perhaps easier to identify the negative consequences of being a federal political system (Huberfield, Gordon, & Jones, 2020) than it is to see the positive, but there do appear to be both types of outcomes. But here, we are concerned with that the crisis surrounding the pandemic can reveal about federalism, in general, and about American federalism, in particular. Crises are useful for helping us understand how institutions and systems of governance function, and the features that are revealed are generally apparent in “normal times” as well as in more difficult times. The first thing that is apparent about federalism from the pandemic is that there have been abject failures of coordination. Dealing with this pandemic

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required horizontal coordination at all levels, given that issues concerning education, social services, housing, and economic welfare, all arose as a result of the disease. But the issues of vertical coordination were even more important, and, as already alluded to, these tended to fail largely because of an absence of leadership from the center of government. The “opportunistic” elements of federalism have been on display for some time, but they were exacerbated by the competition for resources and control in the pandemic. This episode of “uncooperative federalism” (Bulman-Pozen & Gerken, 2009) followed on another in health care, namely the lack of willingness of many states (approximately half at the outset) to expand Medicaid as a part of the Affordable Care Act. In that instance, even the usual federal bribes were ineffective, and states refused to expand Medicaid even though the federal government would pay the entire cost for the first 10 years (Leonard, 2010). The assumptions of less ideological and more rational reactions by the actors involved in negotiating the relative powers of the levels of government have largely been disproved by the responses of state and central governments in the pandemic. A second point concerning American federalism raised by the pandemic is that it has few mechanisms for equalization built into its policy or financial structures. While formulas used in some policy areas such as education do tend to benefit less-affluent states and school districts, there is no longer any general support coming from the center.5 Therefore, more affluent states have, in general, been able to procure more of the personal protective equipment and ventilators they required, while less-affluent states have not. This does not mean that the more affluent states have always been more effective in fighting the pandemic, as the relatively poor results of New York and California have demonstrated, but it does mean that poorer states were inevitably going to be strained in meeting their needs. These differences in resources are also reflected in the number of physicians and hospital beds, especially intensive care beds, which were available within the states. Although the disparities among states are striking, the disparities between rural and urban areas are even more striking. For example, there are 1.7 ICU beds per 10,000 population in nonmetro areas, compared to 2.8 in urban areas (Joyce, 2020). The early images of the pandemic were of city hospitals – especially in New York–being overwhelmed by cases, and cities have certainly been adversely affected. But the pandemic has become more and more rural, especially given that resistance of vaccination is higher in rural 5 For the period of 1972–1986, General Revenue Sharing provided support to all state and local governments using a formula that to some extent favored less-affluent areas of the country.

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areas, and these areas tend to be more poorly equipped with hospitals and physicians than the urban areas (Davoodi, Healy, & Goldberg, 2020). The pandemic has also demonstrated the lack of planning and foresight that exists in American government, whether seen from the perspective of federalism or more generally. The federal government under President Obama had prepared a plan for responding to a major virus outbreak, but that plan was literally thrown in the trash by the Trump administration (Tracy, 2020). State governments have had contingency plans for medical emergencies, but these tended not to consider an outbreak of a deadly disease of pandemic proportion. American governments at all levels tend to be reactive and tend to wait for crises to develop rather than planning for them (Peters, 2019), and the pandemic has made that tendency very apparent. As well as the states depending on the federal government, and to some extent vice versa, the pandemic has demonstrated the level of interdependence among the states. Each of them can make their own policies, but the success or failure of those policies may be influenced by the decisions of the other states (see Bolleyer & Thorlakson, 2012). A state may decide to shut down its own economy and enforce other public health measures rigidly, but the failure of other states to be as rigorous in dealing with the pandemic will prolong the pandemic and to some extent undermine the actions of the more responsible states. Although in practice interdependent, each state government has had to attempt to protect its own citizens, and, therefore, most have not cooperated with other states to the degree that might have made the outcome of the pandemic less severe (for background, see Cook & Cohen, 2008). Coordination in federalism needs to be vertical between the central government and the states or provinces, but it must also be horizontal among the constituent units. Federalism in the United States has few, if any, formal mechanisms to provide that coordination (Gordon, Huberfeld, & Jones, 2020). There are associations of governors and state legislators, but these have only consultative and advisory capacities, and are even weaker given the partisan political divisions among the states. There may be interstate compacts to deal with coordination issues, but these are generally ill-suited for crisis situations that involve decisive actions. More positively, the pandemic did demonstrate that one of the presumed virtues of federalism in the United States – the ability to experiment and try alternatives – did still work. For example, the two most populous – California and New York – adopted very different strategies when coping with the pandemic in general, as well as in attempting to get their populations vaccinated (Almendrala & West, 2021). California made a strong effort to have the most vulnerable elements of the population – including Latinos – vaccinated while Texas relied on individual initiative. California also engaged in more

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economic shutdowns than did Texas. The two states were roughly equal in terms of vaccinations, but California did have better overall outcomes. The future effects of the pandemic on federalism are, of course, uncertain, but again there appear to be two stories contained within the now almost 15month period of the pandemic. The first is a story of an indifferent federal government forcing responsibilities on the states, and further weakening public trust in Washington. In most crises, there is a “rally around the flag” effect with citizens supporting a government struggling with the crisis, but that did not seem to occur during the first part of the pandemic. The second story is of a federal government that has regained much of its governing capacity and has vaccinated almost as much of the population as can be convinced to take the vaccine. This expansion of vaccination is enabling the opening of economies that was so long demanded by Republicans who were not willing to invest in the public health measures necessary to make it happen.

What Did We Learn about Federalism in the Pandemic? Leaving aside some of the numerous peculiarities of American federalism, we also should consider what this pandemic has taught us about federalism as a general solution for governance problems, especially as it functions in crisis situations. The pandemic has made more apparent some of the inherent weaknesses, and well as the inherent strengths, of federal solutions for the generic problem of governing in space. And we should also be cognizant that not all federal systems will perform in exactly the same manner (Hueglin & Fenna, 2015), as is evident from this collection of papers. The pandemic has demonstrated that the strength of federal solutions to governance arises when there is an absence of leadership and central direction, from the national government. This utility of federalism was certainly the case in the first nine months of the pandemic when Washington failed to take the health crisis seriously. The states and localities then had the capacity to develop some of their own solutions, and attempted with varying degrees of success to manage the crisis within their own territories (Lyu & Wehby, 2020). That federal solution was far from perfect, as already noted, with states using “beggar thy neighbor” approaches when attempting to support their own citizens at the expense of those in other states. But at least there was some attempt by government to address the problem. Unitary regimes faced with an equal absence of effective leadership would perhaps be in even worse positions than the United States, or other federal systems, found itself. The states varied markedly in their economic capacities

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and in the leadership of their politicians, but they were in general able to assume some of the responsibility that the federal government abdicated. Some European countries lacking such a second level of empowered political leadership have found themselves with more severe continuing problems with the pandemic (Rousseau, Bevort, & Ginot, 2020). Federalism is far from a panacea, but it can provide a redundant level of governance if central government governance fails. In addition to the general utility of meso-level governments with autonomous powers when faced with a crisis, federal solutions also emphasize the variable nature of policy problems, and the consequent need for differential levels and types of response. In the United States, at different times the epicenter of the pandemic was in the Northeastern cities, or in the rural South, and at this writing, it is the Upper Midwest. Having autonomous decisionmakers dispersed throughout the United States has permitted differential responses. Of course, these responses at time have been inappropriate, as when some governors have opened restaurants and sports facilities win their states while there is still significant chance of the virus spreading. But attempting to impose a completely uniform response might be unwise in both political and policy terms.

CONCLUSION: AMERICAN FEDERALISM AFTER THE PANDEMIC Most Americans appear to feel that life will never return to what it was before the pandemic, and the same may be true of federalism. The shock to the governance system has been extreme, and even though President Biden has restored some aspects of normal governance, the damage to the way in which intergovernmental relations were managed prior to the crisis seems irreparable. The return to something like a normal pattern of in governance under the Biden administration has meant an immense movement of power to the federal government, and an implicit diminution of the role of the states. If all of President Biden’s policies are adopted, the federal government will become involved in a range of social and economic policies that had not been considered possible previously, and state and local governments will have their role in governing reduced accordingly. Blaming the changes in federalism entirely on the pandemic may be, however, not entirely justifiable. Much of the shifting of power back and forth between levels of government, and the conflicts associated with that shifting of power, were a function not of constitutional issues about federalism but of

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partisan politics. The pandemic may have heightened the visibility and the importance of these shifts in responsibility, but the politics of federalism have been confounded with the ongoing politics of right and left. And even the partisan politics of federalism have not always been clear, with some Republicans being centralizers, and some Democrats more willing to cede powers to the states. In addition, some of the movement of power and responsibility to the federal government has been abdication by the states, especially the red states. These states have been focusing on cultural and political issues, e.g. voting rights, for much of 2021 as the pandemic wanes, rather than focusing on rebuilding their own policy capacity in public health and other important policy areas. But the news is not entirely bad for the advocates of the role of state and local governments in American federalism. The pandemic did highlight the need for competent governance at the state and local level to deal with crisis. The federal government, even in the more powerful form which appears to be emerging, could not be expected to mount localized testing or contact tracing in a time of pandemic disease. Local knowledge and decentralized capacity is required to deal with situations such as that emanating from the pandemic. This may mean, however, that some of the real power in public health will be moving to local governments rather than the states. Further, the profound differences in political cultures that exist between the red and the blue states will make centralized solutions unpalatable to some states, almost regardless of which party is in control in Washington.

REFERENCES Almendrala, A., & West, S. (2021). California and Texas took different routes to vaccination: Who’s ahead? California Healthline, April 22. Retrieved from https://californiahealthline.org/news/article/california-andtexas-took-different-routes-to-vaccination-whos-head/? utm_campaign5CHL%3A%20Weekly%20Edition&utm_medium5 email&_hsmi5123071919&_hsenc5p2ANqtz-_-GJ-RoLrO5F17n7E 25qTHXOZS7tiLDiRxGgNlV9x32cdVEx8N3LvmntTHhVCdRdWDo D5wPv3JipAJ0w5XCGsazKugYw&utm_content5123071919& utm_source5hs_email Altman, D. (2020). Understanding the US failure on coronavirus. BMJ, 370, m3417. doi:10.1136/bmj.m3417

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Axelrod, T. (2021). Worries grow over GOP reluctance to take vaccines. The Hill, April 15. Retrieved from https://thehill.com/policy/ healthcare/548422-worries-grow-over-gop-reluctance-to-takevaccines?rl51 Birkland, T., & Waterman, S. (2008). Is the federalism the reason for policy failure in Hurricane Katrina? Publius – The Journal do Federalism, 38(4), 692–714. doi:10.1093/publius/pjn020 Blake, A. (2020). Trump finds someone to blame for coronavirus: Andrew Cuomo. Washington Post, March 24. Bolleyer, N., & Thorlakson, L. (2012). Beyond decentralization: The comparative study of interdependence in federal systems. Publius: The Journal of Federalism, 42(4), 566–591. doi:10.1093/ publius/pjr053 Bolling, C. J. & Pickerill, J. M. (2013). Fragmented federalism: The state of American federalism. Publius: The Journal of Federalism, 43(3), 315–346. doi:10.1093/publius/pjt022 Brubaker, R. (2020, November 3). Paradoxes of populism during the pandemic. Thesis Eleven, 28. doi:10.1177%2F0725513620970804 Bulman-Pozen, J., & Gerken, H. K. (2009). Uncooperative federalism. Yale Law Journal, 118(1256), 1256–1310. Conlan, T. (2006). From cooperative to opportunistic federalism: Reflections on the half-century anniversary of the commission on intergovernmental relations. Public Administration Review, 66(5), 663–676. doi:10.1111/ j.1540-6210.2006.00631.x Cook, A. H., & Cohen, D. B. (2008). Pandemic disease: A past and future challenge to governance in the United States. Review of Policy Research, 25(5), 449–471. doi:10.1111/j.1541-1338.2008.00346.x Davoodi, N. M., Healy, M., & Goldberg, E. M. (2020). Rural America’s hospitals are not prepared to protect older adults from a surge of COVID-19 cases. Gerontology and Geriatric Medicine, 6. doi:10.1177% 2F2333721420936168 Dionne, K. Y., & Turkmen, F. F. (2020). The politics of pandemic othering: Putting COVID-19 in global and historical context. International Organization, 74(S1), 213–230. doi:10.1017/S0020818320000405

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Gordon, S. H., Huberfeld, N., & Jones, D. K. (2020). What federalism means for the US response to coronavirus disease 2019. Retrieved from https://jamanetwork.com/channels/health-forum/fullarticle/2766033? utm_source5twitter&utm_medium5social_jamahf& utm_campaign5article_alert&utm_content5automated_rss Hatchett, R. J., Mecher, C. E., & Lipsitch, M. (2017). Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proceedings of the National Academy of Sciences, 104(18), 7582–7587. doi: 10.1073/pnas.0610941104 Hood, C. (2013). The blame game: Spin, bureaucracy and self-preservation in government. Princeton, NJ: Princeton University Press. Huberfield, N., Gordon, S. H., & Jones, D. K. (2020). Federalism complicates the response to the COVID-19 health and economic crisis: What can be done? Journal of Health Politics Policy and Law, 45(6), 951–965. doi: 10.1215/03616878-8641493 Hueglin, T. O., & Fenna, A. (2015). Comparative federalism: A systematic inquiry (2nd ed.). Toronto, ON: University of Toronto Press. Joyce, A. (2020). Interactive map highlights urban-rural differences in hospital bed capacity. KFF Newsroom, April 23. Retrieved from https:// www.kff.org/health-costs/press-release/interactive-maps-highlight-urbanrural-differences-in-hospital-bed-capacity/ Kanno-Youngs, Z., & Nicas, J. (2020). ‘Swept up by FEMA’: Complicated medical supply system sows confusion. New York Times, April 6. Karni, A., Haberman, M., & Epstein, R. J. (2020). “Wartime president”? Trump rewrites history in election year. New York Times, March 22. Kenen, J., & McGraw, M. (2021). Trump’s former aides say he whiffed on vaccine legacy. Politico, April 20. Retrieved from https://www.politico.com/ news/2021/04/20/trump-vaccines-ex-aides-483387 Kettl, D. F. (2020). States divided: The implications of American federalism for COVID-19. Public Administration Review, 80(4), 595–602. doi: 10.1111/puar.13243 Lasco, G. (2020). Medical populism and the COVID-19 pandemic. Global Public Health, 15(10), 1417–1429. doi:10.1080/17441692.2020.1807581

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Leonard, E. W. (2010). Rhetorical federalism: The value state-based dissent to federal health reform. Hofstra Law Review, 39, 111–168. doi:10.2139/ ssrn.1663947 Liptak, A. (2020). Splitting 5–4, Supreme Court backs religious challenge to Cuomo’s shutdown order. New York Times, November 26. Lyu, W., & Wehby, G. L. (2020). Community use of face masks and COVID-19: Evidence from a natural experiment of state mandates in the US. Health Affairs, 39(8), 419–425. doi:10.1377/hlthaff.2020.00818 Martinez, M. (2021). Texas no longer has a statewide mask mandate. Texas Tribune, March 10. Retrieved from https://www.texastribune.org/2021/03/ 10/texas-mask-mandate-coronavirus-restrictions/ McNeil, D. G., & Jacobs, A. (2020). Blaming China for the pandemic, Trump say us will leave W. H. O. New York Times, May 29. Meyer-Gutbrod, J. L. (2018). American federalism and partisan resistance in an age of polarization. Unpublished Ph.D. dissertation, Department of Government, Cornell University, Ithaca, NY. Moynihan, D. (2021). Populism and the deep state: The attack on public service under Trump. In M. Bauer, B. G. Peters, J. Pierre, K. Yesilkagit, & S. Becker (Eds.), Democratic backsliding and public administration. Cambridge: Cambridge University Press. Peters, B. G. (2019). The American policy style(s): Multiple institutions creating gridlock and opportunities. In M. Howlett & J. Tosun (Eds.), Policy styles and policy-making: Exploring the linkages (pp. 180–198). London: Routledge. Rousseau, A., Bevort, H., & Ginot, L. (2020). La sant´e publique au risque de la COVID19: Du premier retour d’exp´erience a` la formulation de nouvelles exigences collectives. Sant´e Publique, 32(2), 183–187. doi:10.3917/ spub.202.0183 Solomon, M. Z., Wynia, M., & Gostin, L. O. (2020). Scarcity in the COVID-19 pandemic. Hastings Center Report, March–April. doi:10.1002%2Fhast.1093 Stolberg, S. G. (2021). 200 million vaccines in 100 days is the new goal Biden says. New York Times, March 25. Tracy, A. (2020). How Trump gutted Obama’s pandemic preparedness system. Vanity Fair, May 1. Retrieved from https://www.vanityfair.com/ news/2020/05/trump-obama-coronavirus-pandemic-response

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Wallach, P., & Myers, J. (2020). The federal government’s coronavirus response – Public health timeline. Brookings Institution Center on Regulation and Markets. March 31. Retrieved from https:// www.brookings.edu/research/the-federal-governments-coronavirus-actionsand-failures-timeline-and-themes/ Weiland, N., & Smith, M. (2021). Surging virus has Michigan’s democratic governor at loggerheads with Biden. New York Times, April 12. Wright, D. S. (1988). Understanding intergovernmental relations (3rd ed.). Pacific Grove, CA: Brooks/Cole. Yen, H., & Woodward, C. (2020). AP fact check: Trump, ‘wartime’ pandemic leader or ‘backup’? Associated Press. Retrieved from https:// apnews.com/a64cf7fd5095d4d3b002dc4830e32119

3 ARGENTINE FEDERALISM IN COVID-19 PANDEMIC Daniel Alberto Cravacuore

ABSTRACT This chapter has four parts. The first section addresses the legal analysis of the Argentine local governments’ autonomous regime, considering its provinces and municipalities, and the second section analyzes the portfolio of policies – nationals, provincials, locals – to attend the emergency of COVID-19, which show that the Federal State was dedicated to the overall strategy: sustaining the income of citizens, businesses, and subnational governments; and the purchase and distribution of health equipment and supplies, while the attention of COVID-19 cases fell to the provinces and municipalities. The third section analyzes the coordination mechanisms during the pandemic mainly based more on presidential leadership with the support of governors and mayors than on institutional mechanisms. Finally, the role of the political agency especially as for the main interjurisdictional conflicts that took place in 2020 and 2021 once the authorities dimensioned the pandemic scope as well as the Kirchnerism/anti-Kirchnerism cleavage that characterizes Argentine politics since 2008. Keywords: Argentina; “Marble Cake” federalism; presidential leadership; Kirchnerism/anti-Kirchnerism cleavage; pandemic; COVID-19; crisis; intergovernmental Relation

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INTRODUCTION Argentina is exemplary in the region in terms of its decisive and timely response to the pandemic, said the Pan American Health Organization Representative in Argentina (UN, 2020) on June 25, 2020. Time has shown that this evaluation was premature; Argentina was the second Latin-American country with more cases, exceeding five million infected people, and more than 105,000 citizens have died (Worldmeter, 2021). The strict confinement in the Buenos Aires Metropolitan Area – that has a total population of 14.8 million – was the most extensive in the world. On the one hand, this was adequate to prepare the health system, and on the other hand, it substantially affected the economy. The gross domestic product (GDP) decreased 10% in 2020 – a third more than the Latin-American average – and poverty reached 40%. The COVID-19 effects have been devastating for a country facing a structural crisis; Argentine peso lost 68% of its value since April 2018, and the annual inflation exceeds 50% (World Bank, 2020). To discuss the Argentine federalism in the pandemic, this chapter has been divided into four parts. Firstly, the autonomous regime of subnational governments (provinces and municipalities) will be addressed. Secondly, the portfolio of national, provincial, and local policies to attend the emergency of COVID-19 will be analyzed. Thirdly, we will examine the mechanisms of intergovernmental coordination put in place during the pandemic. Finally, we will tackle the role of political agency and the main interjurisdictional conflicts that took place in 2020 and 2021 having the pandemic as a background.

SUBNATIONAL AUTONOMY Argentina is a federal nation composed of 23 provinces (states) plus the Autonomous City of Buenos Aires, and over 2,300 local governments. Its form of federalism has evolved over time from a more dual model to a more cooperative one (Cao & Vaca, 2017). This federal arrangement is characterized by the cooperation between the different levels of government, but the provinces retain a significant degree of decision-making autonomy, and the competence limits are often diffuse between the different levels of government. This was manifested in relevant competencies during the COVID-19 pandemic such as health, social protection, security, and economic promotion. The provinces can promulgate their constitutions and laws, define the system of municipal government in their own jurisdictions, administrate

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day-to-day justice, and organize their own electoral systems. They also have a degree of financial autonomy which is based on the right to levy direct taxes. Since the 1853 Federal Constitution, the national government has retained the exclusive right to promulgate federal laws. This is reflected in various topics covered by the Constitution, and a common legal code that regulates civil, commercial, penal, and labor law. The Federal State also have the right to intervene at the subnational level to protect their territories when facing any threat of internal disorder, declare a state of siege – which was considered at the beginning of the COVID-19 pandemic but later discarded for symbolic reasons – as well as manage international relations. The Constitution grants the provinces all powers not specifically attributed to the Federal Government. In theory, according to the 1853 Constitution, the provinces have powers that are unlimited except for those that have been expressly or implicitly delegated to the Federal Government, and that are, because of that, limited in practice. However, this arrangement has suffered considerable modification brought about by the much greater level of financial resources at the Federal Government’s disposal. These changes led to a centralization process that has also been recognized by the Federal Supreme ´ Court’s decisions (Hernandez, 2002). A special analysis is required for the Autonomous City of Buenos Aires. After the 1994 Constitutional Reform, the national capital city acquired a new status that established an autonomous government regime which has its own powers and jurisdiction besides recognizing it as a participant in the federal dialog with the provinces, municipalities, and the Federal State. Nevertheless, it was only in 2019 that the Supreme Court changed its traditional jurisprudence, recognizing that Autonomous City has the same constitutional status given to the provinces in the regulatory system that governs the jurisdiction of federal courts. This is relevant issue because the autonomy came into discussion during the COVID-19 pandemic for many reasons. Since Buenos Aires was the jurisdiction that, proportional to its population, had the highest number of cases, it is the most important electoral district ruled by opposing political forces to the Federal Government, its per capita budget is higher when compared to its impoverished conurbation, and it is the main electoral base of the national ruling party. In the Argentine constitutional architecture, the Senate is the epitome of a federal body, comprising equal representation by all provinces and the ´ Autonomous City (Hernandez, 2002). Since 1853, the Senate has been composed by two senators elected in each of the provincial legislatures. A 1994 constitutional reform introduced a third senator, and, since then, two senators represent the largest party, and one represents the largest opposition

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party. However, according to the democratic transition from 1983 onwards, the position of the Senate as the prime arena for addressing federal matters has been replaced by direct relationships between federal authorities and provincial governors. At critical moments, the country’s president has held meetings with all of them to decide on actions. This was the case to cope with the pandemic during the first months of the health crisis. The regulatory framework of Argentine local governments is found in the National Constitution. Two of its articles refer to this: the fifth article, inscribed in an 1853 text, and the 123rd, which was included in the 1994 constitutional reform recognizing municipal autonomy. However, the 23 Argentine provinces are the ones who define their municipal laws, the institutional design, and general operation of local governments in all aspects (Cravacuore, 2016). There has been a long-standing debate about the degree of municipal autonomy in Argentina. The Supreme Court initially pronounced in favor of municipal autonomy in underpinning its decisions on Spanish colonial tradition and the views of Juan Bautista Alberdi, the ideologue of the nation state. However, for much of the twentieth century, the Supreme Court subscribed the thesis that municipalities are purely decentralized bodies without any autonomy. They would just be agencies for implementing responsibilities delegated to them by the provinces, besides being limited to execute purely ´ administrative roles (Abalos, 2003). This dispute was finished in 1989 when the Supreme Court ruling “Rivademar against the Municipality of Rosario” pronounced in favor of municipal autonomy, even if provincial constitutions had been promulgating since the late 1950s. This ruling was ratified in Article 123 of the 1994 Constitution, which indicates that “Each province dictates its own Constitution in the terms of article 5, ensuring municipal autonomy and regulating its scope and content in institutional, political, administrative, economic and financial aspects.” Notwithstanding, there are great differences in the level of municipal autonomy in the Argentine provinces (Cravacuore, 2019). The provincial and municipal autonomies were one of the main challenges since the outbreak of the COVID-19 pandemic. Initially, there was interjurisdictional competition for the purchase of respirators and other critical equipment, but it was settled with the federal monopolization of the Federal State assuming their purchase and distribution. There were also conflicts due to the restrictions on people circulation imposed by many municipalities that exceeded their constitutional powers (Ram´ırez de la Cruz, Grin, Pulido, Cravacuore, & Orellana, 2020). Later, the progressive opening of limited

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activities during the quarantine led to further debate on local governments’ autonomy, as well as on vaccine distribution strategies. Governors and mayors assumed national policies without any objection during the COVID-19 pandemic, and, in this way, they exerted their little constitutional autonomy. We understand that the provinces and local governments preferred to voluntarily renounce from their autonomy because the net utility of doing so outweighed not doing it (Feiock & Scholz, 2010). The monopolization of respirators first and vaccines later, the federal financial assistance provided, and the fear of the uncertain pandemic outcomes explain these resignations (Cravacuore, 2020a).

POLICY PORTFOLIO In practice, the Federal Government exercises several exclusive competences in the areas of defense, international relations, the resolution of conflicts between provinces, as well as postal service, and the provision of gas and telecommunications. The Federal Government share competences with the provinces in the higher education public policy and the provinces collaborate in the areas of justice, social security, and maintenance of interstate highways. Finally, there are many competencies that are shared among the three levels of government, such as health, social welfare, economic development, and public transport (Cravacuore, 2016). The exclusive provincial powers include all education levels, except universities, police, social housing, and electrical regulation. In turn, provinces share competences with municipalities in the provision of public services such as water, sanitation, and waste collection and disposal. Finally, there are many exclusive competences of local governments such as construction and maintenance of urban infrastructure, the regulation and control of economic activities carried out in their jurisdiction, traffic control, and the provision of nonmonetary social welfare benefits (for instance, food parcels and building materials) (Cravacuore, 2016). This limited range of formal municipal competences contrasts with the contemporary agenda of local governments as they have been involved in a significantly wider range of activities. From the 1990s on, those municipalities with greater resources have gradually undertaken a range of new responsibilities such as environmental protection, citizen security, local economic development, citizen access to justice, conflict resolution, and social welfare.

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However, given their financial limitations, few local governments are capable to simultaneously engage in all of these activities (Cravacuore, 2016). Health care has a complex design in Argentina, and it is a competitor competence between all government levels. The National Ministry of Health is focused on epidemiological medicine, vaccination, and sanitary policies, and operates only four small hospitals – specialized in addictions, mental health, leprosy, and psychophysical recovery – and five large hospitals (four of them located in the Metropolitan Area of Buenos Aires). Historically, provinces have adopted different strategies – some maintain control over all their health hospital and clinics, others give municipalities control over decentralized hospitals and primary care units, retaining only complex hospitals. Anyway, the provinces take care of patients with severe pathologies according to a referral system, and municipalities support complex health systems according to their own financial capacity. In some cities, there are large military and university hospitals. There is no articulation mechanism in the country between the public and private health subsystems. The private health service is the most relevant system (Bello & Becerril-Montekio, 2011) since it provides the attention of unionized workers – trade unions have their own clinics and private hospitals networks – to older people. The health of the elderly is administered by a federal agency, the National Institute of Social Services for Retirees and Pensioners, but this service is largely operationalized by a private hospitals network – and citizens who voluntarily pay their health insurances. COVID19 has shown the health system’s administrative fragmentation. For example, mechanisms had to be created to build statistics of cases and deaths and availability of intensive care unit (ICU) beds. System reliability was questioned many times because some jurisdictions loaded their data late. On March 18, 2020, when COVID-19 cases appeared, and there was a lot ´ of uncertainty in global context, President Alberto Fernandez implemented a national health strategy – the Social, Preventive, and Compulsory Isolation – characterized by the total limitation of public circulation, which was restricted only to buy food and medicine in nearby shops. The issuance of a single circulation was only permitted for essential workers. A prohibition of interjurisdictional passenger transport was implemented; borders were closed; and there was limitation of flights for international and interprovincial repatriation. Finally, it was mandatory to wear masks in public spaces (Ram´ırez de la Cruz et al., 2020). Another strategy was the creation of the Committee of Experts – integrated mainly by epidemiologists – who evaluated the evolution of infections every two weeks together with the President. The Federal Government decided to justify its actions based on these recommendations.

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´ President Fernandez declared, in opposition to the previous administration: “We are a government of scientists, not of CEOs.” Later, territorial approach was a special strategy to face a significant increase in cases detected; in coordination with provinces and municipalities, the federal detector program carried out massive tests in these neighborhoods. However, this did not reduce scientific and journalistic criticism about the inexplicable low number of tests applied during the pandemic. Furthermore, the health system was in a relatively better situation than other countries – Argentina was third in the Latin America ranking of highest number of doctors and ICU beds (OECD/World Bank, 2020). Despite that, the Federal Government obtained international financing to build, in 45 days, 12 modular small hospitals in most populous districts (Almirante Brown, Flor´ General Rodr´ıguez, Hurlingham, Lomas de encio Varela, General Pueyrredon, Zamora, Moreno, Quilmes, and Tres de Febrero, in the Metropolitan Area of Buenos Aires; Resistencia, capital of the Province of Chaco; Granadero Baigorria, in the Rosario Metropolitan Area, Province of Santa Fe province; and ´ in the city of Cordoba, capital of the homonymous province), which added 350 new ICU beds and 650 intermediate therapy beds to the public subsystem. According to official information, the country increased the number of intensive care beds by 37% in the first pandemic quarter in 2020. Anticipating summer holidays, the National Ministry of Public Works also financed the construction of 19 Modular Sanitary Centers in tourist municipalities – ´ La Costa, Monte Hermoso, Necochea, and Villa Gesell in General Pueyrredon, the Province of Buenos Aires; Mina Clavero, Santa Mar´ıa de Punilla, and ´ ´ Santa Rosa de Calamuchita, in the Province of Cordoba; Colon, in the Province of Entre R´ıos; Humahuaca, in the Province of Jujuy; Cafayate, in the ´ in the Province of Mendoza; Province of Salta; San Rafael and Tunuyan, ´ in the Province of Misiones; Puerto Madryn, in the Province of Puerto Iguazu, Chubut; Bariloche and Las Grutas, in the Province of R´ıo Negro; San Mart´ın de Los Andes, in the Province of Neuqu´en; and Ushuaia, capital of the Province of Tierra del Fuego – in order to improve the capacity to fight the COVID-19 pandemic. They had a dozen hospital beds, laboratories, and clinics. The Federal Government has monopolized the purchase of vaccines, negotiating the delivery of Sputnik V vaccine with the Russian Federation, developed by the Gamaleya National Center for Epidemiology and Microbiology. It has also negotiated with the People’s Republic of China the purchase of the Sinopharm vaccine as well as the Covishield vaccine with the AstraZeneca pharmaceuticals. The Federal Government has maintained exclusive

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control of vaccine distribution to the provinces. The vaccines transfer from the producing countries and has been carried out, almost exclusively, by the flag carrier Aerolineas Argentinas. In opposition, vaccination is decentralized, and the Federal Government only established general application criteria, under the generic name of COVID-19 Strategic Vaccination Plan. Likewise, the National Ministry of Health implemented the Public Vaccination Monitor, a free online database that shows in real time some information about the COVID-19 immunization plan. Other nonhealth issues were also needed for interjurisdictional coordination during the pandemic. Citizen security depends mainly on the provincial police. The Federal Governments controls four security forces: the Federal Police, the National Gendarmerie, the Naval Prefecture, and the Airport Security Police, respectively oriented toward national security; borders; rivers and coasts; and airports. All of these bodies were responsible for controlling vehicular traffic. In Argentina, municipalities do not have police corps, since they only have traffic and commercial inspectors who were called, according to polices instructions, to carry out their tasks with greater dedication than in normal times. In this case, there was an adequate level of complementation between all government levels. Unlike other countries, military forces only developed logistical support tasks: the Army offered food in poor neighborhoods, as families were prevented from attending community and school dining rooms. The Navy did the same in some port cities; and the Air Force was vital for medical equipment distribution. To reduce the economic crisis, the Federal Government implemented the Emergency Assistance to Work and Production Program (ATP). This program financed up to two minimum wage salaries per employee to companies affected by COVID-19, offered zero-rate credits for the self-employed, and increased unemployment insurance. The Federal Government has also provided additional support to activities affected by the quarantine, such as artisanal, cultural, cinematographic, musical, and tourist activities. In addition, provinces and municipalities postponed the collection of taxes and fees from households and companies, even in the context of falling income. When the strict quarantine finished, the National Ministry of Labor, Employment, and Social Security established, in replacement to the ATP program, the Productive Recovery Program II (REPRO II), which had a substantially lower fiscal impact. This program was applicable to a small number of companies, with fixed amounts of money – between USD 100 and USD 200 per worker – according to the kind of economic activity. The National Ministry of Tourism and Sports implemented the Previaje Program, granting a

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credit of 50% expenses incurred for the 2020/2021 summer holidays, which was used for tourist purchases in 2021. The promotion had its utilization valid for travel agencies, hotels, transportation, excursions, car rental, tourist attractions, gastronomy, entertainment, and other tourist services. To access this benefit, it was necessary to spend a minimum of $55 and a maximum of $1,100. Also, active social policies were implemented to mitigate the effects of COVID-19. In 2020, during the pandemic, poverty grew from 35.6% to 44.2%. To face this social crisis, the Federal Government created the Emergency Family Income (IFE), a USD 150 monthly bond that was delivered to eight million informal and self-employed workers. Also, there was an extraordinary reinforcement of the Universal Child Allowance for four million beneficiaries. The disconnection for nonpayment of services such as mobile phone, Internet, and cable TV was suspended for the lower-income population. Moreover, evictions and the price of leases and mortgages were frozen as well as the prohibition of dismissals and suspensions of workers. Finally, the closure of bank accounts was suspended, and the Federal Government determined maximum prices for essential goods (Ram´ırez de la Cruz et al., 2020). The municipalities provided food reinforcements for the poorest households, under the format of weekly baskets or daily meals before the closing of school canteens. This aid was also complemented by the Food Card, which is a USD 15 weekly voucher given to the poorest families. Food assistance had to be extended, in some situations, to the population of fully fenced and quarantined neighborhoods, to which the support of the Army was very useful. The National Ministry of Science, Technology, and Innovation has played an important role in the pandemic; it has financed the development of SARSCoV-2 detection kits based on various technological platforms and the transformation of scientific laboratories in facilities suitable for the identification of cases. This Ministry also provided additional funding for pharmacological and medical research as well as to study the social, economic, and cultural impact of the COVID-19 pandemic. In May 2021, the shortage of vaccines and a new wave of infections forced a new total closure of activities. Nowadays, there are no new policies beyond a monetary reinforcement of social subsidies for mitigating the effects of inflation. All provinces, based on their defined powers, since March 2020, have provided health services in provincial hospitals and health units. They bought sanitary materials that were added to those provided by the Federal Government, implemented the population control movement, took care of the poorest population, and provided financial assistance to their municipalities.

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Many municipalities had a greater diversity of initiatives beyond following federal and provincial policies. For example, local governments disinfected public spaces, urban equipment, ATM machines, and vehicles. While some municipalities with greater resources have developed mobile applications to geolocate open stores, others have launched self-assessment applications and follow-up of the detected cases of COVID-19 before the national government did it. The Municipality of Moreno (Province of Buenos Aires) developed a smart device that provides information through WhatsApp. Finally, there was another use technology to implement random controls to verify the mandatory quarantine of people who returned from abroad. In larger municipalities, such as those in the Buenos Aires Metropolitan Area, spaces were prepared to install isolation beds for the mildly infected people in hotels, universities, schools, and sports clubs (Ram´ırez de la Cruz et al., 2020).

COORDINATION MECHANISMS Argentina is a cooperative federal country in which there is a coresponsibility of all federal pact members in public policies implementation. The continuous challenge is to achieve a synergic articulation of different policies. In general, Argentine citizens have difficulties to identify the levels of governments involved in public management because there is a high degree of overlap and an abusive use of communication at all levels in the supposed policies success. This situation is different from the dual federalism envisaged in 1853 Federal Constitution which presented precise and defined limits between different types of government. Usually, citizens assign responsibilities to the Federal Government in general matters – such as economy, justice, employment, social assistance, and corruption – to the detriment of the provincial and municipal authorities. These two levels of government usually are focused on issues such as public security, health, education, road safety, or public services quality. During the COVID-19 pandemic, these limits seemed to become more diffuse because the links among jurisdictions were tightened and the government of ´ President Alberto Fernandez sought to nationalize many issues searching to get electoral benefits. In terms of intergovernmental relations, the health crisis showed, especially until September 2020, a positive coordination which was more effective than in normal times. The COVID-19 pandemic seems to have encouraged more cooperation agreements between Federal Government and provinces and

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municipalities induced by the uncertainty and fear generated by the health crisis. The Federal Government addressed the large-scale problems: the overall strategy to fight the pandemic; sustaining the income of citizens, businesses, and subnational governments; and organizing the purchases and distribution of health equipment and supplies, while the attention of COVID-19 cases was transferred to the provinces and municipalities. In Argentina, there are weak institutionalized interjurisdictional mechanisms. There are many Federal Councils (Aging Population, Municipal Affairs, Science and Technology, Drugs, Education, Communications, Culture, Human Rights, Disabled People, Electricity, Comprehensive Risk Management and Civil Protection, Taxes, Investments, Registers, Job, Trafficking and Exploitation of People, Environment, Childhood, Adolescence and Family, Planning and Territorial Ordering, Population, Social Security, Foreign Relations and International Trade, Real State Registries, Fiscal Responsibility, Health, Security in Sports Events, Road Safety, Public TV, Tourism, Transparency, Fishing, Ports, among others). All of them are articulation institutions integrated by the Federal Government, provinces, and the Autonomous City of Buenos Aires. However, their role is limited since they are consultative, for concertation, agreement, and planning and mainly because they are subordinate to national agencies. The national ministers or secretaries participate in these forums together with their provincial counterparts. In the COVID-19 crisis, the Federal Health Council (COFESAL) played an important role as a coordinating institution along with provincial governments because pressing demands spurred for more cooperative agreements. Something similar happened since July 2020 with the sending of doctors to provinces with weak health systems. The distribution of vaccines, in 2021, also acted as a limitation of dissent. Intergovernmental coordination during the COVID-19 pandemic was based both on presidential authority and its relations with the governors, the mayor of the Autonomous City of Buenos Aires and the Governor of the Province of Buenos Aires. This happened because the Metropolitan Area of Buenos Aires was the most affected territory by the first pandemic impact. This coordination was more powerful in a moment where the great uncertainty about COVID-19 was high and the political effects to tackle on it seemed uncertain, especially in the poorest neighborhoods. President Alberto ´ Fernandez decided to personally lead the process together with the opposition, the Mayor of the Buenos Aires city, Horacio Rodr´ıguez Larreta, and the Governor of the Buenos Aires province, Axel Kicillof. This initiative was surprising for a country that has been politically polarized for more than a decade.

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President Alberto Fernandez led meetings with the governors before the successive quarantine extensions. The main incentive for coordination was the federal monopoly on the purchases and distribution of respirators. The Federal Government also created the Provincial Financial Emergency Program to financially assist the provinces in the face of increased expenditures and the collapse of their revenues, which was well-received by their governors. In Argentina, workshops among Presidents and Mayors are not frequent because the municipal system is a provincial competence. However, President ´ Fernandez decided, at the beginning of the COVID-19 pandemic, to establish a more direct relationship, especially with the mayors of cities located in the metropolitan Area of Buenos Aires. Since one-third of the Argentine population lives in this territory, a spread of the virus with severe pandemic impact could have occurred, due to the combination of population density, weak public health system, and high poverty. Because of that, President Fernandez, together with national ministers, the Head of Government of the City of Buenos Aires, and the Governor of Buenos Aires, sought to coordinate actions to be implemented in this metropolitan area. A meeting held on March 23, 2020, focused on sanitary conditions, evaluated the availability of hospital beds, mechanical respirators, and places for isolation of mildly infected patients as well as territorial control of preventive and compulsory social isolation. The meeting was incredibly positive, everything is being organized very well and quickly with the municipalities, said an opposition Mayor. Also, another mayor of the same party asserted: There were no chicanes or other political questions. Fear unites us. A Mayor added after that meeting: We are all working together, in permanent communication, seeking to ensure the quarantine program can work better every day. A week later, this time in a virtual platform, the President met again with these metropolitan Mayors, which besides the initial public health concern also addressed the issue on their fiscal situation, due to the provincial tax collapse. They were successful in obtaining support from the national government for the payment of wages and essential services. After this videoconference, an opposition mayor declared: The funds for municipalities are guaranteed (El Cronista, 2020). Two weeks later, the President held an extensive virtual meeting with the mayors of several urban municipalities (Bah´ıa Blanca, Caleta Olivia, Como´ doro Rivadavia, Concordia, Cordoba, Corrientes, Formosa, General Pico, ´ General Pueyrredon, La Banda, La Rioja, Mendoza, Neuqu´en, Posadas, Puerto Madryn, Rafaela, Resistencia, R´ıo Cuarto, R´ıo Tercero, Rosario, Salta, San Fernando del Valle de Catamarca, San Juan, San Luis, San Salvador de Jujuy, Santa Fe, Santa Rosa, Santiago del Estero, Taf´ı Viejo, Ushuaia, Viedma,

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and Villa Mar´ıa) (Ram´ırez de la Cruz et al., 2020). According to the press, the President listened to the report presented from municipal chiefs on the situation in each district, took notes and asked them for details on some specific matters. These mayors were from different parties and represented 25% of the national population. Since then, and as an extension of these videoconferences, the governors have also opted for this type of meeting with their mayors as common practice. This situation contrasts with the lack of coordination verified in the early days of the pandemic when many local governments advanced in regulations that were stricter than those established by the national government regarding the free transit of essential services. Many municipal authorities did not warn that local regulations are only valid on the condition that they do not adversely affect national or provincial regulations. More than that, local restrictions must be regulated by Municipal Ordinance and have clear foundations. For example, local access closures cannot be total because not allowing free movement may constitute a federal crime. In sum, municipalities can only enact more severe local regulations if these norms do not infringe federal national laws. ´ In July 2020, President Fernandez decreed, for the territories not affected by the pandemic, the stage of Preventive and Mandatory Social Distancing allowing the return of normal activities, although with limitations for concentration of people. This decree recognized the infeasibility of continuing with the quarantine in cities that had registered a small number of cases. An opening mechanism was created in phases: mayors proposed the reopening of different commercial, industrial, and social activities which were accepted by the provincial governments and ratified by the National Chief of the Cabinet of Ministers. This coordination mechanism was quite effective although it has been criticized for its slowness and, according to some opposition mayors, for its discretionary use by the federal authorities (Cravacuore, 2020b). The sanction, in August 2020, of the DNU No. 641/20 (Urgency Need Decree is sanctioned by the President and has force as a law), a particular type of regulation sanctioned by the President that is in force as a law, renewed the confinement for areas of community virus circulation and included the prohibition and repression of social meetings, even at home. The implementation of these legal measures has given rise to problems of lack of interjurisdictional coordination. The first voice to speak out against these measures came from the opposition Governor of the Province of Corrientes, who emphasized that he would not comply with this unconstitutional rule, although he later declined. The lack of intergovernmental coordination has been accelerated at the municipal

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level, mainly because the opposition controls a greater number of large local governments than the provinces. This problem has coincided with the increase in cases and their dissemination in multiple areas of community circulation. Mayors have postulated their own positions because it was more attractive for them to act more autonomously. Such a situation should be understood as rejected by the majority of the population who was not in favor of the quarantine extension for economic and political reasons besides the growing social contempt. The ruling party aggressively censored these positions, of which the most notorious case was the Municipality of Tandil, in the Province of Buenos Aires, although other local governments did so with less ostentation. A specific focus is required to analyze the relationship between the Autonomous City of Buenos Aires and the Federal Government. President ´ Fernandez personally led the process together with the mayor Horacio Rodr´ıguez Larreta and Governor of Buenos Aires, Axel Kicillof. This initiative was something surprising in a polarized country for more than a decade because Rodr´ıguez Larreta is the main opposition leader against the Federal Government and Kicillof is the most prominent figure in Kirchnerism. This triad was the main public image of the coordinated fight against the pandemic. However, the intention of the mayor of Buenos Aires toward a greater flexibility in commercial, recreational, and opening of educational activities were turning points, given the refusal of the President and the Governor of Buenos Aires to do so. At this stage, the Government of the Autonomous City of Buenos Aires preferred a lower level of voluntary coordination with collaborative solutions because the mayor decide that it would be more attractive to act with a higher level of autonomy. The reasons that supported this political decision were: (1) the number of cases were stabilized, the ICU beds in Buenos Aires were not at critical levels; (2) the progressive opening of economic activities had not promoted an increase in cases; and (2) the maintenance of a stricter quarantine deteriorated the positive perception of its management to face the COVID-19 crisis, especially because this was the highest among national leaders (Giaccobe & Asociados, 2020). The breaking point of interjurisdictional coordination in the main populated area was the untimely retention, by the Federal Government, of intergovernmental financial transfers from the Buenos Aires city to create a Financial Strengthening Fund for the Province of Buenos Aires. In 2016, President Mauricio Macri increased, by appealing to federal funds, the coefficient of Buenos Aires from the 1.4% established in 2003 to 3.75% – which, in 2018 was reduced to 3.5% – justifying the need to increase financial transfer to support the decentralization of a part of the Argentine Federal Police in the

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City of Buenos Aires. This was timely denounced by provincial governors and generated a substantial increase in city funds for many years. In September 2020, after a police rebellion in the Province of Buenos Aires ´ demanded salary increases, President Fernandez reduced the intergovernmental transfers, through Decree 735/20. The President sent a bill to the Federal Congress seeking to reduce intergovernmental transfers to the city from 3.5% to 2.32%. The Autonomous City filed a lawsuit before the federal Supreme Court alleging unconstitutionality of both norms and, thus, broke a positive relationship with the national governments and the Buenos Aires province. From then on until May 2021, the Federal Government opted for a strategy of decentralization of the pandemic effects considering the substantial deterioration of its public image due to the pandemic handling. A separated section is related to the progressive opening of tourist and recreational activities at the beginning of summer 2020/21. These measures involved coordination between provincial and municipal governments in touristic cities. To this end, the Federal Government developed the “CUIDAR Verano” app that allowed the monitoring of people displacement in the summer. However, the authorizations for the entry of tourists in the provinces and municipalities was overseen by both levels of government.

POLITICAL AGENCY Argentina has been a strongly polarized country since 2008. The Countryside Crisis (Crisis del Campo) manifested the discontent of Argentine society with the government of President Kirchner in which the current president was the vice-president. The trigger for this crisis was the attempt to increase the tax on soy exports. The farmers started large protests together with opposition politicians and even government officials, in particular deputies and mayors of the ´ provinces of Buenos Aires, Cordoba, Entre R´ıos, and Santa Fe (Cravacuore, 2017). Since then, the Kirchnerismo/anti-Kirchnerismo cleavage runs through Argentina’s politics, on all agenda issues, with few exceptions, such as the Abortion Law. This phenomenon, known as the “crack,” has prevented any agreements on public affairs. The first semester of the COVID-19 pandemic implied a truce in this political dispute. The President summoned the most important institutional opposition figure, the Head of Government of the Autonomous City of Buenos Aires, and together with the Governor of the Buenos Aires province, the representative political leader of the most leftist sectors of Kirchnerism, led the

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handling of the pandemic until August 2020. Every two weeks this triad used to expose in harmony, before the media, the quarantine extension. However, the Head of the Government of the Autonomous City proposed a more adjustable flexibility in the commercial, recreational, and educational opening, and opted for a lower level of voluntary coordination. Maintaining a stricter quarantine could deteriorate society’s positive perception of his management of crisis, which was the highest among national leaders, and it could affect their electorate’s perception. The ruling party observed with concern that the crisis handling gave a high popularity to Rodr´ıguez Larreta and decided to create obstacles for his government, such as the removal of intergovernmental financial transfers and the impediment to the partial opening of schools in this city. This was complemented with permanent desertion actions by the official media press. The moderation of the Head of Government of the Autonomous City was not shared by all the opposition; the most radical leaders demanded a greater differentiation from the Federal Government. These, mainly former ministers of President Mauricio Macri, encouraged massive demonstrations against different Federal Government initiatives such as the nationalization project of a grain trading company, the quarantine extension, and a judicial reform, among others – that were felt by the Federal Government. Historically, in Argentina, it has been the ruling Peronist party that has had the ability to mobilize citizens in the streets. Opposition leaders found an ingenious way in long caravans of vehicles, decorated with Argentine flags. The highest levels of radicalization were found in leaders who should not interact with the Federal Government for pandemic management. Therefore, this situation affected intergovernmental relations less significantly than the political climate in general. The school opening was another controversial issue, especially with the Government of the Autonomous City of Buenos Aires. Since October 2020, the Buenos Aires government wanted to open schools, following the return strategy of small groups and alternate days. This was rejected by the Federal Government and the Province of Buenos Aires, as well as by the teachers’ unions, political battering rams of the ruling party at the national level. Since then, the dispute over this issue has reached a high political tension between the ruling party and the opposition, settled by strong social support in favor of the school opening. The Federal and provincial Governments had to change their strategy. The vaccine distribution strategy was also controversial. The Federal Government chose to distribute them proportionally among the provinces according to citizens over 18 years old, while the Government of the

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Autonomous City of Buenos Aires proposed to count people at risk, such as doctors and health workers, and citizens over 60. Then, the vaccination debate began: the Federal Government decentralized this policy in the provinces, which opted for their own strategies. The Government of the Autonomous City of Buenos Aires chose to vaccinate doctors and health workers before starting with other risk groups. The Province of Buenos Aires chose to simultaneously vaccinate doctors, health workers, educators, and people over 70 years old, showing that their vaccination was faster. Previously, in this province, there was another dispute: Governor Kicillof maintained a centralized vaccination strategy because many important ´ Jun´ın, Lanus, ´ La Plata, municipalities – Bah´ıa Blanca, General Pueyrredon, ´ Tandil, Tres of February, Olavarr´ıa, Pergamino, San Isidro, San Nicolas, ´ Vicente Lopez – are in the opposition’s hands, and he did not want to give them the political profit of a successful vaccination. Now, the disputes hinder an adequate coordination between the Federal, provincial, and municipal governments: their main consequence is a slow and corrupt vaccination. The most visible example was the scandal known as “VIP Vaccination”: the National Minister of Health favored federal legislators, political leaders, social leaders, businessmen, and journalists to an early vaccination, which led to his expulsion from the Federal Government. However, this has been repeated in different provinces and municipalities, showing that, more than a coincidence, it was a mechanism associated with the State’s perception as the property of those who govern it. Another serious political conflict occurred in Formosa, a neighboring province with the Republic of Paraguay. The provincial government created some health centers, forcing people with mild, asymptomatic symptoms, and even people who did not have COVID-19 to stay there. In them, the quarantine exceeded 14 days and they did not comply with the hygienic and sanitary conditions recommended by the World Health Organization to prevent the spread of COVID-19. International human rights organizations denounced overcrowding, arbitrary detentions, and unsanitary conditions. This was tolerated by the Federal Government, and in a visit to these centers, the National Human Rights Secretariat indicated that there were no anomalous situations. This provincial government blocked the entry of provincial citizens who wanted to go home, which led to the intervention of the Supreme Court to allow it. It has also done so with the entry of the national press media, which prompted the Federal Justice to act in defense of the expression of freedom. Faced with 17 COVID19 cases in a city of more than a quarter million inhabitants, the provincial government decided to return to strict confinement and violently repressed

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those who protested against it. This situation was strongly used by the opposition to denounce the violation of human rights in that province. In 2021, face-to-face school classes were another reason for debate in the Metropolitan Area of Buenos Aires. The Government of the Autonomous City fought permanently to return them, while the Federal Government and the Government of the Province of Buenos Aires fought to end them. The lawsuit even reached the Supreme Court, which ruled in favor of the capital government.

CONCLUSIONS Argentina has a cooperative federalism: the provinces – and the municipalities – have a significant degree of autonomy in decision-making, and the limits of competence are often diffuse between the different levels of government. This was manifested in the relevant competencies during the COVID-19 pandemic such as health and social protection. Regarding the policy portfolio, the Federal Government addressed the issues on a large scale: the overall strategy; income sustenance of citizens, companies, and subnational governments; and the purchase and distribution of equipment, health supplies, and vaccines, while the provinces and municipalities – and the private sector – treated COVID-19 cases. Intergovernmental coordination relied more on presidential leadership with the support of governors and mayors than on institutional mechanisms. As the president image diminished, this coordination became more difficult. In Argentina, there were two periods: one of intergovernmental collaboration based on the will of the authorities, regardless of their party affiliation, motivated by the uncertain pandemic effects, when institutional rules were fully respected; and a second, when the pandemic effects were known, the political system returned to its fragmentation logic, and when intergovernmental collaboration continued to exist only among the ruling party leaders. After a year of pandemic, Argentine politics has been reordered in the Kirchnerism/anti-Kirchnerism cleavage that has characterized it since 2008.

REFERENCES ´ Abalos, M. G. (2003). El r´egimen municipal argentino, despu´es de la reforma nacional de 1994. Revista Mexicana de Derecho Constitucional, 8, 3–45.

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Bello, M., & Becerril-Montekio, V. (2011). Sistema de Salud de Argentina. ´ Salud Publica de M´exico, 53(2), 96–109. ´ Publica ´ Cao, H., & Vaca, A. (2017). Gestion y Modelos de Federalismo. Documento de Trabajo Año 9, N°2 CIAP. Serie Federalismo y ´ Publica. ´ Administracion Buenos Aires: CIAP. Cravacuore, D. (2016). Gobiernos Locales en Argentina. In J. M. R. De La Fuente & C. V. Cossani (Eds.), Manual de Gobiernos Locales en Iberoam´erica (pp. 15–40). Santiago: Centro Latinoamericano de ´ para el Desarrollo - Universidad Autonoma ´ Administracion de Chile. ´ Municipal en Argentina: Cravacuore, D. (2017). La Recentralizacion ´ Apuntes para su Analisis. Estado Abierto, 2(1), 167–191. ´ de la autonom´ıa municipal en las Cravacuore, D. (2019). Medicion provincias argentinas. Revista Argentina de Derecho Municipal, 4, 1–20. Cravacuore, D. (2020a). Gobiernos subnacionales argentinos en la pandemia ´ Publica ´ del Covid-19. In D. Pando (Ed.), La Administracion en tiempos ´ ´ disruptivos (pp. 133–138). Ciudad Autonoma de Buenos Aires: Asociacion ´ Publica. ´ Argentina de Estudios en Administracion Cravacuore, D. (2020b). Municipios Argentinos Ante La Pandemia Del Coronavirus Covid-19. Paper presented at XXV Congreso Internacional del CLAD, Lisboa, Portugal. El Cronista. (2020). Retrieved from www.cronista.com/economiapolitica/ Monedas-virtuales-y-alumbrado-publico-congelado-dos-propuestas-que-losintendentes-llevaron-a-Alberto-20200401-0050.html. Accessed on September 17, 2020. Feiock, R. C., & Scholz, J. T. (2010). Self-organizing governance of institutional collective action dilemmas: An overview. In R. C. Feiock & J. T. Scholz (Eds.), Self-organizing federalism: Collaborative mechanisms to mitigate institutional collective action dilemmas (pp. 3–32). Cambridge: Cambridge University Press. Giacobbe, & Asociados, S. A. (2020). Especial Covid 19. Informes I a XV. Retrieved from https://giacobbeconsultores.com. Accessed on July 31, 2021. ´ ´ del poder en el estado Hernandez, A. M. (2002). La descentralizacion argentino. In J. M. S. De La Cruz (Ed.), Federalismo Y Regionalismo (pp. ´ 211–274). M´exico: Universidad Nacional Autonoma de M´exico.

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OECD/World Bank. (2020). Panorama de la Salud: Latinoam´erica y el Caribe 2020. Paris: OECD Publishing. UN. (2020). Retrieved from https://news.un.org/es/story/2020/06/1476542. Accessed on September 17, 2020. Ram´ırez de la Cruz, E. E., Grin, E. J., Pulido, P. S., Cravacuore, D., & Orellana, A. (2020). The transaction costs of government responses to the COVID-19 emergency in Latin America. Public Administration Review, 80(4), 683–695. World Bank. (2020). Argentina: Panorama general. Retrieved from https:// www.bancomundial.org/es/country/argentina/overview. Consulta July 3, 2021. Worldometer. (2021). Retrieved from https://www.worldometers.info/ coronavirus/

4 BRAZILIAN FEDERALISM IN THE PANDEMIC Fernando Luiz Abrucio, Eduardo Grin, and Catarina Ianni Segatto

ABSTRACT Brazilian federalism was important in the political game of combating the pandemic for three reasons. First, Brazil’s public health system depends heavily on intergovernmental relations between Union, states, and municipalities because there is a policy portfolio based on federative cooperation. Second, the subnational governments’ autonomy to act against COVID-19 was constantly questioned by the Federal Government – the conflict between the President and governors was a key piece in all health policy. Finally, states and local governments were primarily responsible for policies to fight against pandemic, but the absence and/or wrong measures taken by the Federal Government (such as the delay in purchasing vaccines) generated intergovernmental incoordination, increased territorial inequality, and reduced the effectiveness of subnational public policies, especially those linked to social isolation. In this context, Brazilian federalism played a dual role in the pandemic. On the one hand, the federative structure partially succeeded in averting an even worse scenario, mitigating the impact of mistaken presidential decisions. The role of subnational governments, especially of the states, was critical as a counterweight to federal decisions. On the other hand, the President actively acted against governors and mayors and, above all, sought to weaken intergovernmental articulations within the Unified Health System (SUS), the federative model designed three decades ago. One could say that the federative actors, such as the Supreme Court (Supremo Tribunal Federal – STF) and subnational governments, were the main obstacles for the Bolsonarist antiscientific agenda. The success of this reaction to President Bolsonaro’s negationist populism was partial, but the results of

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the fight against COVID-19 would have been much worse without these federalist barriers. Keywords: Cooperative federalism; Bolsonaro’s federalism; incoordination; Unified Health System; national leadership; war of vaccines

INTRODUCTION At the end of May 2021, Brazil had the third highest number of infections (16 million people) and the second number of deaths (450 thousand) by COVID19 in the world. In the Americas, these numbers were second only to the United States. However, when comparing the number of deaths per 1000 inhabitants, Brazil performs much worse than the United States, whose population is considerably larger (328 million vs. 211 million people). In the same period of time, the situation was also not good regarding people immunization: concerning vaccination per 1000 inhabitants, Brazil was in the 81st in the world ranking (Hallal, 2021). Much of this poor performance is owed to the Brazilian President’s populist attitude, Jair Bolsonaro, who denied the seriousness of the pandemic, boycotted social isolation, and replaced the Minister of Health four times in a year and a half, without ever managing to implement an effective national policy (Abrucio, Grin, Franzese, Segatto, & Couto, 2020; Castro et al., 2021; Barberia & Gomes, 2020). Political institutions were the main focus of presidential actions, especially the federative structure. Federalism was important in the political game of combating the pandemic for three reasons. First, Brazil’s public health system depends heavily on intergovernmental relations between Union, states, and municipalities because there is a policy portfolio based on federative cooperation. Second, the subnational governments’ autonomy to act against COVID-19 was constantly questioned by the Federal Government – the conflict between the President and governors was a key piece in all health policy. Finally, states and local governments were primarily responsible for policies to fight against pandemic, but the absence and/or wrong measures taken by the Federal Government (such as the delay in purchasing vaccines) generated intergovernmental incoordination, increased territorial inequality, and reduced the effectiveness of subnational public policies, especially those linked to social isolation.

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In this context, Brazilian federalism played a dual role in the pandemic. On the one hand, the federative structure partially succeeded in averting an even worse scenario, mitigating the impact of mistaken presidential decisions. The role of subnational governments, especially of the states, was critical as a counterweight to federal decisions. On the other hand, the President actively acted against governors and mayors and, above all, sought to weaken intergovernmental articulations within the Unified Health System (SUS), the federative model designed three decades ago (Arretche & Fonseca, 2018; Menicucci & Marques, 2016). One could say that the federative actors, such as the Supreme Court (Supremo Tribunal Federal – STF) and subnational governments, were the main obstacles for the Bolsonarist antiscientific agenda. The success of this reaction to President Bolsonaro’s negationist populism was partial, but the results of the fight against COVID-19 would have been much worse without these federalist barriers. The paradox of this federative strife is that Brazil has, like few other Federations in the world, a Public Health Governance that is highly coordinated and cooperative among the three levels of government, but the current government has embraced the logic of dual federalism and intergovernmental confrontation as its stance in the fight against the pandemic (Abrucio et al., 2020; Souza & Fontanelli, 2021). The institutional and cooperative design of Brazilian health policy is very well suited to solve a situation of complex intergovernmental problem (CIP), even becoming an example for other countries on how to address territorial dilemmas in the fight against the COVID-19. However, the presidential leadership reduced the previous coordination of the Unified Health System (SUS), generating negative impacts on the health policy’s effectiveness. The chapter analyzes the functioning and performance of the Brazilian federalism under the Bolsonar government in combating the pandemic. To this end, after a synthesis of the historical development of Brazilian federalism, the current federative structure, created by the 1988 Constitution, is discussed. Three aspects will be highlighted here: the autonomy that was acquired by the subnational governments, the setting up of a cooperative federalism, especially in the field of public policies, and the intergovernmental design of the SUS (policy portfolio), based on intergovernmental articulation. In the second part of the chapter, the model of federalism proposed by President Bolsonaro will be exposed in opposition to the cooperative federalism built in the last 30 years. Based on the slogan “More Brazil, Less Bras´ılia [Brazilian capital],” the current government advocates a more dualist federalism, which seeks to transfer more functions and

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responsibilities to subnational governments, while reducing the role of the Federal Government in the national coordination of public policies and in the fight against territorial inequality. The following section analyzes the dynamic of Brazilian federalism in the context of pandemic, showing that there have been several critical phases in the intergovernmental relationship since the beginning of the health crisis, in February 2020. At some critical moments, federative tensions between the Federal Government and state and municipalities required arbitration by the Supreme Court and National Congress, with decisions almost always favorable to subnational autonomy. At other times, the Union sought cooperation with state governments or acted in favor of national coordination. But, in general, as will be shown, President Bolsonaro preferred the federative confrontation because he believed that the population, even with a large number of deaths, would support the return of economic activities more than social isolation. Also, according to his negationist approach, herd immunity, it would be acquired if the population were infected by the virus. The strategy adopted by presidential leadership in the federative game brought political gains to Bolsonaro, but the emergence of the pandemic’s second wave in January 2021 and the initial failure to vaccinate reduced the presidential popularity. Nevertheless, due to the low performance in the fight against COVID-19, all levels of government lost due to confrontation and lack of coordination, generating more of negative-sum than a zero-sum game. In conclusion, the chapter presents the lessons that can be drawn from the performance of Brazilian federalism in the face of pandemic. These lessons will be important because new complex problems are likely to arise in the future, and they will require greater intergovernmental coordination.

THE NEW BRAZILIAN FEDERALISM: DECENTRALIZATION WITH FEDERATIVE COORDINATIVE Brazil is the fifth largest country in the world as for territorial size and the sixth in terms of population. There is a great deal of physical, cultural, socioeconomic, and political heterogeneity throughout its immense territory. However, Brazil was not always a Federation: in its origins, in 1822, it was a unitary state, and it was like that for almost 70 years. Brazil has become a federative country since the end of the nineteenth century when a dualistic model was

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implemented with great power granted to the states, inspired by the American model (Abrucio, 1998). This dualistic pattern persisted for 40 years and increased inequality among states. In 1930, Getulio Vargas came to presidential power with a project to expand state intervention in the economy. On that logic, for the next five decades there was a continuous strengthening of the Union in Brazilian federalism (Arretche, 2012), especially during two authoritarian periods in the twentieth century. The Federal Government became the most important element of the country’s political system. The Brazilian federalism built during the twentieth century left two main legacies. First, there was a great centralization of power, reducing the federal safeguards of subnational governments through authoritarian mechanisms. Second, territorial inequality increased, and despite that the state’s economic intervention grew, social policies were very fragile and heterogenous throughout the country. After almost 20 years of military rule, the Brazilian democratization, started in 1985, consolidated with the 1988 Constitution, brought about several institutional changes, including a wide transformation of federalism. This new federative design has four major pillars. First, institutional instruments ensured, according to Lijphart (1999), a democratic federative structure, with safeguards and forms of participation by subnational governments in federal decisions. In addition to bicameralism and the defense of their interests before the Supreme Court, there was also the implementation of federative forums in which states and municipalities take part in the deliberation of public policies (Grin, Bergues, & Abrucio, 2020). Second, the Federal Constitution defined that the Brazilian Federation is triadic, with Union, states (26 units plus a Federal District), and municipalities (5,570) autonomously holding the same rights as federative entities. The two other features are central to understanding the process of tackling the COVID-19. One is an important decentralization of powers, resources, and responsibilities to states and municipalities, while retaining a substantial capacity of the Union to finance, support, and expand welfare policies (Arretche, 2015). Besides, national public policy systems have been created based on division of powers among federal entities and intergovernmental articulation (Franzese & Abrucio, 2013). Public health was the first area to embrace this model and the one that most reinforced federative coordination and cooperation. Without this extant arrangement in the public health policy, the impact of COVID-19 would have been far worse.

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Autonomy of Subnational Governments Brazilian states and municipalities acquired greater political, legal, administrative, and tax autonomy after 1988. Municipalities are federative entities and not mere creatures deriving from state power, as is the case in most Federations. Municipal governments cannot be extinguished by the state legislature, but the judicial structure and control agencies (Courts of Accounts and Prosecution Service) may impose sanctions on mayors and oversee local public policies. Brazil is a symmetrical federation, since all 5,570 municipalities and 26 states have same institutional structure and responsibilities, except the justice system, which exists only in states and the Union. The 1988 Federal Constitution consolidated the decentralization of most policies giving powers to subnational governments to provide public services and public policies. Nevertheless, it determined shared responsibilities in most policies as well as kept the Federal Government as the main decision-maker (Arretche, 2012). As a result, subnational governments are key in implementing and managing the most important public policies, especially the welfare ones (education, health, and social assistance), while the Federal Government lays out the basic legal frameworks, national public policy guidelines and regulations, and federative mechanisms for administrative and funding support. Moreover, changes that happened during the 1990s and 2000s in financing through project grants and equalization mechanisms gave prominence to municipalities in different policies. In other words, funding was combined with the adoption of national strategies and programs by subnational governments, mainly municipalities, which resulted in a “municipalization” process of policies (Viana et al., 2008). Despite same institutional structure and powers, there is an enormous heterogeneity among subnational governments. There are huge socioeconomic inequalities that have had implications in their fiscal capacities, as local taxes are linked to cities’ socioeconomic development, resulting in disparities in terms of human capital and municipal state capacities. Because of these structural limits, there are tremendous challenges regarding the increase of service coverage, and, at the same time, the guarantee of minimum life standards, particularly, for the poorest populations (Grin & Abrucio, 2018; Grin & Fernandes, 2019; Souza, 2004). In practice, the institutional powers of subnational governments and their competences in implementing major public policies are constrained by their managerial and financial limitations. For many municipalities, and also the poorer states, there is a de jure autonomy which does not match the de facto subnational autonomy.

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The Brazilian federative model has responded to this dilemma of subnational autonomy in three ways. First, the Federal Government seeks to reduce disparities between levels of government in providing conditions for implementing important public policies and providing services. Second, there are cooperative intergovernmental mechanisms seeking to improve the performance of federative entities. The Unified Health System (SUS) relies on both instruments – federal aid and intergovernmental cooperation – as means to decentralize provision of services and universalize free access to all population. Third, due to the limits of the expansion of social provision through “municipalization,” national changes led to the adoption a regionalization model during 2000s, giving states the role of regional coordinators in some public policies, especially in the health care, education, and social assistance systems (da Silva, 2020; Menicucci et al., 2017; Viana et al., 2015). During the pandemic, subnational autonomy was key to allow flexible responses considering regional differences and inequalities in a context in which there was not a national coordination, as it happened in other federal countries (Greer, King, Massard da Fonseca, Peralta-Santos, 2021). States gained centrality to tackle the pandemic in different policy fields, including determining social isolation measures, building hospitals, implementation of massive testing, closing schools, and adopting remote education, and coordinating state and municipal responses, especially in the first months of the pandemic (Abrucio et al., 2020; da Fonseca, Nattrass, Arantes, & Bastos, 2021; Pereira, Oliveira, & Sampaio, 2020). Nevertheless, a great heterogeneity among subnational responses had prevailed, and not all states have assumed a coordination role throughout the pandemic (Pereira et al., 2020). The subnational governments – states and municipalities – based on their constitutional autonomy reinforced by the Supreme Court decisions behaved in a mixed way. Many of them have adopted their own decisions on sanitary measures without worrying about surrounding cities (similar to beggar-thyneighbor approach). Other were more prone to coordinate actions whether in more formal or informal basis. A successful shared solution was that of health consortia, which had better results in the pandemic in reducing cases and deaths than municipalities that acted separately (Grin, Abrucio, Silveira, & Gomes, 2021). Unfortunately, this type of intermunicipal cooperation is still not the majority in the country. This lack of a more coordinated intergovernmental arrangements in the subnational level was a consequence of three mingled issues: structural (constitutional subnational autonomy), political parties cleavages among some state governors and mayors, especially in larger cities and capitals such as Rio

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de Janeiro, and the intensified “uncoordinated federalism” (Bulman-Pozen & Gerken, 2009) set in motion by the Federal Government.

Policy Por tfolio Brazil’s health-care system path combines centralization of decision-making in the Federal Government and subnational health-care provision at the subnational level. This framework resulted from a centralized path that prevailed until the end of military rule in which decision-making was under federal agencies’ responsibilities that had contracts with nonprofit and private organizations to provide health-care services (Arretche, 2004). This path only changed during the 1980s when federal agencies decentralized service provision through contracts with subnational governments to expand health-care coverage across the country – first with Integrated Health Actions (AIS), and after the Health Unified and Decentralized System (SUDS). The decentralization of service provision was consolidated by the 1988 Federal Constitution. In the following years, national regulations determined specific changes in the health-care system in order to ensure constitutional determinations, especially the decentralization of its provision, clarifying states’ and municipalities’ responsibilities, shaping the Unified Health System (SUS). The health sector was not the only one to build a type of cooperative federalism. National public policy systems were created between the 1990s and 2000s in sectors such as Social Assistance and Water Resources, in addition to forms of federative coordination in terms of financing in education. The model was based on national guidelines related to the regulation and resource redistribution, decentralized implementation, and institutionalized arenas for social participation and intergovernmental negotiation (Franzese & Abrucio, 2013). During the 1990s, different national decisions gave centrality to municipalities to reinforce the focus on primary care, especially through the adoption of a per capita formula for intergovernmental transfers and the family health ´ program. In 1996, a national regulation (the Norma Operacional Basica) divided the federal funding according to two categories of service provision: municipalities that provide primary care and municipalities that provide primary care and medium complexity services. This regulation also reinforced the importance of regionalization through intermunicipal cooperation. Municipalities should cooperate with their neighbors that provide medium complexity as to provide their citizens with services they do not offer. Even

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though municipalities became the major provider of primary care, the Health Ministry kept being the main actor in control of resources and policy formulation (Viana et al., 2008). Another change made during the 2000s included national regulations that reinforced regionalization, territorialized provision, and regional planning, in which states started have gained centrality in the coordination of healthcare system through health regions. In 2006, the Health Pact (Pacto Pela ´ Saude) determined the adoption of coordination mechanisms at the state level with intergovernmental agreements (Termos de Compromisso de Gestão) constituting Integrated Health-Care Networks to develop a regional plan with common and shared goals and defined responsibilities among entities and to create Regional Management Boards (Colegiados de Gestão Regional) with representatives from state and municipal governments (Vargas et al. 2014). In 2011, a new national regulation gave other guidelines to the organization of the regions, including the creation of Intermanagers Commissions at the regional level. Studies show that states have been progressively implementing the Pact, but there are great differences on resources and technical capacities among them (Menicucci et al., 2017; Viana et al., 2015). As a result of these several changes, municipalities are basically in charge of preventive health and provision of primary care to the population, but the local governments with more population and fiscal and administrative capacities can offer medium complexity services as well. However, it is more common to found states that assumed most or all services of medium and high complexity (e.g., exams and management of major hospitals). The federal sphere is responsible for other broader issues such as large-scale government purchases. This institutional arrangement has successfully handled complex issues such as policies against AIDS and free medication to the poorer population, in addition to generating substantive improvements in most health indicators for the last 30 years. The Federal Government also is responsible for Immunization National Program that yearly distributes vaccines to whole country. It is a successful program that has existed for 45 years and was created under the military regime. This Brazilian program is known worldwide as an example of coordinated action led by Health Ministry. In the case of the pandemic, Federal Government was an absolute absent author in this process which intensified still more dualistic and opportunistic stances from governors seeking to buy vaccines as well as other medical equipment or medicines. This “vaccine war,” as we will see later, is one of the most negative effects of President Bolsonaro’s stance in the pandemic, weakening one of the country’s best health programs.

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The list of functions under the command of the Union still contains two regulatory agencies, the National Health Surveillance Agency (with a role similar to the American Food and Drug Administration [FDA]) and National Complementary Health Agency, and two foundations, the Oswaldo Cruz Foundation – that produce and disseminate technology useful for the SUS, including vaccines – and National Health Foundation, that further public health and social inclusion through sanitation and environmental health actions. Considering this policy framework, states and municipalities were the main actors in responding to the pandemic, particularly issues related to health-care service provision. States and municipalities increased hospital capacities and bought medical equipment. In some cases, states cooperated with municipalities to increase hospital capacities in different regions within a state, advancing in the regionalization process. Notwithstanding problems of underfunding and management difficulties, the performance of the SUS is highly valued especially because it provides a universal public system to a country that is very unequal both in population and territorial terms (Massuda, Hone, Leles, Castro, & Atun, 2018). With regard to federalism, a hybrid style of health public policies was established, merging majoritarian aspects (high regulatory and financial induction power at the hands of the Federal Government) and consociative characteristics (decentralized implementation and federative deliberation forums) (Grin & Abrucio, 2019). At any rate, it should be noted that the rules of the Health System clearly define that the Federal Government also must deal with issues of national scope, such as pandemic situations. However, at the beginning of pandemic, the Federal Government tried to centralize decisions in the Minister of Health, determining that subnational government should ask for authorization to fight against COVID-19. The Supreme Court considered this decision against constitutional determinations and reinforced the shared responsibilities between three entities in the SUS, which was used by the President as a mechanism to blame governors and mayors for economic downturns and COVID-19 contamination and deaths. The President Bolsonaro, instead of acting for coordinating intergovernmental efforts, stimulated a more confrontational relationship between Federal Government and states and municipalities. As a consequence of that, the Federal Government adopted blame shifting and shirking behaviors that kept it away from its own policy portfolio responsibilities in health sector, especially after the dismissing the first out of four Health Ministry since the pandemic outbroken in February 2020 (at least until May 2021).

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It is important to note that other policies, particularly social assistance and education, were also fundamental during the pandemic to tackle the inequalities produced by the closure of nonessential activities. Similarly to the health care, the Federal Government has a prominent role in approving guidelines and redistributing resources to subnational provision of social services, as well as managing well-known cash transfer program, called Bolsa Fam´ılia. Despite Union’s centrality, the emergency relief (Aux´ılio Emergencial) was only approved in April 2020 as a result of National Congress’ initiative. At the same token, subnational governments had to adapt social services locally, distributed food products, and created subnational cash transfer programs, but these responses varied greatly (da Fonseca et al., 2021) according to available local resources. In the case of educational policy, most municipal governments did not have the budget to guarantee access to remote education for the majority of the poorer students in the country, nor did they have the resources to buy the hygiene kit necessary for safe return to school. Nevertheless, the Federal Government refused to help subnational governments and went on to blame mayors and governors for shutting down schools. It is important to emphasize that, as in health and social assistance, the Brazilian Constitution indicates that the Union must have a supplementary role to combat territorial inequalities in education (Abrucio, 2021).

Coordination Mechanisms Health policy is based on a complex system of federative articulation and deliberation (Menicucci & Marques, 2016). More than that, Brazilian public policy health is structured for both vertical and horizontal bodies of intergovernmental relations as well as councils in all levels of government. Also, in the institutional design of health policy, there are councils functioning as bodies of intergovernmental governance since they are organized based on governmental and social actors in order to reinforce the control in the implementation of actions. There are federative forums to articulate vertically the three levels of government or just the two subnational levels through intergovernmental arenas – Comissões Tripartites (CITs) and Comissões Bipartites (CIBs), respectively. This national forum of intergovernmental relations can count all states and municipalities participation represented by Council of State Health Secretaries (Conass) and Council of Municipal Health Secretaries (Conasems), which are forms of horizontal articulation. In Brazilian federation, the challenge lies in

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defining deliberative and decision-making mechanisms. This has been addressed with the creation of institutional decision-making forums in which municipal, state, and federal managers participate: the CIT brings together officials from the three levels of government and, in Brazil’s 26 states, CIB coordinates state and municipal officials (Abrucio & Grin, 2015; Paiva, Gonzalez, & Leandro, 2017). The appearance and evolution of the arrangement created by the health-care policy became a very relevant contribution to Brazilian cooperative federalism. The SUS was so innovative in terms of intergovernmental agreement that its institutional format was replicated in social work area (Abrucio & Grin, 2015; Paiva et al., 2017; Leandro & Menicucci, 2018). Concerning SUS, cooperative federalism is mediated by CIT and CIB management boards that are controlled by national, state, and municipal participatory councils. The success of this decision-making style stems from the cooperative behavior of the three government spheres, decentralization, and social participation. With the institution of the CIT, the Federal Government is no longer able to unilaterally establish norms for subnational governments (Fructuoso, 2010, pp. 93–94). SUS is not synonymous with perfect balance of forces between the federation’s three levels of government in intergovernmental relations, since in these consensus-driven policy-making bodies, political dispute also arises, as each level seeks to achieve best possible outcomes. The Federal Government provides the funding and drives cooperation, while subnational governments rely on their power of implementation (Franzese & Abrucio, 2013). Nonetheless, there are also problems of interjurisdictional competition (Abrucio, 2005) and difficulties to carry out regional health programs within the states (Menecucci, 2019). Considering this intergovernmental policy design with its advances and limits, the political influence of SUS’s institutional design has been critical to establishing tripartite government cooperation to tackle the COVID-19 pandemic. Both for CIT at the federal level as well as CIBs at the state level have been pivotal to act as institutional and intergovernmental safeguards against more unilateral federal decisions. If these coordination bodies did not exist, the Brazilian federation’s cooperative characteristic would certainly be even more injured to cope with the pandemic. Brazil’s health-care system counts on intergovernmental arenas – CITs, CIBs, and health regions – to decide on operational, financial, and administrative issues, elaborates national, regional, and intermunicipal strategies

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related to health-care service provision, and the implementation of national decisions on subnational contexts (Segatto & B´eland, 2019), working as a mechanism of “shared management” (Franzese, 2010). During the pandemic, the CITs and CIBs were fundamental in approving guidelines and protocols and allocating funding regionally. These commissions and regions allowed the expansion of intensive care in municipalities in the countryside and the distribution of patients in municipalities within the same region. Likewise, states cooperated horizontally. On the one hand, advocated for national coordination, and, on the other hand, states coordinated their ´ responses. At the beginning of the pandemic, the Governors’ Forum (Forum dos Governadores) promoted meetings with state leaderships to negotiate with the Federal Government and oppose Bolsonaro’s decisions. However, due to the lack of national coordination, states strengthened horizontal coordination to share information and coordinate subnational responses in different policy fields. Two cases called more attention: the role of the National Council of State ´ Health Secretaries and the Northeast Consortium (Consorcio do Nordeste). The National Council of State Health Secretaries (Conselho Nacional de ´ ´ Secretarios de Saude) supported states’ decisions and integrated and shared data related to COVID-19 contamination and deaths in all states, when the Ministry of Health decided, in May 2020, to no longer publish the daily pandemic data. The Northeast Consortium was created in 2019 to institutionalize previous horizontal coordination among governors from the ´ Northeast states (Forum dos Governadores do Nordeste). It shares information, manages research, and funds services in different policy fields, but during the pandemic, it created a committee (Comitˆe Cient´ıfico de Combate ao Coronav´ırus), gave guidelines to states, bought medical equipment, coordinated policies, and promoted data sharing among them. Also, it should be highlighted for the role of many intermunicipal consortia which were responsible for developing collective responses, especially considering the smaller destitute municipalities of financial and technical capacity to face alone the pandemic. The existence of vertical coordination and horizontal partnerships in the Brazilian Federation was an important element in combating the pandemic, but it did not prevent President Bolsonaro from fueling the confrontation with governors and mayors, in addition to reducing intergovernmental coordination in health policy. This type of presidential leadership stemmed from a new proposal for federalism, contrary to the standard created in 1988.

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A TURNAROUND IN BRAZILIAN FEDERALISM: BOLSONARO’S MODEL The federative health model developed after the 1988 Constitution has everything it takes to perform well in a pandemic. However, the Bolsonaro government has been working against this institutional structure, promoting fragmentation and incoordination of the system, which has aggravated the government’s response and increased social and territorial inequality in health policy. Instead of using the of the SUS’s positive legacy, the presidential leadership favored antiscientific discourse and advocated for keeping economic activities on track as something more important than social isolation (Barberia & Gomes, 2020). President Bolsonaro began to alter the pattern of a more cooperative federalism even before the outbreak of the pandemic. This model has existed since the beginning of its management, in 2019, and can be summarized in three aspects. The first was the devolution of responsibilities to subnational entities, with the Union reducing its role of financial and management support. The outcome of this dual federalism was the Federal Government’s abdication of liability for territorial inequalities, thus neglecting its role as mandated by the 1988 Constitution. This change in the federative model was anchored in the slogan “More Brazil, Less Bras´ılia,” an idea that, in theory, aimed to reduce forms of centralization. However, the main objective of this project was to make the Federal Government not responsible for any support to subnational governments and to leave the burden of the main social policies to them. This attitude of the Union reached the states, as well as the municipalities (da Rocha, 2021). It is worth mentioning that, despite wanting to pass on the burden of combating social problems to states and municipalities, the Federal Government, since the beginning of the Bolsonaro Government, has often sought to centralize autocratically the command of several decisions, overcoming cooperation forums and intergovernmental coordination created in the last 30 years. This occurred at various times in the fight against the pandemic. The second aspect of Bolsonaro’s federalism was the heightened confrontation with subnational governments. This dynamic also began before the pandemic and involved attrition with states in areas such as education and the environment, in which the Federal Government set out to act alone in decisionmaking processes that used to be federatively agreed upon. In response, states and municipalities sought their own paths with no national support for those policies, including through increased cooperation among them. The consequence of this Bolsonaro’s model of Federation has been an increased level of

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intergovernmental incoordination since 2019, the third aspect of Bolsonaro’s federalism (Abrucio et al., 2020). The culmination of Bolsonaro’s federalism came with the pandemic’s outbreak. The three aspects described above were clearly expressed. First, dual federalism was evident with an attempt to completely shift the responsibility for health policy results on to subnational governments. Second, the plot to combat COVID-19 was marked by a major conflict between President Bolsonaro and state governors. Finally, the Federal Government tried to weaken the instances of federative coordination, although they served for horizontal federative articulations, both to act together with the Union and to set up horizontal partnerships. In addition to the three previous aspects – dualism, confrontation, and incoordination – two other elements were added: the usual negationism of contemporary populism and the political calculation of opposing health and economy. The worst consequence of this was undermining the SUS by dismantling the Ministry of Health and refusing to use federative forums to coordinate a national policy with states and municipalities. Bolsonaro changed two ministers of health (Luiz Henrique Mandetta e Nelson Teich) because they wanted to obey the technical standards defined by the World Health Organization. As a solution to this instability, the President appointed a military officer to the Ministry of Health, in May 2020, politicizing a sphere that should be occupied by health experts. The intersection between Bolsonarist federalism and the pandemic can be summed up, on one hand, in the lack of a national policy against COVID-19 and, on the other, in states and municipalities relying on their constitutional autonomy to respond to the health crisis. To this end, they resorted to federative forums that had not been dismissed by the Federal Government and to new forms of cooperation, such as the consortium established among the nine states of the Northeast region. The protagonism of subnational entities was a result of intense intergovernmental confrontation, including the use of institutions that safeguard federative rights, such as the Federal Supreme Court, which warranted the freedom of governors and mayors to operate with autonomy on health policy, and the National Congress, which authorized the distribution of 125 billion reais to assist states and municipalities in fighting the pandemic. The institutional structure of Brazilian federalism, especially the cooperative model that is at the heart of the SUS, has been able to mitigate some of the backlash from President Bolsonaro’s negative actions. However, the final outcome was much worse than it would have been had the SUS been able to operate as it did in the past, with its many modalities of intergovernmental

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articulation. The final account shows that the Federal Government is crucial in reducing territorial inequalities and that national leadership is essential to tackle a CIP. The absence of the Federal Government in this game, thanks to both the presidential leadership’s gamble on negationism and the opportunism of shifting the responsibility and the blame to states and municipalities, has resulted in a massive tragedy in Brazil.

FEDERALISM IN ACTION – THE COVID-19 PANDEMIC UNDER BOLSONARO The fight against the pandemic in Brazil had as a major federative mark the conflict between the Federal Government and subnational governments. It is interesting to analyze the progress of this tug of war because there were different phases of this process that, in each round, redirected the intergovernmental game around the pandemic. The president’s political leadership has acted to weaken and prevent any form of federative coordination. Every time the president seeks confrontation with governors and mayors, as well as attitudes characterized by shirking of federal responsibilities and blame shifting to subnational governments. Not to mention the intention to intrude on the autonomy of subnational governments. When the first cases started to appear in Brazil, in February 2020, especially at the moment when the first deaths occurred, in March 2020, the first conflict was intragovernmental: the then Minister of Health, Luiz Henrique Mandetta, supported measures of social isolation to be followed by the country, while President Bolsonaro built a political strategy based on dichotomy between health and the economy, in which maintaining economic activities open was the most important issue. Bolsonaro went so far to minimize the severity of the pandemic, saying that COVID-19 was just “a little cold.” The emphasis on the economic aspect was related to two fears of the Bolsonaro government. First, the country’s fiscal situation was bad, and the paralysis of economic activities, as well as the need to help people and companies during the crisis, would increase public debt. For this reason, the Federal Executive wanted to approve a lower income transfer program for vulnerable people three times less than the value finally approved by the National Congress (April 2020). Besides, the president and his allies feared a prolonged recession, whose political impact on the reelection project could be fatal. In a nutshell, Bolsonaro was more concerned with the future presidential election in 2022 than with avoiding COVID-19 contamination and deaths.

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In this initial dispute, the Ministry of Health gained an important political ally: the governors. From the beginning, they opted for tighter control of the pandemic and were in tune with the ministerial agenda. Bolsonaro endured this disagreement with the minister for two months and dismissed him on April 16, 2020. From then on, a minister (Nelson Teich) with less power and political capacity to defend World Health Organization’s sanitary measures took over. Moreover, the presidential leadership defined as the main political adversary the governors of states and large cities. Example of this is that the president of the National Council of State Secretaries of Health (Conass) was not even invited to the inauguration of the new minister, something unprecedented in recent history. A new phase of the federal tug of war had begun, in which the Federal Government wanted to define unilaterally how to respond to COVID-19 pandemic, while the governors acted to guarantee their federative autonomy. Although there were some states closer to the Bolsonaro’s view, between 20 and 22 of the 27 governors have always acted in defense of the federal safeguards and against the negationist model defended by the President. Several letters in defense of democracy, subnational autonomy, and cooperative federalism were drawn up by the political leaders of states and municipalities (Abrucio et al., 2020; Souza & Fontanelli, 2021). Thus, in contrast to the United States, where the party cleavage defined the behavior of governors, in Brazil, most of them were against the Federal Government. The culmination of this second phase of federalism in action against COVID-19 was from April to September 2020. Bolsonaro organized his political followers to make street and social media demonstrations against congressional political leaders and the Supreme Court’s members because the President believed that the political system was unduly benefiting the states and municipalities, removing the Federal Government’s authority in responding to the pandemic. In this political conflict, Bolsonaro aimed to attack mainly the governors linked to the opposition parties – especially those in the Northeast Region of the country – and those of the largest states, emphasizing his public clashes with the governors of Rio de Janeiro and São ´ Paulo. In the case of São Paulo Governor, João Doria, the President even said that “There is a state government that has done everything but declared independence from Brazil” (Abrucio et al., 2020, p. 671). In fact, there was an ambiguity in the behavior of the Federal Government. On the one hand, it sought to follow dual federalism by taking no responsibility for large purchases of equipment and medication for COVID-19, which were left to the states at a time of global scarcity. With the difficulty of obtaining these materials and low levels of state capacity, many subnational

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governments were accused of corruption by the Union, which even used the Federal Police to inspect governors and mayors. And here comes the contradiction, or political strategy, that drives Bolsonaro’s federalism: passing the blame on to incumbent locals and, at the same time, trying to control them. Even so, the most significant federative victories at this stage were from subnational governments. They managed to ensure that the Federal Supreme Court guaranteed the autonomy to act against COVID-19, whether in health policy, or creation of social isolation or lockdown measures (Souza & Fontanelli, 2021). In addition, the National Congress offered a package of aid to state and municipal governments to face the health crisis, including the freeze on payment of debts with the Federal Government. The federal safeguards for autonomy functioned properly allowing health-care responses, based on the World Health Organization’s guidance, across the country. Also, using SUS cooperative mechanisms, states and municipalities were able to act more jointly against the pandemic. The intergovernmental political landscape began to change from September 2020, opening a third phase in the history of the fight against COVID-19 in Brazil. Three reasons led to this. First, after contamination and death rates were around 4 months (from May to August) at a high level but without major changes, the indicators started to improve. Besides, tiredness concerning to social isolation measures began to manifest itself and governors had to back down or relax a series of social isolation measures. As a corollary of this transformation, President Bolsonaro’s popularity, after having fallen a lot, improved a lot in late 2020, reaching, according to data from Datafolha (Brazil’s main Opinion Research Institute), at its best level since the beginning of the mandate (Tavares, 2021). Much of this increased support came from the cash transfer called Emergency Aid (Aux´ılio Emergencial), which had benefited 68 million people. Paradoxically, this effect occurred because the National Congress, when taking measures against the negative view of the Federal Government, had tripled the amount initially granted by the President. The situation again changed in January 2021, when a second wave of the pandemic began, much more violent than the first – in the first five months of 2021 more people died of COVID-19 than throughout 2020. The sign of alert was given by the huge crisis in Manaus’ hospital system, the capital of the state of Amazonas. A vast number of people died of the disease due to a lack of hospital oxygen. After this episode, which touched the Brazilian society, state and municipal governments had to return to taking social isolation stricter measures. The beginning of this fourth phase in the history of COVID-19 in Brazil revealed three major problems on the federative front. First, although there

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was a more general consensus in subnational governments since the beginning of the pandemic to make policies in line with the World Health Organization’s recommendations, there were also different financial and administrative state capacities and ways of implementing health policies (Pereira et al., 2020). Thus, the results of government responses were very heterogeneous among Brazilian states and municipalities, highlighting the Brazil’s territorial inequality. Added to this is the erosion of social isolation measures, partly because of the long time that this has been used, but especially because the presidential leadership has played against this strategy all the time. Some studies have shown that in places where President Bolsonaro had the most votes in the last presidential election (2018), there were high levels of COVID-19 contamination and deaths (Cabral, Pongeluppe, & Ito, 2021; Fernandes et al., 2020). Such data show that an important portion of the Brazilian population has believed in the negationist discourse and followed its guidelines, representing something that ranges from 25% to 30% of the population. Undoubtedly, such an opposition to measures of social isolation measures hinders a more effective health-care policy. The most important episode of this fourth phase was called the “vaccine war.” President Bolsonaro did not have an active national policy, that include negotiation of the purchase of vaccines and, on the contrary, postponed the negotiation with Pfizer (for six months) and prohibited, in October 2020, the purchase of a vaccine that was being produced by the government of the state of São Paulo, through the Butantan Institute in partnership with the Chinese company Sinovac. The last three months of 2020 were a conflict over whether or not to buy this vaccine. In any case, in January 2021 the government of São Paulo obtained approval from the National Health Surveillance Agency and started vaccination before the Federal Government. The negative impact of this episode for President Bolsonaro forced him to buy this vaccine, called CoronaVac, in addition to acquiring AstraZeneca, which is produced in Brazil in partnership with the Oswaldo Cruz Foundation, a federal health research institution. In the case of Pfizer and Janssen vaccines, which had been offered to the Brazilian government, the negotiation was too late and the contracts were only signed a few months later. Even having acquired such immunizations, the volume obtained was hampered by the fact that the inputs come from Indian factories and, in a much larger quantity, from China. As Bolsonaro and his allies have criticized the Chinese government since the beginning of the mandate, including calling COVID-19 the “Chinese virus,” there was likely retaliation with a long delay

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in sending material for the production of vaccines. As a result, Brazil had a lack of vaccines in the first half of 2021, although it had excellent vaccination logistics, linked to the National Immunization Plan that has been in place for over 40 years in the country with great success. The fact is that the population saw the President Bolsonaro as the one responsible for the delay in the purchase of vaccines, precisely at a time when a second and more powerful wave of COVID-19 was emerging. Because of this political failure, the current health minister, General Pazuello, was fired, and presidential popularity fell to the worst level since the beginning of his term: 24% of the population considered his government to be good or excellent, while 45% considered his presidential leadership to be bad or terrible. (Tavares, 2021). To complete Bolsonaro’s list of problems, a Parliamentary Inquiry Commission was opened in the Senate to investigate the errors made by the Federal Government during the pandemic.

FINAL REMARKS: FIVE LESSONS There are five important lessons to be drawn from the way Brazilian federalism has dealt with the pandemic. First, federative safeguards of autonomy and intergovernmental forums – two important dimensions of SUS – secured states and municipalities the possibility of responding to COVID-19, even within a context in which the presidential leadership was working against World Health Organization’s recommendations. Second, the federative confrontation led to the strengthening of horizontal cooperation among subnational governments, such as the National Council of State Health Secretaries and the Consortium of the Northeast. Both institutional structures highlight the positive role that intergovernmental relations can play in the diffusion of policies (Fuglister, 2012). Notwithstanding, the concomitantly autonomous and collaborative reaction of subnational governments was not sufficient to reduce the effect of territorial inequalities in health service provision – this is the third lesson. The pandemic was responsible for many deaths across the country, which was particularly significant in the poorest regions, such as the North Region where state and municipal departments have less financial and administrative capacities in health care. In this sense, inequalities reinforced gaps in the service provision. The fourth lesson is that COVID-19 is not just a problem of federative coordination within the of health-care systems. Being a CIP, it also brings for

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federative coordination in other public policies, such as education and social assistance, and intragovernmental coordination among them, which are essential responding the pandemic and tackling inequalities. The lack of national coordination also featured these other policies, resulting in a significant heterogeneity in subnational responses. Finally, the fifth lesson is related to the absence of effective national leadership that led to thousands of deaths that could have been prevented. Bolsonaro politicized the fight against the pandemic, combining antiscientific discourse with a confrontation with governors and mayors. The fact remains that, given the heterogeneity in governments’ responses and the uncontrolled spread of the virus, a national articulated action, under the leadership of the country’s President, would have been critical in preventing Brazil from reaching the top of the ranking of nations with the worst outcomes in the fight against COVID-19.

REFERENCES Abrucio, F. L. (1998). Os Barões da Federação: os governadores e a redemocratização brasileira. São Paulo: Editora Hucitec. Abrucio, F. L. (2005). A coordenação federativa no Brasil: A experiˆencia do per´ıodo FHC e os desafios do governo Lula. Revista de Sociologia e Pol´ıtica, 24, 41–67. doi:10.1590/S0104-44782005000100005 Abrucio, F. L. (2021). Bolsonarismo e Educação: quando a meta e´ ´ desconstruir uma pol´ıtica publica. In L. Avritzer, F. Kerche, & M. Marona ´ (Eds.), Governo Bolsonaro: Retrocesso democratico e degradação pol´ıtica (pp. 255–270). Belo Horizonte: Autˆentica. Abrucio, F. L., Grin, E. J., Franzese, C., Segatto, C. I., & Couto, C. G. (2020). Combating COVID-19 under Bolsonaro’s federalism: A case of ´ intergovernmental incoordination. Revista de Administração Publica, 54(4), 663–677. doi:10.1590/0034-761220200354x Abrucio, F. L., & Grin, E. J. (2015). From decentralization to federative coordination: The recent path of intergovernmental relations in Brazil. Paper presented at the II International Conference on Public Policy, Milan, Italy. Arretche, M. (2004). Federalismo e pol´ıticas sociais no Brasil: Problemas de coordenação e autonomia. São Paulo em Perspectiva, 18(2), 17–26.

84

Fernando Luiz Abrucio et al.

Arretche, M. T. S. (2012). Democracia, federalismo e centralização no Brasil. Rio de Janeiro: Editora FGV. Arretche, M. T. S. (2015). Intergovernmental relations in Brazil: An unequal federation with symmetrical arrangements. In J. Poirier, C. Saunders, & J. Kincaid (Eds.), Intergovernmental relations in federal systems: Comparative structures and dynamics (pp. 108–134). North York, ON: Oxford University Press. Arretche, M. T. S., & Fonseca, E. M. (2018). Brazil: Local government role in health care. In G. P. Marchildon & T. J. Bossert (Eds.), Federalism and decentralization in health care: A decision space approach (pp. 40–50). Toronto/Buffalo/London: University of Toronto Press. Barberia, L. & Gomes, E. (2020). Political and institutional perils of Brazil’s COVID-19 crisis. Lancet, 396, 367–368. doi:10.1016/S0140-6736(20) 31681-0 Bulman-Pozen, J., & Gerken, H. K. (2009). Uncooperative federalism. Yale Law Journal, 118(1256), 1256–1310. Cabral, S., Pongeluppe, L., & Ito, N. (2021). The disastrous effects of leaders in denial: Evidence from the COVID-19 crisis in Brazil. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id53836147 Castro, M. C., Kim, S., Barberia, L., Ribeiro, A. F., Gurzenda, S., ... Singer, B. H. (2021). Spatiotemporal pattern of COVID-19 spread in Brazil. Science, 372(6544), 821–826. doi:10.1126/science.abh1558 da Fonseca, E. M., Nattrass, N., Arantes, L. B., & Bastos, F. I. (2021). COVID-19 in Brazil: Pragmatic command, social contention, and political challenges. In S. L. Greer, E. J. King, E. A. da Fonseca, & A. Peralta-Santos (Eds.), Coronavirus politics: The comparative politics and policy of COVID-19 (pp. 511–521). Ann Arbor: University of Michigan Press. da Rocha, M. M. (2021). Os munic´ıpios e a pol´ıtica local sob o governo Bolsonaro. In L. Avritzer, F. Kerche, & M. Marona (Eds.), Governo ´ Bolsonaro: Retrocesso democratico e degradação pol´ıtica (pp. 151–164). Belo Horizonte: Autˆentica. da Silva, A. L. N. (2020). Os Estados Importam! Determinantes ´ do da cooperação subnacional nas pol´ıticas de educação e saude ´ Brasil. Ph.D. dissertation, Fundação Getulio Vargas, Rio de Janeiro.

Brazilian Federalism in the Pandemic

85

Fernandes, I., et al. (2020). Ideology, isolation, and death. As Analysis of the effects of Bolsonarism in the COVID-19 pandemic. Retrieved from https:// papers.ssrn.com/sol3/papers.cfm?abstract_id53654538 Franzese, C. (2010). Federalismo Cooperativo no Brasil: da Constituição de ´ 1988 aos Sistemas de Pol´ıticas Publicas. Ph.D. dissertation, Escola de Administração de Empresas de São Paulo, São Paulo. Franzese, C., & Abrucio, F. L. (2013). Efeitos rec´ıprocos entre federalismo e ´ ´ pol´ıticas publicas: Os casos dos sistemas de saude, assistˆencia social e de educação. In G. Hocman e C. A. P. Faria (Eds.), Federalismo e pol´ıticas ´ publicas no Brasil (pp. 361–385). Rio de Janeiro: Editora Fiocruz. ´ ´ Fructuoso, J. A. (2010). Gestão do Sistema Unico de Saude. In R. P. Oliveira & W. Santana (Eds.), Educação e federalismo no Brasil: Combater as desigualdades, garantir a diversidade (pp. 89–108). Bras´ılia: Unesco. Fuglister, K. (2012). Where does learning take place? The role of intergovernmental cooperation in policy diffusion. European Journal of Political Research, 51(3), 316–349. doi:10.1111/j.1475-6765.2011. 02000.x Greer, S. L., King, E. J., Massard da Fonseca, E., Peralta-Santos, A. (Eds.). (2021). Coronavirus politics: The comparative politics and policy of COVID-19. Ann Arbor: University of Michigan Press. Grin, E. J., & Abrucio, F. L. (2018). Las capacidades estatales de los ´ de pol´ıticas. municipios brasileños en un contexto de descentralizacion Reforma y Democracia, 70, 93–126. Grin, E. J., & Abrucio, F. L. (2019). The co-evolutionary policy style of Brazil: Structure and functioning. In M. Howlett & J. Tosun (Eds.), Policy styles and policy-making (pp. 115–134). London and New York, NY: Routledge Taylor & Francis Group. Grin, E., Bergues, M., & Abrucio, F. L. (2020). Toma de decisiones pol´ıticas ´ intergubernamental y salvaguardias en Brasil: Arenas de negociacion federativas. In J. M. Ruiz & E. J. Grin (Eds.), Federaciones de las Am´ericas: ´ relaciones intergubernamentales y recentralizacion ´ Descentralizacion, (pp. 181–238). Ciudad de M´exico: INAP. Grin, E. J., Abrucio, F. L., Silveira, M. C., & Gomes, R. (2021). Together it is possible to go further: Brazilian health intermunicipal consortium as a collaborative and innovative governance to fight COVID 19. Public Management Review. forthcoming.

86

Fernando Luiz Abrucio et al.

Grin, E. J., & Fernandes, G. A. L. (2019). Capacidades estatales en los municipios brasileños: Resultados t´ımidos en un contexto de autonom´ıa pol´ıtica local y un escenario de dependencia financiera. In E. J. Grin, E. Completa, A. P. H. Carrera e F. L. Abrucio (Eds.), Capacidades estatales en gobiernos locales iberoamericanos – Actualidad, brechas y perspectivas (pp. 92–149). Rio de Janeiro: Editora FGV. Hallal, P. (2021). O Brasil e´ o 81º no ranking mundial de vacinação. Folha de S. Paulo, 18 de maio de 2021. Retrieved from https:// www1.folha.uol.com.br/colunas/pedro-hallal/2021/05/brasil-e-81o-noranking-mundial-de-vacinacao.shtml Leandro, J. G., & Menicucci, T. M. G. (2018). Governança federativa nas ´ ´ e assistˆencia social: Processo decisorio pol´ıticas de saude nas Comissões ´ Intergestores Tripartite (2009–2012). Revista do Serviço Publico, 69(4), 817–848. doi:10.21874/rsp.v69i4.3155 Lipjhart, A. (1999). Patterns of democracy: Governments forms and performance in thirty six countries. New Heaven, CT and London: Yale University. Massuda, A., Hone, T., Leles, F. A. G., Castro, M. C., & Atun, R. (2018). The Brazilian health system at crossroads: Progress, crisis and resilience. BMJ Glob Health, 3(4), 1–8. Menicucci, T. (2019). Regionalização no federalismo brasileiro. Cadernos de ´ Publica, ´ Saude 35, 1–3. doi:10.1590/0102-311x00078419 Menicucci, T., & Marques, A. (2016). Cooperação e Coordenação na ´ ´ Implementação de Pol´ıticas Publicas: O Caso da Saude. Dados - Revista de Ciˆencias Sociais, 59(3), 823–865. doi:10.1590/00115258201693 Menicuci, T. M. G., Marques, A. M. F., & Silveira, G. A. (2017). O ˆ desempenho dos munic´ıpios no Pacto pela Saude ´ no ambito das relações ´ ´ e Sociedade, 26(2), 348–366. ´ federativas do Sistema Unico de Saude. Saude doi:10.1590/S0104-12902017170844 Paiva, A. B., Gonzalez, R. H., & Leandro, J. G. (2017). Coordenação ´ federativa e financiamento da pol´ıtica de saude. Novos Estudos, 36(2), 55–81. doi:10.25091/S0101-3300201700020004 Pereira, A. K., Oliveira, M. S., & Sampaio, T. S. (2020). Heterogeneidades das pol´ıticas estaduais de distanciamento social diante da COVID-19: Aspectos pol´ıticos e t´ecnico-administrativos. Revista de Administração ´ Publica, 54(4), 678–696. doi:10.1590/0034-761220200323

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Segatto, C. I., & B´eland, D. (2019). Federalism and decision making in health care: The influence of subnational governments in Brazil. Policy Studies, 42(3), 308–326 doi:10.1080/01442872.2019.1634187 Souza, C. (2004). Governos locais e gestão de pol´ıticas sociais universais. São Paulo em Perspectiva, 18(2), 27–41. doi:10.1590/S010288392004000200004 Souza, C., & Fontanelli, F. (2021). Ant´ıodotos institucionais do federalism ˆ brasileiro: A COVID-19 mudou a dinamica federativa? In L. Avritzer, F. ´ Kerche, & M. Marona (Eds.), Governo Bolsonaro: Retrocesso democratico e degradação pol´ıtica (pp. 135–150). Belo Horizonte: Autˆentica. Tavares, J. (2021). Aprovação de Bolsonaro recua seis pontos e chega a 24%, a pior marca do mandato; rejeição e´ 45%. Folha de S. Paulo, 12 de maio de 2021. Retrieved from https://www1.folha.uol.com.br/poder/2021/ 05/datafolha-aprovacao-a-bolsonaro-recua-seis-pontos-e-chega-a-24-a-piormarca-do-mandato-rejeicao-e-de-45.shtml ´ Vargas, I., Mogollon-P´ erez, A. S., Unger, J., da Silva, M. R. F., de Paepe, P., ´ & Vazquez, M. (2014). Regional-based integrated healthcare network policy in Brazil: From formulation to practice. Health Policy and Planning, 30(6), 705–717. doi:10.1093/heapol/czu048 Viana, A. L. D., Bousquat, A., Pereira, A. P. C. M., Uchimura, L. Y. T., Albuquerque, M. V., Mota, P. H. D., … Ferreira, M. P. (2015). Typology of ´ e health regions: Structural determinants of regionalization in Brazil. Saude Sociedade, 24(2), 413–422. doi:10.1590/S0104-12902015000200002 Viana, A., Ibanez, N., Elias, P., Lima, L., Albuquerque, M., & Iozzi, F. ´ (2008). Novas perspectivas para regionalização da saude. São Paulo em Perspectiva, 22(1), 92–106.

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5 CANADIAN FEDERALISM IN THE PANDEMIC Catarina Ianni Segatto, Daniel B´eland, and Shannon Dinan

ABSTRACT This chapter analyzes governmental responses to the COVID-19 pandemic in a highly decentralized federal country. Canada has a decentralized approach in many policy areas, including health care, in which provinces are the primary decision-makers and service providers. This decentralized health-care system allowed provinces to respond according to regional and local contexts and needs. The capacity building and the policy learning related to previous crises and horizontal coordination were key to policy responses to the pandemic. Moreover, unlike other countries, Canada did not centralize decisions throughout the pandemic, and did not reinforce competition and uncoordinated actions. The federal government also has had a central role coordinating COVID-19 policy responses. Nevertheless, Canada faced some challenges stemming from the lack of uniformity across the country, especially related to regional and local restrictions, enforcement mechanisms, testing, and travel restrictions. Keywords: Federalism; intergovernmental relations; health care; COVID-19; Canada; decentralization; coordination

INTRODUCTION Canada is one of the most decentralized countries in the world and certainly the most decentralized case analyzed in this book. This chapter focuses on Canada’s response to the COVID-19 pandemic in the context of such a

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decentralized federal system (Requejo, 2010) that, differently from other countries, did not centralize decisions throughout the pandemic (Fafard, Cassola, MacAulay, & Palkovits, 2021). Specifically, this chapter seeks to better grasp how the federal government and the 10 provinces (and to a lesser extent the three sparsely populated territories) have responded to the COVID-19 pandemic. The COVID-19 pandemic required regional and local responses due to differences in regions’ contexts and needs. However, a highly decentralized country like Canada with significant provincial autonomy in various policy areas, especially in health care, could reinforce competition among provinces and fragment governmental actions. Canada’s experience managing recent public health crises, particularly the SARS and H1N1 outbreaks, and horizontal coordination among provinces, helped the country address potential “blind spots” in the policy responses to the pandemic (Fafard et al., 2021; Marchildon & Bleyer, 2020; Migone, 2020; Paquet & Schertzer, 2020). Even though governments coordinated some of their policy responses, the highly decentralized nature of Canadian federalism has created strong obstacles to the implementation of uniform or even coordinated regional and local restrictions, mechanisms of enforcement, testing, and travel restrictions. Despite uneven responses, provinces were able to tackle COVID-19 and, at least in some parts of the country, coordinate their actions through intergovernmental relations, balancing the competitive nature of decentralized federal systems. This chapter is divided into four sections, besides this Introduction. In the first section, we briefly discuss Canada’s health-care system path and its main features and dynamics, especially the responsibilities of the federal government and provinces, and how they influence governments’ responses to tackle COVID-19. In the second section, we present the coordination mechanisms in the health-care system and their effects in strengthening governments’ responses. In the third section, we discuss the role of the national and provincial leaderships in adopting and coordinating responses, despite ideological differences. Finally, the last section outlines policy lessons derived from an assessment of the role of federalism during the COVID-19 pandemic.

SUBNATIONAL AUTONOMY AND POLICY PORTFOLIO When created in 1867 Canada was by design a fairly centralized federation, as the federal parliament had powers in most policy areas that really mattered at

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the time (Lecours, 2017). Although a push for decentralization took place in the following decades, following the Great Depression, the federal government assumed a leading role in the expansion of social policies, in part through the use of its perceived spending power (Banting, 2006; Cameron & Simeon, 2002), which “made the Canadian welfare state possible” (Cameron & Simeon, 2002, p. 51). Yet, after World War II, the provinces, especially Quebec, pushed back against fiscal and social policy centralization. This situation led to shared-cost measures enacted during the late 1950s and the 1960s (Maioni, 1998). In part as a result of this provincial mobilization, Canada is a highly decentralized country – the most decentralized among the countries analyzed in this volume. In the case of health care, after World War II, the federal government’s fiscal role did allow the expansion of health-care coverage across the country. Yet, Canada’s health care was a result of a provincial innovation – the hospitalization and medicare programs introduced in Saskatchewan in 1947 and 1962 by, respectively, the Co-operative Commonwealth Federation (CCF), and later developed by the New Democratic Party (NDP) – that influenced the national agenda and was diffused to other provinces with the help of federal funding, which proved fundamental to diffuse public health-care across the country (Banting & Corbett, 2002; Maioni, 1998). As a result, all provinces offer universal health-care coverage approved medical and hospital services. It is important to note that dental services and prescription drugs purchased outside of hospitals are not included in medicare. These services and others, including home care, are covered by provincial governments mainly when dealing with vulnerable groups (Marchildon, 2018; Tuohy, 1994). Regarding medicare even though there are differences across the country, all provinces have to offer free-of-charge services and have to follow national guidelines ensuring that all services are covered and all residents have equal access to them, even if they move from one province to the other (B´eland, Lecours, Marchildon, Mou, & Olfert, 2017). However, other policies had a different structure. Canada features by a combination of policy areas with subnational autonomy that resulted from decentralization processes, such as immigration, policies with a previous path of great subnational autonomy, which is the case of education, as there is no federal department, and provinces are the only decision-makers, and centralized policies, particularly social welfare policies, like unemployment insurance and old age security (Lecours, 2017). Moreover, because of its francophone minority and the presence of Quebec nationalism, Canada has a “binational nature” (Lecours, 2017, p. 60), and a dual system characterizes it with a high degree of provincial autonomy and

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asymmetry in powers and responsibilities among provinces, shared responsibilities in a limited number of policy areas policies, and a less vertically integrated party system (Lecours, 2017; Marchildon, 2018). It is important to notice that, differently from other federal countries, and similarly to the United States, local governments are linked to provinces, being their “creatures.” Local governments have responsibilities in urban planning and settlement and integration policies for immigrants and refugees, among others, but are not key players in health-care provision (Marchildon, 2018). This means that health care is mainly under provincial control, as provinces are the main decision-makers and service providers, responsible for singlepayer coverage plans for hospital and medical services. Provinces additionally cover other services and prescription drug and subsidized long-term and home care for specific groups, especially vulnerable ones. Many provinces also created regional health authorities to coordinate health-care provision, as it was previously a responsibility of local hospital boards. However, the federal government has responsibilities in the health-care policy, including regulation of health products and pharmaceutical drugs, funding research, and redistributing fiscal resource to provinces. Moreover, the federal government guarantees access to health care for Indigenous peoples and refugees (Marchildon, 2018). The federal government was implemented screening and quarantine measures in airports and international border restrictions (Fafard et al., 2021), but, on the health front, Canadian provinces were the main actors in responding to the COVID-19 pandemic, each operating their own health-care system, making rapid decisions as the situation evolved on the ground. Most provinces acknowledged the coronavirus outbreak at the end of January 2021 and, starting in March, regulated physical distancing, approved precautionary measures for long-term care facilities, and closed schools and selected businesses. Provinces also implemented actions to increase hospital capacity and put in place health hot lines and different policies to protect health-care workers (Allin & Marchildon, 2020a, 2020b, 2020c; Allin, Urban, & Marchildon, 2020; Allin, Camillo, & Marchildon, 2020; Allin, Roerig, & Marchildon, 2020; Karsenti, Marchildon, & Allin, 2020; Kulandaivelu, Allin, Karsenti, & Marchildon, 2020). Even though policy changes resulted from previous crises, long-term care facilities were the new “blind spot,” as 80% of COVID-19 pandemic deaths included individuals living in long-term care facilities (Marchildon & Bleyer, 2020; Migone, 2020). The situation was particularly dire in Quebec, the province that was the most negatively affected by the first wave of the pandemic. The high number of deaths in long-term care facilities in this

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province and in other jurisdictions across the country pointed to existing, wellknown challenges with long-term care in Canada. In this context, the pandemic helped move long-term care onto the policy agenda, with a push for the federal government to provide more fiscal support to the provinces in this policy area and in health care more generally (B´eland & Marier, 2020). There were differences among provincial responses, but most provinces adopted relatively analogous responses at a similar pace (Breton & Tabbara, 2020). Provinces especially the federal government also acted in social and economic fields with initiatives that involved the postponement of student debt payments, financial assistance for businesses, online learning platforms, funding for vulnerable and at-risk populations, including funding for housing and shelter, electricity relief, financial assistance for individuals that lost their income and were not eligible for the federal governments’ benefit, and childcare subsidies (Allin & Marchildon, 2020a, 2020b, 2020c; Allin, Urban et al., 2020; Allin, Camillo et al., 2020; Allin, Roerig et al., 2020; Karsenti et al., 2020; Kulandaivelu et al., 2020).

INTERGOVERNMENTAL COORDINATION Despite being highly decentralized, there are fiscal coordination mechanisms in Canada, including federal transfers and cost sharing. This notably affects the funding of Canada’s health-care system, which relies on such mechanisms. The most important of these is the federal government’s Canada Health Transfer (CHT), which creates fiscal incentives for provinces to abide by federal principles embedded in the 1984 Canada Health Act.1 This Act includes five principles: portability, accessibility, universality, comprehensiveness, and public administration. These principles mean that all provinces must ensure that a public authority is responsible for health care, all necessary health services are insured, and all insured residents have the same access and level of health care even if they move to different provinces or territories.

1 The federal shared-cost programs were important for welfare expansion, but, in the 1970s, they were replaced by less conditional transfers (Lecours, 2017). Later, in 1995, the federal funding was combined in one block fund, called the Canada Health and Social Transfer (CHST), increasing provincial autonomy for spending this resource, which, in 2004, was split into the Canada Health Transfers (CHT) and the Canada Social Transfers (CST). Besides these transfers, there is an equalization system, officially created in 1957 to balance fiscal capacity among provinces (B´eland et al., 2017).

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According to B´eland et al. (2017), the federal government can impel the provinces to follow the Act by reducing transfers if they do not follow these principles or if they allow user fees or extra billing. However, the amount transferred represents only a limited share of Canada’s total health spending, which in 2019 was $254.6 billion (CIHI, 2021), and the federal government cannot track provincial spending. This means that these transfers can be used at the province’s discretion. The federal government also uses its role to subsidize services to specific groups, including First Nations and Inuit residents and eligible refugee claimants, and has responsibilities in pharmaceutical regulation, research, and data collection (Marchildon, 2018). The relationship between the federal government and provinces has changed over time. During the Harper governments (2006–2015), an “open federalism” approach prevailed reinforcing decentralization. As Lecours notes (2017), this was oriented by a market-preserving approach that relied on the idea that more decentralization would produce competition among the provinces and thus spur innovation. The federal government also lost its prominence shaping policies as federal funding to provinces was reduced; though the CHT fund grew, it did not meet provinces’ expectations. Instead, the federal government made changes that displeased the provinces. One response to this dual funding model and decentralized framework has been increased horizontal provincial collaboration in health care (Fierlbeck, 2013; Marchildon, 2018) and collaborative federalism (Cameron & Simeon, 2002). According to Marchildon, this has led to the creation “of arm’s-length, special-purpose intergovernmental agencies to support longer-term work in areas they deemed a priority to offset the fragmentation caused by a highly decentralized health system” (2018), p. 50. While this collaboration is laudable, there are challenges including the institutionalization of intergovernmental relations (Bakvis & Brown, 2010), the limited scope of certain initiatives (Banting & Corbett, 2002), the federal government’s unilateral decisions, and governance problems (Fierlbeck, 2013; Marchildon, 2018). Another well-known issue raised by scholars is that Canada relies on relationships among federal and provincial executives, a form of executive federalism that has constrained legislative participation (Watts, 2006). This policy framework has influenced Canada’s response to the COVID-19 pandemic. According to some, partial …success of the Canadian policy response to COVID-19 depends on the patterns of executive cooperation embedded in Canadian

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federalism which were a central feature of the evolution of the country’s public health system. (Migone, 2020, p. 390) The horizontal cooperation among provinces allowed for the exchange of information and coordination efforts between governments, avoiding competitive behaviors (Migone, 2020; Paquet & Schertzer, 2020). Intergovernmental arenas, especially the Pan-Canadian Public Health Network (PHN), have played an essential role in this process. The PHN, which is composed of government officials from the federal government, provinces, and territories, as well as representatives from nongovernmental organizations, local and regional authorities, and universities, created the Special Advisory Committee on COVID-19 in January 2020. Within this Committee, other committees were created: the Technical Advisory Committee, the Logistics Advisory Committee (that allowed collaboration in buying and exchanging equipment and materials), the Public Health Network Communications Group, and the Public Health Working Group on Remote and Isolated Communities. The PHN also includes the Strategic Advisory Committee for the Federal/Provincial/ Territorial Chief Medical Health Officers that allows the exchange of information and practices among provinces and provides recommendations to the PHN Council and Committees (Pan-Canadian Public Health Network, 2020). Despite this coordination, divergences became clear in key areas. For instance, some provinces adopted more aggressive public health restrictions than others. Simultaneously, the smaller, sparsely populated and geographically isolated Atlantic provinces faced fewer cases than other regions of the country and, in early July 2020, implemented a cooperative and integrated form of internal border control known as the “Atlantic Bubble.” The Atlantic Bubble was the product of an agreement between the governments of New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador. This agreement involved imposing travel restrictions on people living in other regions of the country to make it harder for them to enter the Atlantic Bubble while facilitating the internal circulation of people from these four provinces within the bubble. Although other internal border restrictions were set up within specific provinces and around some Indigenous communities, the Atlantic Bubble is the most striking form of internal border control adopted in Canada during the pandemic.2 This example illustrates potential

2 For example, Ontario restricted interprovincial travel to Quebec and Manitoba during the third wave of the pandemic. Other provinces also restricted travel within their territories during the pandemic.

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collaboration among provinces but also how this can lead to the imposition of travel restrictions on residents of provinces excluded from the intergovernmental agreement. Simultaneously, because participating provinces moved in and out of the Atlantic Bubble after it was created depending on their own public health situation, the agreement did not curtail provincial autonomy in a dramatic way and, by the second wave of COVID-19, the bubble had burst (Brown, 2021). Finally, although unique within Canada, the Atlantic Bubble is an example among others of internal travel restrictions implemented in parts of federal countries such as Australia and the United States (Studdert, Hall, & Mello, 2020). Regarding the federal government’s coordinating role, during the pandemic, compared to the provinces and the territories, the federal government played a more limited role in both health care and public health. Yet, it remained a key actor of the policy responses to the pandemic on several levels. In addition to (rather slowly) imposing international travel restrictions, the federal government played a key role in fiscal policy and support for businesses and families. In part because it already played a major role in income security such as Employment Insurance and in part because it has a much greater capacity to raise revenues and to spend it than the provinces, the federal government took the lead by enacting large-scale, temporary emergency economic and social policy measures in the spring of 2020. These bold measures were consistent with “emergency Keynesianism” (Bremer & McDaniel, 2020, p. 439) as an attempt to avoid an economic free fall amid restrictive provincial and territorial public health measures that led to a swift decline in economic activity and a related increase in social insecurity and unemployment rates. This approach was consistent with the one adopted by other advanced industrial countries, which used massive deficit spending to help citizens and businesses while avoiding economic collapse altogether (B´eland, Cantillon, Hick, & Moreira, 2021). In this context, as soon as COVID-19 emerged, Justin Trudeau, Canada’s Prime Minister since the fall of 2015, announced massive emergency policies that included financial support for individuals, especially the Canada Emergency Response Benefit (CERB), which offered temporary financial relief for people who lost their income because of the pandemic. Between March and October 2020, this temporary program paid more than 81 billion dollars CDN in benefits to nearly nine million people (Government of Canada, 2021a). The CERB was phased out in the early fall of 2020 and the federal government replaced, and later extended, elements of the program with three new Employment Insurance benefits for workers still affected by the crisis, caregivers, and those who become ill or must quarantine and do not have sick leave.

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In addition to the CERB, the federal government funded numerous employment and social policy initiatives. This includes funding for businesses, subsidizing salaries for employees of private and nonprofit organizations, funding for vulnerable or at-risk groups, which included funding for Indigenous Services Canada to First Nations communities, the elderly, and families with young children. It also established national standards through the Federal Quarantine Act. Moreover, Ottawa implemented special, temporary health care and emergency transfers to support the policy efforts of the provinces and the territories during the pandemic. The federal government has also temporarily increased transfers to the provinces. As of October 2020, Canadian governments had announced $29 billion in additional funding in response to the pandemic (CIHI, 2021a). Of this funding, the three largest areas are personal protection equipment (33%), screening the virus (15%), and increased funding for health-care workers (11%). Much of this funding consisted in direct transfers to the provinces and territories for research, testing, and improving the health-care systems’ ability to manage higher caseloads. Despite the increase in public spending, cooperation between the federal and provincial governments on health care has come under pressure. In September 2020, the premiers unanimously demanded the federal government increase the CHT from 22% to 35% of annual provincial health spending. The premiers maintained a united front and continued to apply pressure for increased transfers, releasing a report in February 2021 in support of the increase citing the federal government’s positive fiscal situation and long-term provincial fiscal constraints (Council of the Federation, 2021). The federal government did not negotiate new transfer funding, preferring instead to focus on other elements of the pandemic response such as vaccine procurement (Government of Canada, 2020). In its 2021 budget, it did announce new and increased spending in areas of provincial jurisdiction including childcare and long-term care. The federal government also increased spending for employment policies and specific groups such as the elderly and youth (Government of Canada, 2021d). Announcements for new spending aside, provincial cooperation also remains necessary in many of these policy areas. Furthermore, the budget was criticized by provincial officials for a lack of new spending in health care and other areas related to the pandemic (Gray, Keller, & Hager, 2021). As mentioned, the limited coordination in the area of long-term care has led to tragic results. While the federal government provided funding and deployed members of the Armed Forces to assist long-term care homes in Quebec and Ontario during the first wave of the pandemic, reports have shown that the

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number of infections and deaths rose between waves and numerous lessons were not applied (CIHI, 2021b). This has led scholars to point to the need to learn from previous experiences and renewed questions about the role the private sector plays in long-term care (B´eland & Marier, 2020; Stall, Jones, Brown, Rochon, & Costa, 2020; Webster, 2021). Another essential role performed by the federal government concerned the procurement of COVID-19 vaccines, as they became available. Although the provinces and territories are tasked with administrating the vaccines, the federal government took care of international procurement in the context of Canada’s limited vaccination production capacity. Over time, the federal government spent more than a billion dollars in security vaccine supply through negotiated agreements with pharmaceutical companies. These agreements became possible through the leadership of the Public Services and Procurement Canada (PSPC), which worked on this file in collaboration with the Public Health Agency of Canada (PHAC) and other federal departments and agencies. This led the federal government to order millions of doses of vaccines before they were even approved by Health Canada, in a global context where the European Union, the United States, and other jurisdictions competed against one another to secure doses for their inhabitants. More specifically, Canada secured 20 million doses of the AstraZeneca vaccine, 44 million doses of the Moderna vaccine, up to 76 million doses of the Pfizer vaccine, and up to 38 million doses of the Johnson and Johnson vaccine. Agreements were also signed with other pharmaceutical companies for up to 224 million more vaccine doses, which amounted to a genuine shopping spree, considering that the population of Canada is only around 38 million inhabitants (Government of Canada, 2021b). Yet, delays in the delivery of foreignmade vaccines created much political uproar in early 2021, when opposition leaders and several premiers criticized the Trudeau government for what they saw as vaccine supply lagging behind the one witnessed in other countries such as the United Kingdom and the United States, who have much greater vaccine production capacity than Canada (Wherry, 2021). Delays in vaccine distribution caused the provinces to adapt their rollout strategies with immunization campaigns varying across the country. Quebec most notably opted for a controversial strategy of delaying the second vaccine dose beyond the pharmaceutical companies’ recommendations. This approach was defended by the province’s public health institute (INSPQ, 2020) with other provinces and the Canada’s National Advisory Committee on Immunization eventually following suit (Government of Canada, 2021c). In the end, Canada’s vaccination rates increased rapidly in the late spring and early

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summer and, by early August, the country had some of the highest vaccination rates in the world. Despite this, scholars have shown some skepticism about the effectiveness of intergovernmental coordination and cooperation over time. Firstly, as shown, the border controls in, and agreements among, the four Atlantic provinces have triggered tensions with other provinces. Moreover, before and during the pandemic, differences in provincial fiscal capacities and the scope of the economic and fiscal crisis in the provinces can result in intergovernmental conflicts between provinces that are recipients and nonrecipients of federal equalization payments and between provinces and the federal government ¨ 2020). While B´eland et al. (B´eland, Lecours, Paquet, & Tombe, 2020; Noel, (2020) argue that the federal government should assist provinces negotiating provincial debt and using the emergency financial assistance program and ¨ (2020) equalization systems to decrease fiscal imbalances among them, Noel calls attention to the change in federal dynamics that these modifications can bring, as the federal government would become more central than it traditionally is in defining provincial policies. This means that, while coordination is a key factor explaining part of Canada’s successes during the pandemic, it has thus far only led to temporary adjustments and been restricted to provincial health-care systems’ decisions. Increases in funding in specific policy areas and vertical coordination between the federal government and provinces have not led to structural changes to the equalization mechanisms seeking to tackle regional inequalities. Furthermore, the horizontal coordination among provinces did not spill over to other policy fields. This has meant that, although Canada performed relatively well in the initial months of the pandemic, issues related to long-term care have shown the country’s performance is less robust in the later stages of the pandemic.

POLITICAL AGENCY Canada’s ability to coordinate despite provincial autonomy and decentralization in health care is facilitated by long existing institutions for intergovernmental coordination. Moreover, governments cooperate to avoid political costs in moments of crisis, what Migone (2020) has called “an emergency coordination.” In the Canadian case, this has come in the form of provincial premiers cooperating with and supporting the federal government in the initial stages of the crisis and becoming more critical in later stages.

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Political leadership at the beginning of the crisis was strong with unity among first ministers in Canada. Provincial governments, many of which were led by conservative parties, were largely supportive of the minority centre-left Liberal government’s initial decisions. This support began to waver over issues including health-care funding and vaccine procurement. While political leadership can ease coordination, institutionalized structures are a key explanatory factor. Structures of intergovernmental relations, particularly the PHN, have been institutionalized, allowing for the activation of these “intergovernmental capacities” to create committees to deal with the COVID-19 pandemic. Likewise, the legacy of other critical events allowed for capacity building and policy learning over time, particularly the 2003 SARS outbreak and the 2009 H1N1 pandemic (Migone, 2020; Paquet & Schertzer, 2020). The creation of the Public Health Agency of Canada in 2004 resulted from the need for a national guidance during the SARS outbreak (Marchildon & Bleyer, 2020; Migone, 2020; Paquet & Schertzer, 2020). Ontario also created its own public health agency in 2008 (Migone, 2020). Another opportunity for learning came from the provinces’ challenges with tracking the illness and protecting health-care workers during SARS. Additionally, over 40% of those infected by SARS were healthcare workers, a category that represented a ‘blind spot’ in the planning. […] SARS was not a pandemic but it triggered significant reactions and learning on the part of both the domestic and international public health systems. (Migone, 2020, p. 395) Finally the H1N1 pandemic also produced learning, especially related to its impact on remote communities (Migone, 2020).

FINAL REMARKS AND LESSONS Canadian federalism was key to allow provinces to develop their own responses to the pandemic. Canada shows that, differently from other federal countries, the federal government did not have to centralize decisions to respond to the pandemic. The pandemic required a decentralized response, and, due to Canadian provinces’ great autonomy, they were able to respond in a timely manner, being less dependent on federal funding and national regulation than they would be in other federations. However, a highly decentralized federal system could result in competitive behavior, which did not occur

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because of coordination mechanisms for COVID-19 responses. Even though Canada faced some challenges related to the lack of uniformity across the country, a model that combined subnational autonomy with vertical and horizontal coordination worked in this relatively well case. The capacity building and the policy learning after the SARS outbreak and the H1N1 pandemic were important to cover possible “blind spots,” especially health care workers’ protection. However, new and sometimes tragic “blind spots” became apparent. A first one was the high number of deaths among individuals living in long-term care facilities. A second one is related to data management on COVID-19. Marchildon and Bleyer (2020) point out that “Canada as a whole has performed poorly when it comes to public health surveillance and data sharing. Data on COVID-19 has not been consistently collected, categorized or disseminated” (Marchildon & Bleyer, 2020, p. 2). Another important lesson of the Canadian case is that the COVID-19 pandemic being a “complex intergovernmental problem” (Paquet & Schertzer, 2020), policy responses to tackle the effects of the pandemic have involved coordination among jurisdictions not only in one policy field, mainly health care, but also in other various policy fields. In health care, there has been a need for horizontal coordination among provinces and with the federal government. However, mechanisms of enforcement, travel restrictions, testing, financial support for businesses and families, and the acquisition of vaccines have involved different coordination arrangements, more complex and less institutionalized ones, among the federal government, provinces, and local governments. Canada’s successes and failures during the pandemic resulted from the combination of these different arrangements. The federal government has had a central role in fiscal and social policy and increased its role in coordinating COVID-19 policy responses, including transferred resources to the provinces and the acquisition of vaccines, even though some gaps still existed. Finally, coordination with local governments was also important during the COVID-19 pandemic (Eidelman & Lucas, 2020; OCDE, 2020). In British Columbia, for example, local health teams tracked and monitored cases, and the provincial government and some local governments collaborated to address issues like homelessness (Allin & Marchildon, 2020b). Nevertheless, there were cases of lack of coordination, in which the provincial government had to revise municipal guidelines to ensure consistency and uniformity (Allin, Camillo et al., 2020). Cities will also be crucial in adopting and managing initiatives postpandemic recovery and development (OCDE, 2020).

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REFERENCES Allin, S., Camillo, C. A., & Marchildon, G. (2020). North American COVID-19 policy response monitor: Saskatchewan. Toronto, ON: North American Observatory on Health Systems and Policies. Allin, S., & Marchildon, G. (2020a). North American COVID-19 policy response monitor: Ontario. Toronto, ON: North American Observatory on Health Systems and Policies. Allin, S., & Marchildon, G. (2020b). North American COVID-19 policy response monitor: British Columbia. Toronto, ON: North American Observatory on Health Systems and Policies. Allin, S., & Marchildon, G. (2020c). North American COVID-19 policy response monitor: Nova Scotia. Toronto, ON: North American Observatory on Health Systems and Policies. Allin, S., Roerig, M., & Marchildon, G. (2020). North American COVID-19 policy response monitor: Newfoundland and Labrador. Toronto, ON: North American Observatory on Health Systems and Policies. Allin, S., Urban, A., & Marchildon, G. (2020). North American COVID-19 policy response monitor: Quebec. Toronto, ON: North American Observatory on Health Systems and Policies. Bakvis, H., & Brown, D. (2010). Policy coordination in federal systems: Comparing intergovernmental processes and outcomes in Canada and the United States. Publius: The Journal of Federalism, 40(3), 484–507. doi: 10.1093/publius/pjq011 Banting, K. G. (2006). Social citizenship and federalism: Is a federal welfare state a contradiction in terms? In S. L. Greer (Ed.), Territory, democracy and justice: Regionalism and federalism in western democracies (pp. 44–66). New York, NY: Palgrave MacMillan. Banting, K. G., & Corbett, S. (2002). Health policy and federalism: An introduction. In K. G. Banting & S. Corbett (Eds.), Health policy and federalism: A comparative perspective on multi-level governance (pp. 1–37). Montreal, QC and Kingston, ON: McGill-Queen’s University Press. B´eland, D., Cantillon, B., Hick, R., & Moreira, A. (2021). Social policy in the face of a global pandemic: Policy responses to the COVID19 crisis. Social Policy and Administration, 55(2), 249–260.

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B´eland, D., Lecours, A., Marchildon, G. P., Mou, H., & Olfert, M. (2017). Fiscal federalism and equalization policy in Canada. Toronto, ON: University of Toronto Press. B´eland, D., Lecours, A., Paquet, M., & Tombe, T. (2020). A critical juncture in fiscal federalism? Canada’s response to COVID-19. Canadian Journal of Political Science, 53(2), 239–243. doi:10.1017/ S0008423920000323 B´eland, D., & Marier, P. (2020). COVID-19 and long-term care policy for older people in Canada. Journal of Aging & Social Policy, 32(4–5), 358–364. doi:10.1080/08959420.2020.1764319 Bremer, B., & McDaniel, S. (2020). The ideational foundations of social democratic austerity in the context of the great recession. Socio-Economic Review, 18(2), 439–463. doi:10.1093/ser/mwz001 Breton, C., & Tabbara, M. (2020). How the provinces compare in their COVID-19 responses. Policy Options. Retrieved from https:// policyoptions.irpp.org/magazines/april-2020/how-the-provinces-compare-intheir-covid-19-responses/ Brown, S. (2021, March 5). Bringing back the bubble: N.B. Premier floats early summer as possible re-do date. Global News. Retrieved from https:// globalnews.ca/news/7679583/bringing-back-the-bubble-n-b-premier-floatsearly-summer-as-possible-re-do-date/ Cameron, D., & Simeon, R. (2002). Intergovernmental relations in Canada: The emergence of collaborative federalism. Publius: The Journal of Federalism, 32(2), 49–71. doi:10.1093/oxfordjournals.pubjof.a004947 Canadian Institute for Health Information (CIHI). (2021a). National health expenditure trends, 2020. Ottawa, ON: CIHI. Canadian Institute for Health Information (CIHI). (2021b). Long-term care and COVID-19: The first 6 months. Ottawa, ON: CIHI. Council of the Federation. (2021). Increasing the Canada health transfer will help make provinces and territories more financially sustainable over the long term. Report of the provincial and territorial ministers of finance to the council of the federation. Retrieved from https://www.canadaspremiers.ca/ wp-content/uploads/2021/03/PT_Finance_Report.pdf Eidelman, G., & Lucas, J. (2020, May 1). Municipal leaders happy with “Team Canada” response to COVID. Policy Options. Retrieved from https://

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policyoptions.irpp.org/magazines/may-2020/municipal-leaders-happy-withteam-canada-response-to-covid/ Fafard, P., Cassola, A., MacAulay, M., & Palkovits, M. (2021). The politics and policy of Canada’s COVID-19 response. In S. L. Greer, E. J. King, E. M. da Fonseca, & A. Peralta-Santos (Eds.), Coronavirus politics: The comparative politics and policy of COVID-19 (pp. 459–477). Ann Arbor, MI: University of Michigan Press. Fierlbeck, K. (2013). The political dynamics of health care federalism. In K. Fierlbeck & W. Lahey (Eds.), Health care federalism in Canada: Critical junctures and critical perspectives (pp. 45–70). Montreal, QC and Kingston, ON: McGill-Queen’s University Press. Government of Canada. (2020). Prime Minister hosts First Ministers’ meeting on fighting COVID-19 and strengthening health care. Retrieved from https://pm.gc.ca/en/news/news-releases/2020/12/10/prime-ministerhosts-first-ministers-meeting-fighting-covid-19-and Government of Canada. (2021a). Canada emergency response benefit and EI statistics. Retrieved from https://www.canada.ca/en/services/benefits/ei/ claims-report.html Government of Canada. (2021b). Procuring vaccines for COVID-19. Retrieved from https://www.canada.ca/en/public-services-procurement/ services/procuring-vaccines-covid19.html Government of Canada. (2021c). Recommendations on the use of COVID-19 vaccines. Retrieved from https://www.canada.ca/en/public-health/services/ immunization/national-advisory-committee-on-immunization-naci/ recommendations-use-covid-19-vaccines.html#a1 Government of Canada. (2021d). A recovery plan for jobs, growth, and resilience. Retrieved from https://www.budget.gc.ca/2021/report-rapport/ toc-tdm-en.html Gray, J., Keller, J., & Hager, M. (2021). Federal budget 2021: Budget falls short on health, housing, provinces, cities say. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/politics/ article-federal-budget-2021-budget-falls-short-on-health-housing-provinces/ INSPQ. (2020). Strategy for vaccination against COVID-19: Postponement of the second dose in a context of shortage. Institut national de sant´e publique du Qu´ebec. Retrieved from https://www.inspq.qc.ca/en/ publications/3098-vaccination-second-dose-context-shortage-covid19

Canadian Federalism in the Pandemic

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Karsenti, N., Marchildon, G., & Allin, S. (2020). North American COVID-19 policy response monitor: Alberta. Toronto, ON: North American Observatory on Health Systems and Policies. Kulandaivelu, Y., Allin, S., Karsenti, N., & Marchildon, G. (2020). North American COVID-19 policy response monitor: Manitoba. Toronto, ON: North American Observatory on Health Systems and Policies. Lecours, A. (2017). Dynamic de/centralization in Canada, 1867–2010. Publius: The Journal of Federalism, 49(1), 57–83. doi:10.1093/publius/ pjx046 Maioni, A. (1998). Parting at the crossroads: The emergence of health insurance in the United States and Canada. Princeton, NJ: Princeton University Press. Marchildon, G. P. (2018). Health care in Canada: Interdependence and independence. In G. P. Marchildon & T. J. Bossert (Eds.), Federalism and decentralization in health care. Toronto, ON: University of Toronto Press. Marchildon, G. P., & Bleyer, P. (2020, August 4). Federalism done right in a post-COVID-19 Canada. Policy Options. Retrieved from https:// policyoptions.irpp.org/magazines/august-2020/federalism-done-right-in-apost-covid-19-canada/ McIntosh, T. (2004). Intergovernmental relations, social policy and federal transfers after Romanow. Canadian Public Administration, 47(1), 27–51. doi:10.1111/j.1754-7121.2004.tb01969.x Migone, A. R. (2020). Trust, but customize: federalism’s impact on the Canadian COVID-19 response. Policy and Society, 39(3), 382–402. doi: 10.1080/14494035.2020.1783788 ¨ A. (2020, May 4). COVID-19 et tensions intergouvernementales. Noel, Policy Options. Retrieved from https://policyoptions.irpp.org/magazines/ may-2020/covid-19-et-tensions-intergouvernementaleschronique-dalainnoel/ OCDE. (2020). Cities policy responses. Retrieved from http://www.oecd.org/ coronavirus/policy-responses/cities-policy-responses-fd1053ff/ Pan-Canadian Public Health Network. (2020). About the Pan-Canadian Public Health Network. Retrieved from http://www.phn-rsp.ca/sac-covidccs/index-eng.php

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Catarina Ianni Segatto et al.

Paquet, M., & Schertzer, R. (2020). COVID-19 as a complex intergovernmental problem. Canadian Journal of Political Science, 53, 343–347. doi:10.1017/S000842392000028 Requejo, F. (2010). Federalism and democracy: The case of minority nations–A federalist deficit. In M. Burgess & A. Gagnon (Eds.), Federal democracies (pp. 275–298). London and New York, NY: Routledge. Stall, N. M., Jones, A., Brown, K. A., Rochon, P. A., & Costa, A. P. (2020). For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths. Canadian Medical Association Journal, 192(33), E946–E955. doi:10.1503/cmaj.201197 Studdert, D. M., Hall, M. A., & Mello, M. M. (2020). Partitioning the curve – Interstate travel restrictions during the COVID-19 pandemic. New England Journal of Medicine. doi:10.1056/NEJMp2024274. Retrieved from https:// www.nejm.org/doi/full/10.1056/NEJMp2024274 Tuohy, C. (1994). Health policy and fiscal federalism. In K. G. Banting, D. M. Brown, & T. J. Courchene (Orgs.), The future of fiscal federalism (pp. 189–212). Kingston, ON: Queen’s University. Watts, R. L. (2006). Origins of cooperative and competitive federalism. In S. L. Greer (Ed.), Territory, democracy and justice: Regionalism and federalism in Western democracies (pp. 201–223). New York, NY: Palgrave MacMillan. Webster, P. (2021). COVID-19 highlights Canada’s care home crisis. The Lancet, 397(10270), 183. doi:10.1016/S0140-6736(21)00083-0 Wherry, A. (2021, January 27). Canadian politicians struggle to come to grips with the global vaccine race. CBC News. Retrieved from https:// www.cbc.ca/news/politics/federal-leaders-vaccine-supply-struggles1.5890339

6 MEXICAN FEDERALISM IN THE PANDEMIC ´ Edgar E. Ram´ırez de la Cruz and D. Pavel Gomez Granados

ABSTRACT The response of governments to the health crisis caused by COVID-19 has been different in each country. This chapter analyzes the reaction that the Mexican government had to the health crisis. At first, the context in which the pandemic occurs is described, characterized by high social and political polarization, a process of centralization of authority, a precarious health sector with limited institutional capacities, and government communication characterized by ambiguous and confusing messages. Subsequently, we discuss the tensions and limitations of state autonomy and the coordination mechanisms, such as the National Health Council. We also present the policies portfolio developed and implemented to address the health crisis, like the national healthy distance program, hospital reconversion, and the national vaccination program. Finally, we identify a series of challenges and learnings offered by the Mexican case to improve health crisis management in the future. Keywords: Emergency management; health policy; institutional capacities; coordination; federalism; government; policies portfolio; COVID-19; centralization

INTRODUCTION Statistics on infections, hospitalization, and deaths from COVID-19 in Mexico reflect long-standing deficiencies in health care and the inadequate management of the epidemic in Mexico. Twelve months after the first case

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detected, Mexico ranks third worldwide in confirmed deaths from COVID19 (more than 220,000 official deaths). Even more telling is that some studies estimate that the number of deaths is twice as high as the result of mismanagement of the emergency (IHME, 2020). Various media, civil society organizations, companies, academics, and international organizations have offered critical accounts of the management of the health emergency. The criticisms have focused primarily on the communication strategy, the state of the health system, and the decision-making process (Cos´ıo, 2020; UN Mexico, 2020). Like other countries in the American continent, Mexico had more time to prepare to face the pandemic than other areas of the world that experienced early surges. Despite the time to prepare, the national health system conditions exhibited critical deficiencies that greatly limited the response to the pandemic. These shortcomings are evidenced in several ways. Prior to the start of the pandemic there was an installed hospital capacity of approximately 4,718 hospitalization units of the second and third level of specialization, of which 38% are public. These units are distributed across the federal, state, and municipal levels of government (with most in the hands of the national health services (IMSS and ISSSTE). The OECD (2020) identified a deficit of hospital beds in Mexico with 1.4 registered hospital beds for every 1,000 inhabitants, a figure below the average for Latin America (2.1). The OECD recommended 4.7 hospital beds per 1,000 inhabitants. Even more critical for dealing with the pandemic, there is a shortage of beds in intensive care units (ICUs) (3.3 per 100,000 inhabitants), doctors (3.4 per 1,000 inhabitants), and nurses (2.9 per 1,000 inhabitants), all of which are below the Latin American average. The geographic distribution of population and economic inequality exacerbate these deficiencies. Geographical inequality is reflected in hospital capacity, which is concentrated in the country’s main cities. Half of the hospital capacity (52%) is concentrated in two states, the State of Mexico and Jalisco. Likewise, highly specialized hospitals are mostly concentrated in Mexico City (33%). Other states have limited capacity. Five entities: Morelos, Colima, Aguascalientes, Quer´etaro, and Tlaxcala have only 5% of the total number of hospitals (Campos & Balam, 2020). Other problems follow from the limited capacity of infrastructure and personnel. Among the deficiencies are the limited supply of medicines, insufficient protective equipment for medical personnel, lack of payments for residents and staff eventually, and inadequate training on the pandemic. These shortcomings dated from before the pandemic’s start but increased

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greatly during the pandemic generating protests designed to call attention to and demand that these shortcomings be addressed. Medical personnel and relatives of cancer and HIV patients – to mention a few – who require prolonged treatment engaged in protests that closed streets and avenues and organized strikes in public hospitals requesting the intervention of health authorities. However, medical workers and other protesters were attacked by the same authorities, accusing the directors of the hospitals, union leaders, and sometimes even the doctors themselves of corruption. This polarization pushed people with a disease that needs treatment to seek protection by legal means, seeking judicial recognition of their right to health and to guarantee the supply of medicines. Also, medical doctors had to take civil legal actions against the government to receive adequate protective equipment to care for patients with COVID. As a result, federal authorities dismissed a few hospitals’ directors after demonstrating against austerity measures and trying to defend medical personnel. The constant polarization that the country has experienced over the course of the pandemic has increased the complexity of coordinated actions and limited the capacity to respond to the pandemic. The executive branch, the legislators of the president’s party, and other allies constitute a majority in Congress. This group built a public discourse to claim they fight “neoliberalism and corruption,” using “austerity and moral authority” as a flag to modify laws, budgets, public agencies, and programs. This group also labels as conservatives other political rivals such as Constitutionally Autonomous Organizations (OCA), legislators from other parties, state and municipal levels of government, civil society organizations, private companies, media, and intellectuals. If controlling the pandemic depends on well-coordinated efforts between various functional and territorial authorities (Moon, 2020), then the polarized structure and functioning of the federal system can explain in part the failures to adequately respond to the health-care emergency. The institutional arrangement of Mexican federalism concentrates on the federal government functions for conducting national policy but decentralizes the operations to states. The federal structure provides substantial autonomy to states for designing and managing their health system and includes appropriate mechanisms for coordination in a national health system. However, the federal government’s leadership shares essential responsibility for implementing the institutional arrangement; moreover, it centralizes crucial decisions for the health strategy. These centralization efforts fuel political feuds

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between authorities from different parties, reducing the effectiveness of policy instruments and the mechanisms of collaboration necessary to control the pandemic.

THE STRUCTURE OF MEXICAN FEDERALISM ´ President Lopez Obrador upon taking office in December 2018 reconfigured intergovernmental relations and Mexican federalism. These modifications advanced rapidly, accompanied by legal changes that have reduced the autonomy of subnational governments and limited their functions and coordination with the federal government. Given this strategy, functions such as public security were centralized under the army’s control by creating the National Guard as a national police force. The National Guard established some limited coordination with state governments through workgroups. In public education, control of teachers has returned to the federation, removing monetary transfers from state governments to pay teachers’ payroll. Thus, the Ministry of Public Education resumed control of the payroll of basic education teachers and began a process to eliminate teachers’ evaluations. In matters of social policy, the former delegations of federal secretaries were consolidated in each state, creating “super delegates” who would concentrate the implementation of all federal social programs in the states and would serve as intermediaries between municipalities, states, and the national government. This new form of intergovernmental relations would soon generate disagreement and rejection by the governors and mayors, who stated that they would not negotiate with intermediaries. One of the most relevant changes during the pandemic relates to public health. The modifications completely transformed intergovernmental relations in this sector. They eliminated the “popular insurance” program, which targeted people who did not have social security coverage, offering medical attention in public hospitals. Also, the federal government slowed the purchase of drugs with pharmaceutical companies, alleging corrupt purchasing deals by previous administrations, generating a shortage of medicines in public hospitals. As a measure of austerity and efficiency, the purchases of treatments for the public sector were consolidated, conditioning health spending for state governments and causing paralysis in this sector, which increased with the pandemic. Looking for a new way of acquiring medicines, the national government signed an agreement with the United Nations Office for Project

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Services (UNOPS) to buy drugs abroad, which increased the cost and delayed the delivery of medicines in public hospitals. Through the National Health System (NHS), the institutional framework places the federal government in control of the governance of health policy. This includes strategic planning of the health sector, the definition of priorities, intersectoral coordination, and health-care regulatory activities. Health-care regulations are mandated to be developed in collaboration with various professional bodies and institutions of civil society. The same legal structure requires states to implement all the same functions within their jurisdictions. States have to organize, operate, supervise, and evaluate the provision of health services. States and the federal government coordinate through case-bycase agreements, material, and human and financial resources necessary for the operation of the NHS. Although Mexican federalism clearly defines the role of each of the levels of government, specific gaps in the institutional framework allow the federal government to avoid taking immediately unpopular measures. Given the lack of clarity about the measures to be taken to control the novel coronavirus, the federal government avoided any checks and balances in decision-making that would force it to take actions such as the complete shutdown of the economy. These decisions weakened the federal system’s highest coordinating body for health policy: the General Health Council (GHC).

STATES’ AUTONOMY AND LIMITED COORDINATION The GHC was established as a coordinating body for programming, budgeting, and evaluating public health policies in 1986. It is a collegiate body that depends directly on the President of Mexico. It operates as a health authority, with normative, advisory, and executive functions across the country. During the COVID-19 epidemic, the medical and scientific community urgently demanded that the GHC analyze the situation and establish the necessary sanitary measures to prevent possible effects. Former health officials, deputies and opposition senators, academics, retired ministers, and specialists emphasized the urgency of convening experts to discuss policy alternatives to deal with this sanitary emergency. The Mexican president downplayed the seriousness of the pandemic and until March 19, almost three weeks after the first confirmed case in the country to hold the first extraordinary session. Under intense social pressure, the council had to acknowledge the severity of the situation and announced that it

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would issue preparation, prevention, and control measures for the COVID-19 epidemic. In that meeting, an ad hoc committee (Health Security National Committee, HSNC) chaired by the Undersecretary of Prevention and Health ´ Promotion (SPSS), Hugo Lopez-Gatell Ram´ırez, and representatives of various federal agencies and secretaries presented a series of guidelines for the federal response to the emergency. The intervention of HSNC in GHC decisions created controversy over the legality of the established measures (Coss´ıo, 2020). States objected to their exclusion from the decision-making process and denounced concentration of all information and decisions with the Ministry of Health and the Committee’s lack of transparency and validation of decisions already made (Coss´ıo, 2020). Despite not being part of the GHC, the guidelines generated by HSNC were adopted as general measures to address the epidemic and published in the official federation gazette on March 20, 2020. HSNC delegated authority to the Health Secretary, with decision power in the emergency concentrated in the office of the Undersecretary of Health. The fact that the President appoints the majority of members of the GHC facilitated this concentration of decision-making power with the Undersecretary. This generated strong reactions from various governors who demanded more information, resources, technical support, and decentralization of decisions. For instance, the governors’ central claim was that, although the NHS establishes coordination with the federal entities, in practice, health decisions in the country were centralized. While states retain autonomy to implement their health systems, only a few can adequately fund them. Most do not have sufficient resources to maintain the provision of services. Thus, states are highly dependent on federal transfers given their low revenue collection. On average, 80% of states’ resources come from the fiscal coordination agreement with the federal government. Moreover, states do not take advantage of their taxation powers given the 18 taxes they can collect. This limited fiscal autonomy requires states to coordinate with the federal government for health services provision from a dependent position. The health system provides care mainly based on employment status. Various systems of public hospitals serve formal workers and their families, such as the Mexican Social Security Institute (IMSS), State Workers Social Security Institute (ISSSTE), Mexican Petroleum (PEMEX), as well as systems for states’ public employees. Until 2018, people in the informal sector or without a job were served by the private sector or two large federal welfare programs, Popular Insurance Federal Program (PIFP) (49.9% of the population), or IMSS opportunities 2019. This health system established coordination for

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providing health services through counterreferrals and the transference from federal resources. The new federal administration started a health sector reform by establishing universal and progressive free medical care and medicines. However, the federal government established intermediate structures between the federation and states that concentrate all the welfare programs’ operations, including health programs. Opposition governors and legislators s denounced this new bureaucratic program as a violation of the federal pact because it established new units called “Delegations of Development Programs.” These programs would be in charge of coordinating actions between state and municipal authorities and the federal government. These changes further fragmented Mexico’s health system, obstructing direct dialogue between states and the federal government. To replace the PIFP, the federal government created the Institute of Health for Wellbeing (INSABI), a new public health insurance program. However, the new program mandated federal control of the state health systems in exchange for financial support. The implementation of INSABI “forced” different state governments to sign coordination agreements where they entirely or partially cede the facilities and operation of the health services. This concentration is not exclusive to the health strategy. The federal government presented centralization as a mechanism to solve the corruption problem that has plagued the country for decades. The federal government claims that centralization can reduce corruption and increase efficiency by consolidating medical supplies and medicine purchases. States lost autonomy to purchase medicines and medical supplies with resources from the Contribution Fund for Health Services (FASSA). Through coordination agreements, the federal government took control of purchasing drugs through consolidating procurement in the Ministry of Finance and Public Credit (SHCP). Twenty-two out of the 32 states participated in this purchasing system in 2019. However, problems with these purchases arose. In 2019, 62% of the 3,090 products requested by the Ministry of Health were not purchased, generating a shortage of medical supplies. The consolidations did not foresee the necessary resources to cover the cost of distributing medical supplies, contributing to the shortage of products (Ram´ırez, 2019). Given the shortage of medicines and the federal government’s consolidated purchasing policy, by 2020, only the 27 states that adhered to INSABI could access these medicines. The federal government also centralized drug distribution through the parastatal Biological and Reagent Laboratories of Mexico (Birmex). Today, only five states, Jalisco, Aguascalientes, Tamaulipas, Chihuahua, and Guanajuato, purchase their own medical supplies and medicines.

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POLITICAL AGENCY OF ACTIONS AND COMMUNICATIONS The role of political agency in recent years has privileged conflict over coordination, and led to a permanent politicization of government actions. In this sense, it has focused on pursuing the president’s political objectives under the rhetoric of a fourth transformation, coordination with other levels of government was disregarded and decisions to address public problems were made unilaterally, not only on a national scale, but sometimes also on a state scale. These conditions increased significantly during the health crises as evident in opportunistic and coercive behaviors in managing the crisis, and in the various legal modifications undertaken during this period. The centralization design and management decisions in the health crisis increased IGR’s tensions. Two examples of centralization through mandatory guidelines are the “National Healthy Distance” and the “Epidemiological Traffic Light” programs. Limited economic support offered by the federal government to state and municipal governments to support the inhabitants of their territories has also characterized this regime’s response to the pandemic. It denied all financial support for these levels of government and rejected the credit requested by states like Jalisco. Another characteristic is the disappearance of the “Popular Insurance” program, which served the population that did not have social security. This program was an axis of coordination between the federation and the state health institutes that served the beneficiary population. The pattern of politicization is also present in government communications. The World Health Organization (WHO) has identified mixed messages from leaders, which undermined trust – the most critical ingredient in any response – as one of the failures in handling the pandemic (UN Mexico, 2020). Since the beginning of the pandemic, the government released repeated statements playing down the pandemic, reflecting a lack of knowledge about the virus and its effects. The President repeatedly dismissed the seriousness of the virus in his “morning conferences” with phrases like “the virus is not so harmful,” “it is not something fatal, not even equivalent to influenza,” and even offering the use of religious stamps as protection from the virus (Badillo, 2020). Also, subnational authorities such as the governor of Puebla claimed that COVID-19 only attacked rich people and that poor people had immunity ´ (Avila, 2020). Other federal officials promoted the consumption of “drops of citrus nanoparticles” as a preventive measure against COVID-19 (Aguirre, 2020). Federal health authorities offered daily press conference communicating recommended actions in response to the crisis. At this conference,

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recommendations are given to the general population. However, some of the measures established as general guidelines such as social distancing, the use of face masks, hand washing, confinement, use of antibacterial gel, among others, were contradicted by government authorities. At the beginning of the epidemic, the politicized health authorities rejected using a mask in a generalized way claiming “there is no scientific evidence that it reduces contagion.” Social distancing and confinement measures have been controversial. At the beginning, the national government established healthy distance for two months, limiting nonessential activities and the movement of people on public roads to reduce the transmission of the virus. This measure advocated by the health authorities were soon contradicted by the president. On one hand, health authorities asked people to establish distance and avoid contact. On the other hand, the president called to embrace other people, saying that nothing was happening. Public events were canceled, and meetings were restricted with a limited number of people, but in the case of the federal government, the president continued to make work tours to inaugurate public infrastructure and to hold press conferences with a large number of people. In this regard, the health authorities justified the activities by stating that “the President’s strength is moral. It is not a contagious force” (Morales, 2020), so he could continue his regular activities. During the first months, President Lopez Obrador communicated several unrealistic claims of “flattening of the curve,”“the pandemic had been tamed,” and “we are already coming out of the worst part.” However, infections continued to increase, inundating hospitals. The continuous adjustments, justifications, and validation of the models generated uncertainty and a poor prediction of the epidemic. Also, the prediction errors on the epidemiological curve first predicted the highest number of infections in May and later in August, leading to criticisms and dismissal of the epidemiological model and its predictions. This situation left people in a position of great uncertainty as to the reality of the epidemic. One of the greatest failures of communication has been in the consistency and veracity of the president’s statements. These statements dismissed the use of a mask as a protection measure in contradiction of guidance of former officials with experience in the influenza epidemic, public health experts and virologists, academics, civil society organizations, doctors, the media, and anyone who demonstrates against the measures taken by the government. With the daily presentations reporting on the state of the epidemic, the SPSS soon came into conflict with the media, analysts, academics, state and

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municipal officials, and legislators who offered evidence of the mismanagement of the pandemic. On several occasions, various studies that presented information on the government’s failures to face the pandemic were dismissed without offering any evidence to refute the studies. Finally, the recurring message of progress to address the epidemic and the preparation of health services generated great unrest in various sectors. There have been frequent confrontations between the government and independent experts about the deficiencies of the national health system and a lack of empathy and support for sick people, small businesses, and health sector personnel. Regarding business support, the government’s refusal to provide temporary universal income proposed by NGOs generated critisism.

POLICY PORTFOLIOS AND THE LIMITS OF POLICY INSTRUMENTS Federalism in Mexico establishes an institutional design for policy collaboration between the different levels of government. In recent years, the policy portfolios and their structures have undergone significant changes not only in their design but also in their implementation. These modifications were enacted prior to the start of pandemic and had not yet consolidated. The result has been the generation of outcome much different than what was intended. However, the portfolio of policies to respond to the pandemic has been highly centralized, undermining collaboration by state and municipal governments in its design and execution. Some governors responded to this centralization and exclusion by establishing a federalist alliance to counteract that proved ineffectual. Despite the concentrated locus of policy decisions, a few states with more robust institutional, administrative, and technical capacities formulated their own local policies. However, few states have these capacities, limiting their actions and creating dependence on the portfolio of federal policies to address COVID 19. Subnational governments dependence on federal aid is high makes them vulnerable to opportunistic federal actions and politically motivated decisions on support for state needs. In this sense, the federal government has focused the attention of the pandemic on four central policies, the national healthy distance program, hospital reconversion, National Vaccination Policy against the SARS-CoV-2 virus for the prevention of COVID-19, and the learn at home program. Each of these programs is discussed in turn.

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The Healthy Distance National Program (HDNP) The HDNP which was implemented between March 23 and May 30 in 2020, constituted the main instrument to contain the epidemic in Mexico. The program restricted work, social, and educational activities, and promoted social distancing to reduce the spread of infections. At the end of this period, the Federal Health Secretary developed a monitoring system (known as "the epidemiological traffic-light") to identify the level of epidemiological risk in every state. With this instrument, the federal government transferred the responsibility of managing the epidemic to the local level. Initially, the results of the traffic light system were to be mandatory for all states. The limited legitimacy of GHC, lack of transparency of methodologies used, and pressure from the governors led to a shift from mandatory to voluntary application. The Ministry of Health established four levels of risk and set a graduated opening of work, educational, and social activities. The traffic light system has been fed daily by two information systems that use data provided by states through their health systems. However, from the beginning, seven states rejected the adoption of the system, questioning how the epidemiological traffic light was created and pointing out inconsistencies in the data presented. For example, municipalities challenged the methodology to determine the so-called "municipalities of hope" as COVID-free spaces by the federal government. These municipalities could resume their activities before ending the social distancing period without any control. Jalisco was the most representative case of this rejection since the state undertook alliances with universities and experts that generated alternative epidemiological models and specific measures to address the epidemic in its territory. States provided diverse responses to these controversies and to demands from businesses and society. For example, Aguascalientes was the first state to reject the traffic light system and reopen its industry. The lack of coordination and attempts to centralize the decision-making process eventually led a group of governors to build a federalist alliance to work together. They worked on basic issues such as epidemic management, renew the fiscal pact, and request the resignation of the undersecretary responsible for the strategy of containment of the COVID epidemic.

Hospital Conversion With the increase in positive cases across the country, hospitals soon began to exceed capacity due to the high demand for hospitalization required by people

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with severe illness from the virus. Public hospitals were overwhelmed, mainly in urban areas, between June to September 2020 and November to February 2021. Faced with this scenario, the federal government reconverted public hospitals at the national level, establishing specific guidelines. The government reconverted hospitals in three stages. The first stage installed capacity for ICUs such as functional ventilators and oxygen. In this stage, the government suspended outpatient consultation and scheduled surgeries, reassigning the personnel and spaces for attending to COVID patients. The second stage relocated critical patients from other services to other hospitalization areas to use free up beds for COVID patients. The third stage focused on allocating spaces from non-public hospitals for the care of COVID patients. Hospital reconversion had positive results because as hospitalizations increased, beds were available to all people who needed care. The highest number of infections has concentrated in Mexico City. Hospital reconversion allowed the installed capacity to grow by 38% in this city, from 5,492 beds to 7,570 by January 2021 (SEDESA, 2021). The increase resulted from the collaboration of federal and local health secretariat, Mexican Social Security Institute (IMSS), State Workers Social Security Institute (ISSSTE), the military and navy hospitals, the National Institutes of Health and High Specialty Hospitals (CCINSHAE), and Mexican Petroleum (PEMEX). Private companies, supported by public universities in their operation and directed by the local health secretary, contributed with two temporary hospitals. Finally, private hospitals joined the effort by signing an agreement with the federal government to treat non-covid related patients whom public hospitals would serve in normal conditions. Despite the considerable increase in hospital beds, some complications remained, such as lack of ambulances, lack of training in treatment of respiratory illness, delayed COVID test results, and the dissemination of false information through electronic means and social networks.

National Vaccination Policy against the SARS-CoV-2 Virus for the Prevention of COVID-19 in Mexico With the development of new vaccines, the Mexican government designed a national vaccination policy that included the approval, purchase, and emergency use of Pfizer-BioNTech (December 2020) and Oxford-AstraZeneca vaccines (January 2021). Likewise, they would join the COVAX mechanism promoted by WHO to have equitable access to vaccines. Later, Sinovac and Sputnik V (February 2021), and CanSino (March 2021) were also approved and used.

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The design of this policy was marked by complaints about a lack of transparency, centralization, creation of committees of experts without recognition, and lack of coordination with other sectors. Taking these considerations into account, the federal government, through the health secretariat, spearheaded the design of the vaccination policy. The conditions generated by the pandemic demonstrated the need to establish soft actions to create effective coordination and find creative alternatives to face the challenges of this health crisis. However, the federal government decided to omit coordination and collaboration of other actors, giving new assignments to federal officials, increasing the complexity of government actions. For instance, the secretary of foreign relations was tasked with a new role leasing eefforts to search for and negotiation for the acquisition of vaccines. Following the recommendations of the WHO, the federal government created the COVID-19 Vaccine Technical Advisory Group to advise on the purchase of vaccines. The committee included six permanent members of the Advisory Group installed in 2019 and 11 members representing various government agencies. Also, included were public health institutes, national and foreign universities, advised by Panamerican Health Organization at the ´ Covid, national and regional level (Grupo T´ecnico Asesor de Vacunacion 2021). This group analyzed the information available on the prioritization criteria for the allocation of vaccines. The group recommended their use first for health personnel, second for people aged 60 years and over, and third for the population group between 50 and 59 years, and finally to the rest of the population. With this information, the federal government established the National Vaccination Policy against the SARS-CoV-2 virus to prevent COVID-19 in Mexico. There were three versions of the policy as it changed over time. The Secretary of Health, and specifically the SPSS, established additional criteria for applying vaccines. These criteria continued to generate polarization. First, the new measures differentiated between the medical personnel of public and private hospitals, applying the vaccine only to physicians from public hospitals. Second, territorial segmentation offered the vaccine to rural municipalities with fewer infections and deaths, than urban areas not getting access. Various groups questioned these decisions and they generated significant discomfort in the general population. Following the guidelines provided by Covid Vaccination Technical Advisory Group, the vaccination strategy included five stages for the vaccination of the population. The first stage was for health personnel on the first line of epidemic control (between December 2020 and February 2021); the second

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stage was for the remaining health personnel and people aged 60 years and older (February to April 2021); the third stage was for people from 50 to 59 (April to May 2021); the fourth stage was for people between 40 and 49 (May to June 2021); and the fifth stage was for the rest of the population (June 2021 to March 2022). However, this schedule would soon be modified due to constant logistics failures. The government created the “roadrunners” cells, which included 12 members belonging to the health sector, the Secretary of National Defense, Navy, and “servants of the nation” of the Secretary of Welfare. The armed forces played an important role by transporting and protecting vaccines. However, the “roadrunners” had limited coordination with state or municipal governments at first. The federal government centralized the strategy and application of the vaccine and rejected the collaboration with other levels of government. The first stage of vaccination for health personnel was deficient due to outdated medical records, which facilitated some managers to vaccinate family members. The second stage of vaccination was more complicated simply because of the larger number of people to be vaccinated: an estimated 14.4 million older adults. The federal government opened an electronic registry to facilitate the process, but it quickly collapsed due to excess demand. The problems persisted for extended periods because the personnel of the federal government brigades lacked familiarity with local territories. Issues such as wrong addresses, restricted access, lack of infrastructure, and inadequate numbers of personnel to attend to people were recurring errors. Once the federal government recognized its limitations, it finally collaborated with state and municipal governments to improve the vaccination process. Thus, state governments took care of the logistics for vaccinations, increased the number of personnel for vaccination, and provided support personnel to offer information and help to older adults with limited mobility. In cases, such as Mexico City, state government enabled an additional electronic record, telephone number, and SMS messages to confirm vaccination appointments. In extreme cases, local authorities provided brigades to visit and vaccinate people who could not leave their homes. Finally, local governments collaborated by offering spaces and sometimes furniture to make vaccination more accessible and the process more fluid. Although the vaccination is continuing in summer 2021, progress depends on additional vaccines arriving to increase coverage. Moreover, the problems with the additional criteria established continue. For instance, there have been various protests and civil lawsuits by public and private doctors who have not received vaccinations because they do not belong to the first line and have had to resort to judicial protection to get vaccinated.

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Learn at Home Program The pandemic prevention and containment measures have generated a different dynamic not only in the work of the people but also in the dynamics of the students who have had to participate in distance learning. The pandemic situation challenged the Ministry of Public Education (SEP) at all school levels to quickly develop content and guidelines to continue with the 2020 school year. The “learn at home” program offers content through national open television channels and the Internet. It is complemented with free textbooks and sometimes by advice from the teachers at each school. Given the lack of capacities to create and disseminate specialized content internally, the SEP established an agreement with four television stations to transmit educational content; and a deal with Google Education to implement a massive training of teachers. SEP also created guidelines and trained teachers at each school level. The results of the program are not encouraging. A survey on the Impact of COVID-19 on Education (INEGI, 2021) assessed the impact of the pandemic on education with alarming results. Around 5.2 million students did not enroll in the following school year. Preschool and secondary levels were the most affected. Moreover, the primary media used were smartphones (65%), followed by laptops (18%) and desktops (7%), and in the last places, television (5%) and electronic tablets (3%). In terms of the actual learning experience, the survey indicates that students learned far less than in person. There was also a lack of monitoring of students’ learning, lack of technical capacity or the pedagogical ability of parents or tutors to transmit knowledge, excess academic load and school activities (19%), inadequate conditions at home, and lack of socialization with friends and colleagues. Despite the critical efforts to respond to the different aspects of the pandemic, these efforts have not mitigated most of its impacts. Over time, disadvantaged sectors have increasingly lagged behind, increasing the already large inequality gaps.

Limited Use of Instruments to Stop the Economic Decline OECD recommended that interventions be focused on mitigation and containment, the economy, and health (Ben´ıtez et al., 2020) and be developed based on the administrative capacities of the health systems, coordination capacity between levels of government, and capabilities to assess risk and

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´ vulnerability (Gonzalez-Bustamante, 2021). Various governments have designed instruments to face the health crisis under constrains of budget restrictions, little information, limited capacity of health systems, and uncertainty. The Mexican responses created to address the pandemic ignored essential aspects, such as coordination capacities at different levels of government and the assessment of risk and vulnerability. To a large extent, the national government centralized decisions in the federal health secretariat, assuming all responsibility and initially excluding state and municipal governments. Their central containment and mitigation strategy was the National Healthy Distance Program. In terms of risk and vulnerability assessment, the estimates of the federal health ministry predicted three scenarios from the beginning. The first scenario with the importation of cases and second-generation transmission estimated “dozens of cases”; the second scenario with community dispersal estimated “hundreds of cases”; and the third scenario, called “catastrophic”, considered as an epidemic with regional outbreaks and possible national dispersion with thousands of cases. Each scenario estimated the number of deaths where the minimum was 6,000, and the catastrophic scenario could reach 60,000 (Cullell, 2020). However, this forecast was soon surpassed, demonstrating management failure and that the epidemic was out of control. In terms of the economy, support for companies was weak. The federal government gave few and small loans to support family microbusinesses and self-employed workers. Likewise, the federal government denied extensions and tax waivers, that were commonly granted in other countries. The results were devastating. The drop in the Gross Domestic Product (GDP) was 8.5% in 2020, according to the study on Business Demography by the National Institute of Statistics and Geography (INEGI). The crisis also produced an estimated 1.1 million establishment closings, mainly affecting private nonfinancial services (24.9%), commerce (18.9%), and manufacturing (15%). The Bank of Mexico estimated a loss of 12.46 million jobs for April–May 2020, where informal employment was the most affected (10.38 million) and formal employment to a lesser extent (2.08 million). In summary, the government’s focus on the Healthy Distance National Program combined with limited support to small and medium-sized businesses severely impacted the economy.

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SOME LESSONS FROM THE MEXICAN CASE This examination of the Mexican federal systems response to the pandemic provides new insights into how fragmentation and local autonomy operate as a safeguard, the importance of administrative capacity across levels of government. It also points to important challenges for federalism in Mexico once the pandemic is over. The pandemic’s novelty allowed the federal government to disseminate ambiguous messages to citizens such as messages about the importance of wearing masks and to avoid taking unpopular measures such as a complete shutdown of the economy. In this context, jurisdictional fragmentation allowed state governments not to act as agents of the federal government and tempered more substantial adverse effects. Although the uncoordinated and heterogeneous response provided poor results, a strong argument can be made that states’ and municipalities’ relative autonomy allowed them to restrict economic activities and promote social distancing long before the national government. In the absence of a firm and appropriate response from the federal government, some states and municipalities achieved relative control of the pandemic. However, those states that best confronted the pandemic so far are those with the most significant resources and capabilities. With less developed bureaucracies and fewer capacities, the most impoverished states continue to be led by the federal government and have paid the pandemic’s highest social cost. An important lesson from the government’s reaction to the pandemic is that there is an urgent need to develop a professional bureaucracy isolated from political pressures. Like any form of government, a well-functioning federal system requires the presence of administratively and technically capable professionals who are isolated from political pressures. The health system had been characterized by professional administrators, making it a relatively successful case of decentralization in the 1990s (Rowland & Ram´ırez, 2001). Despite the existence of administrators with a high degree of experience, the institutional framework’s relative weakness has allowed the adoption and execution of a strategy with an evident lack of coordination between actors. Thanks to its resources, the federal government has excluded critical voices from relevant actors. The policy portfolio during the health crisis showed significant weakness in two aspects. The first relates to the low or null coordination of the federal government with state and municipal governments, not only in design but also

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in implementation. In some cases, such as the National Vaccination Policy against the SARS-CoV-2 for the prevention of COVID-19, the federal government implemented policies with federal personnel avoiding coordination with other levels of government. This lack of coordination highlights institutional fragmentation that increases transaction costs and continuously produces policy due to the central authorities’ ignorance of local situations, territories, and populations. A second aspect is the limited administrative and technical capacity to design and implement a portfolio of policies for managing the health crisis. The institutional fragmentation of the health sector in Mexico magnifies the capacity gaps between state governments. On the one hand, state governments with more significant resources and cities such as Mexico City, Monterrey, Guadalajara, and Quer´etaro had a more significant portfolio of policies to complement federal policies, generating specific strategies to address local problems. On the other hand, state governments with lower capacities, such as Tabasco, Chiapas, and Quintana Roo, had a greater dependence on federal policies. As the pandemic passes, relevant challenges are looming that the different levels of government will have to address and are associated with new routines generated by the health crisis. The first challenge for the government will be to address the significant inequalities that were exacerbated by the pandemic. In the case of Mexico, these gaps are observed in increased poverty, lack of adequate conditions in homes for teleworking and distance education, loss of employment, worsening of previous illnesses, and the consequences of COVID in patients without social security coverage. A second challenge to consider is the recovery of economic, labor, and social activities. What will happen to the people who do not have access to new health services in the health sector? How will it be integrated or not into the new postpandemic dynamics? A third challenge has to do with integrating learning about the pandemic into health-care management and governance. Lessons learned in various sectors must be documented for future health crises. Mexico’s recent experience in 2009, with the AH1N1 influenza epidemic, should have provided lessons for this new epidemic. However, the current response did not draw upon that experience or consider those lessons because relevant actors had left their positions and could not participate in decision-making policies this time, and their knowledge had not been institutionalized. Finally, the country’s dependence on innovation and technology highlights the government’s limited investments in science and technology. The weakening of science and technology in Mexico is evident and has

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accelerated with the anti-intellectualism of the current regime. Economic resources have decreased considerably, limiting research and technology development in the country. The innovation and technology capabilities showed their advancement in the response we had in the pandemic. This lack of support for research and development of medical equipment, information systems, and a vaccine is perhaps one of the most pressing issues for the country in a postpandemic world.

REFERENCES Aguirre, S. (2020). ¿Qu´e son las nanopart´ıculas de c´ıtricos que toma Olga ´ Sanchez Cordero? Animal Pol´ıtico. Retrieved from https:// www.animalpolitico.com/elsabueso/que-son-las-nanoparticulas-de-citricosque-toma-olga-sanchez-cordero/ ´ Avila, E. (2020). Los pobres estamos inmunes al coronavirus. El Universal. Retrieved from https://www.eluniversal.com.mx/estados/covid-19-lospobres-estamos-inmunes-al-coronavirus-dice-barbosa-gobernador-mexicano Badillo, D. (2020). AMLO y sus pol´emicas declaraciones sobre el coronavirus. El Economista. Retrieved from https:// www.eleconomista.com.mx/politica/AMLO-y-sus-polemicas-declaracionessobre-el-coronavirus-20200321-0001.html Ben´ıtez, M. A., Velasco, C., Sequeira, A. R., Henr´ıquez, J., Menezes, F. M., & Paolucci, F. (2020). Responses to COVID-19 in five Latin American countries. Health Policy and Technology, 9(4), 525–559. doi:10.1016/ j.hlpt.2020.08.014 Campos, M., & Balam, X. (2020). La infraestructura hospitalaria ante el Covid-19: Debilidad extrema. Nexo. Retrieved from https:// www.nexos.com.mx/?p547571 Coss´ıo, J. (2020). Acuerdos para la pandemia en M´exico. Hechos y Derechos, 1(56). Retrieved from https://revistas.juridicas.unam.mx/ index.php/hechos-y-derechos/article/view/14523/15635 ´ Cullell, J. (2020). M´exico supera el “escenario catastrofico” de las 60.000 muertes por COVID-19. El Pa´ıs. Retrieved from https://elpais.com/mexico/ 2020-08-23/mexico-supera-el-escenario-catastrofico-de-las-60000-muertespor-covid-19.html

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´ Gonzalez-Bustamante, B. (2021). Evolution and early government responses to COVID-19 in South America. World Development, 137, 105–180. doi: 10.1016/j.worlddev.2020.105180 ´ Covid. (2021). Priorizacion ´ inicial y Grupo T´ecnico Asesor de Vacunacion ´ contra SARS-CoV-2 en la poblacion ´ consecutiva para la vacunacion ´ mexicana. Recomendaciones preliminares. Salud publica de m´exico, 63(2), 286–307. doi:10.21149/12399 ´ del Impacto INEGI. (2021). Resultados de la Encuesta para la Medicion ´ (ECOVID-ED). Retrieved from https:// COVID-19 en la Educacion www.inegi.org.mx/contenidos/investigacion/ecovided/2020/doc/ ecovid_ed_2020_presentacion_resultados.pdf Institute for Health Metrics and Evaluation (IHME). (2020, August 20). COVID-19 Projections. Retrieved from https://covid19.healthdata.org/ mexico Moon, M. J. (2020). Fighting COVID-19 with agility, transparency, and participation: Wicked policy problems and new governance challenges. Public Administration Review, 80(4), 651–656. doi:10.1111/puar.13214 Morales, A. (2020). AMLO no es una fuerza de contagio. El Universal. Retrieved from https://www.eluniversal.com.mx/nacion/amlo-no-es-unafuerza-de-contagio OECD/The World Bank. (2020). Health at a glance: Latin America and the Caribbean 2020. Retrieved from https://www.oecd.org/health/health-at-aglance-latin-america-and-the-caribbean-2020-6089164f-en.htm ONU M´exico. (2020). Mensajes contradictorios de los lideres socavan la confianza, advierte la OMS – ONU M´exico | Enfermedad por el Coronavirus (COVID-19). Retrieved from https://coronavirus.onu.org.mx/mensajescontradictorios-de-los-lideres-socavan-la-confianza-advierte-la-oms Ram´ırez, M. (2019, July 2019). «Compra consolidada, mucho ruido y pocas nueces» El Economist. Retrieved from https://www.eleconomista.com.mx/ opinion/Compra-consolidada-mucho-ruido-y-pocas-nueces-201907010002.html ´ y los gobiernos Rowland, A., & Ram´ırez, E. (2001). La descentralizacion ´ CIDE, 93. subnacionales en M´exico: Una introduccion.

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SEDESA. (2021). Incrementan Gobierno Capitalino y Gobierno de M´exico capacidad hospitalaria en 38% en la ciudad. Secretar´ıa de Salud de la Ciudad de M´exico. Retrieved from https://covid19.cdmx.gob.mx/comunicacion/ nota/incrementan-gobierno-capitalino-y-gobierno-de-mexico-capacidadhospitalaria-en-38-en-la-ciudad

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7 CONCLUSIONS Eduardo Grin, B. Guy Peters, and Fernando Luiz Abrucio

GENERAL ISSUES ON THE FIVE FEDERATIONS By analyzing five American federations this book has discussed two questions: how have the institutional design and political agency of the presidents, governors, and mayors affected actions to combat the COVID-19 pandemic? Second and more specifically, what institutional and political factors within federal systems could be related to the success or failure of their attempts to face this crisis? For this purpose, the analytical model considered three issues related to the federal design (autonomy of subnational governments, mechanisms of coordination, and policy portfolio) and performance of political leadership (national presidents, governors, and mayors). The five federations are different taking into account the two ideal types: the dual and cooperative models. Dual federalism assumes that each entity has strict constitutional autonomy over different areas to prevent the centralization of power (Loughlin, Kincaid, & Sweden, 2013). Its premise is that subnational governments spend and collect tax more efficiently, are more accountable to their constituencies, and their public policies are more responsive to local particularities. Federal coordination would be contingent, circumstantial, and, ultimately, unnecessary, as it would be detrimental to efficient decision-making and resource allocation. In the cooperative model, shared authority combines subnational autonomy with national coordination. Its spread followed the Welfare State expansion after World War II (Obinger, Leibfried, & Castles, 2005). To ensure universal rights, federations combined centralized processes (such as

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financing, regulation, and incentive for subnational governments to implement national policies) with decentralized and autonomous implementation of public policies. Thus, the cooperative model does not oppose centralization and decentralization, but understands them as a combination and not as opposites (Broschek, Petersohn, & Toubeau, 2017). Considering that, the dual model is the reference for Canada and the United States even if there are differences between the countries. Canada is more decentralized (Elazar, 1987), since the provinces have larger autonomy and the federal government is less active in the intergovernmental context than in the American case. Brazil and Argentina have been implementing, over the years, a more cooperative federalism, albeit in different ways. In Brazil the federal design is more underpinned by constitutional rules defining responsibilities for each level of government, and the federal level has a larger coordinator role. In Argentina the provincial autonomy is confronted with power of the purse of federal government which still has a larger discretion to politically organize intergovernmental relations. Mexico is the most centralized federation, and over the last eight years has been increasing the recentralization of many responsibilities and fiscal powers at the national level, which have weakened the fragile channels for intergovernmental relations. When comparing these five cases it is obvious that federalist design affected the way in which each country coped with the pandemic. All countries have heterogeneous behaviors, and the complex intergovernmental problem (CIP) originated from the COVID-19 was distinctly addressed in each federal structure. Federalism matters, but in what way and with which effects to fight this CIP? How has the pandemic also affected the way the organization of these federations and intergovernmental relations (IGRs)? How has the pandemic accelerated some trends of federal dynamics that already were in motion before its outbreak? The cases addressed in this book clearly show how this mutual influence took place. In Canada, the so-called executive federalism based on horizontal cooperation of provincial premiers and on the pivotal role of the provinces in the provision and funding of public health policy were key characteristics of tackling the pandemic. In the United States, the responses by government were made individually, but they were also shaped in part by federalism, and the differing responsibilities and resources of the levels of government. At the same time blame-shifting characterized the Trump government. A fragile vertical or horizontal cooperation was higher than Canadian case. In Brazil, the constitutional basis of the federalism functioned as a safeguard to preserve subnational autonomy in a context in which the “conflict federalism” (Abrucio, Grin, Franzese, Couto, & Segatto, 2020) was the preferred route adopted by

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President Bolsonaro. The federal rules guaranteed conditions for what state and local governments could fight the pandemic with considerable autonomy. In Argentina, the weaker mechanisms for IGRs and their ad hoc characteristics, in addition to health policies being basically a provincial function, generated two effects: decreasing of horizontal cooperation among provinces and blame-shifting from the federal government. In Mexico, the federal government steers the national public health policy but decentralizes its operations to states. However, the federal government’s leadership shares essential responsibility for implementing the institutional arrangement. This federal design was responsible for concentrating much decisional power in the national sphere to deal with the pandemic. These general issues guide our final reflections on the five federations according to the theoretical model proposed. The chapters describe how the dual or cooperative approaches are useful to grasp each federal functioning and characteristics, even if they vary according to different political or constitutional aspects.

SUBNATIONAL AUTONOMY The levels of subnational autonomy are not fixed characteristics into federal dynamics since there can exist patterns of continuity and change (Benz & Broschek, 2013). Because of that, subnational autonomy can be preserved, increased, or even suffer different kinds of reduction through unilateralist actions from the national government (Schnabel, 2020). Based on the cases, it was possible to identify different situations of de jure and de facto subnational autonomy. At the formal level, the five American federations have constitutional rules defining the scope of subnational autonomy and authority. Constitutional autonomy is based on exclusive, common, or competitor responsibilities and powers among different levels of government. This design is a safeguard for preserving territorial distributional authority and federal robustness (Bednar, 2009) as well as in avoiding opportunistic behaviors by both national and subnational units. All countries analyzed in this book have norms recognizing this constitutional status of autonomy and the set of public policies for which each level of government is responsible. However, the pandemic revealed that these rules were confronted by national governments in different manners. In Mexico, Lopez Obrador’s government has been reshaping federalism through legal measures that have

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reduced subnational autonomy in public policies such as education and public security. The federalist institutional gaps have facilitated more unilateral stances to avoid or postpone the adoption of unpopular measures, such as the shutdown of the economy, without considering state’s opinions. In Argentina, the political federal dynamic featured three issues: (1) centralized decisions from national governments reducing fiscal transfers to Buenos Aires as well as to buy medical equipment to distribute to provinces and cities; (2) local governments surpassing their constitutional responsibilities (for example, seeking to reduce circulation of people) had to cancel measures; and (3) voluntary reduction of states and municipalities’ autonomy and the acceptance of national policies based on financial transfers. In Canada, the decentralized responses from the provinces, in line with their constitutional autonomy, were the main characteristic, which also was facilitated by the “executive federalism” model. Since provinces are less dependent on federal funding and national legislation, when compared to Argentina and Mexico, they were able to implement measures to fight the pandemic more rapidly and with more autonomy. Federalism in Canada works better as a safeguard to protect subnational autonomy from national encroachment (Bednar, 2009) or unilateralism. In the United States, states have considerable autonomy in taxing, spending, “police powers,” and may impose their own constraints on individual actions unless it violates federal law. During the pandemic, although the Trump government had declared that federal government was in control, states and larger cities exerted their constitutional autonomy and began to use their capacities to deal with the pandemic situation. Similar to the Canadian case, the political dynamics of federalism in the United States had a strong underpinning on the constitutional autonomy of state governments. In Brazil, subnational autonomy is inscribed in the Federal Constitution even if under the tenet of the federal symmetry: rules are similarly applied to all constituent units. The Bolsonaro government sought to overturn subnational autonomy to centralize measures to cope with the pandemic. The Supreme Court reasserted that states and municipalities have competing competencies with the national government to fight against COVID-19, especially in the absence of federal actions. As this has been the main situation since the beginning of the pandemic, states and municipalities have exerted their constitutional autonomy. Another relevant related issue is the real asymmetries of state capacity (Hanson & Sigman, 2020) among states and local governments which variedly affect the possibility to exert their de jure autonomy. The five cases showed how this is a not irrelevant when facing a CIP such as the pandemic. This

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situation was highlighted in the American and Brazilians cases (disparities of resources between urban and rural areas considering the number of physicians, hospitals, and beds, for instance). In Mexico, only a few states have enough financial capacity to fund their health systems without depending on federal transferences. In Argentina, provinces and municipalities implemented only tax support actions, such as the postponement of the collection of some provincial taxes and municipal fees, both from affected households and businesses, even in the context of the income collapse of governments. But this varied according to the greater or lesser economic capacity of municipalities. In the Canadian case it was not highlighted as a significant problem. In sum, the federal political dynamic was influenced by COVID-19 as a CIP as well as federalism design of de jure and de facto subnational autonomy. However, this process occurred in different ways in the five cases: preserving and reinforcing subnational autonomy (Canada), attempts for more frustrated unilateral decisions from the national government, the maintenance of subnational autonomy with less federal coordination (Brazil and the United States), recentralization of subnational competences (Mexico), and a mingle of subnational autonomy with resignation in favor of national policies and federal centralization (Argentina).

MECHANISMS OF INTERGOVERNMENTAL COORDINATION Perhaps this was the most challenging federal dimension facing all levels of government when coping with the pandemic. Basically, four approaches were implemented: uncoordinated federalism, centralization in federal government, territorial or sectoral vertical coordination mechanisms (Philipmore, 2013), and horizontal arrangements of intergovernmental relations. These three federal routes may evidence different or even competing trends of coercion, participation, or agreement (Hueglin & Fenna, 2015). But it is worth mentioning that in each country these approaches were used in different moments or depending on the kinds of activities. In federal systems IGR instruments are useful in defining incentives for more cooperative arrangements since each constituent unit enjoys some level of autonomy. This demand could be even more relevant to face problems with spillover effects such as COVID-19 that requires policy coordination (Hueglin & Fenna, 2015; Paquet & Schertzer, 2020). Certainly, the path and federal design matter as for the level of IGR formalization which could be organized under a more institutional or ad hoc basis (Bolleyer, 2009).

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In the United States “uncooperative federalism” (Bulman-Pozen & Gerken, 2009) was most striking than the other four cases both in vertical as well as horizontal mechanisms, which was reinforced by the absence of leadership from the national government. The federal design has few routes for intergovernmental cooperation since it is more oriented to guaranteeing the autonomy of action for states than to incentivizing coordination between them. These existing devices tend to be more hierarchical and led by the federal government or work in a bilateral and ad hoc manner, not mention political parties cleavages among state and federal government. The outbreak of the COVID-19 pandemic showed that responses to fighting it were made individually by the states. Uncoordinated federalism and the lack of federal government leadership were two aspects of how the United States dealt with the pandemic. Yet, this CIP would require collective and coordinated actions from all levels of government. In Canada, also a very decentralized federation, the role of horizontal cooperation and collaborative federalism in health care was pivotal to dealing with the pandemic. Regarding the federal government’s coordination, during the pandemic, compared to the provinces and the territories, the federal government played a more limited role in both health care and public health. This kind of cooperation in public health policy was influenced by the patterns of executive federalism and avoided competitive behaviors as it occurred in the United States despite being limited to certain actions and facing governance problems. Intergovernmental arenas, especially the Pan-Canadian Public Health Network (PHN), also played an essential role. But this collaborative process also faced problems of collective action since some provinces adopted more stringent public health measures than others whose effects weakened horizontal collaboration. However, the evidence that intergovernmental collaboration in fighting COVID-19 in its initial months is less forceful to change the political federal dynamic to dealing with regional inequalities and long-term care, just to take two examples, or even when considering the weaker intergovernmental coordination in procurement and distribution of vaccinations. In Argentina, federalism is characterized by weaker institutionalized interjurisdictional mechanisms, both vertically or horizontally. Despite that, the split power between central government and provinces as well as among them induced for a more collaborative stance (“fear bonds us”) to dealing with the pandemic. During the COVID-19 pandemic, the limits of authority among all governments has become more diffuse because the links between jurisdictions ´ were tightened and because the government of President Fernandez sought to nationalize many issues. The more uncoordinated federalism was changed for

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a more positive coordination, at least in the initial period of the health crisis. The Health Federal Council had an important role, as did ad hoc instruments such as meeting among the President and state governors. However, the institutional weakness of these coordinative arenas and instruments soon began to show their limitations. The president stopped meeting governors and began delegating this task to senior officers, and issued legal measures about social distancing without discussing them with state governors and the Buenos Aires Autonomous City. Both measures induced lessened interjurisdictional coordination in a context of weaker formal intergovernmental relations. In Brazil, IGRs are formally organized and stronger in health and social assistance areas, as well as in fields of public finance and management. The Brazilian federation does not have a formal forum for rallying national and subnational governments (as in Germany) or even horizontal arenas (e.g., Canada). Instead, federal cooperation is based on sectoral lines, with public health policy being the most striking example of participation by the three levels of government. Even this formal and institutionalized arena was affected by the political stance of the federal government neglecting to collaborate. Despite that, three horizontal bodies worked to organize minimal cooperation in health policy (National Council of Health State Secretaries and its analogs at the municipal level). Another arena was the informal and weaker horizontal coordination by state governors. Ultimately, the state and intermunicipal cooperation were implemented or had their roles reinforced to fight the pandemic. The political federal dynamic to fight the pandemic was marked for federal incoordination, horizontal and vertical IGR in public health policy, and informal collaboration by state governors. In Mexico, even if jurisdictional fragmentation allowed state governments not to act as agents of the federal government, the uncoordinated and heterogeneous response has provided poor results. States have been providing diverse responses, responding to these controversies and under the pressure of demands from businesses and society. Since the federal government did not offer firm responses, some states and municipalities acted to control the pandemic. But the limited fiscal autonomy requires states to coordinate with the federal government for health services provision. At the same time, the national government took decisions which weakened the intergovernmental relations in health policy when it disregarded the role of the General Health Council and excluded the states to participate in the discussion. The Ministry of Health concentrated all information and decisions without sharing the formulation of measures to fight the pandemic with the states. In practice, it installed a centralized process in case of emergency. Finally, in the vaccination process the three levels of government collaborated in different manners. The

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political federal dynamic to fight the pandemic was marked by federal incoordination, vertical, informal IGR in vaccination process, and centralization in national government. In the five cases, even in the face of the analyzed challenges of the federal political dynamics, the federal government assumed the coordination and implementation of comprehensive measures of social relief and economic support to the business community, for example. Also, the federal government was responsible for buying and distributing vaccines. Despite this general task at the hands of the national government, due to characteristics of federalism, the dilemmas of collective action are a constant possibility to unbalance intergovernmental relations. The trade-off between federal coordination and taking an individual stance can cause different levels of federal strain. But the CIP represented by the COVID-19 made three issues clearer: (1) the relevance to strengthen the interdependency of IGRs (vertical and horizontal) and develop political and public policy skills for that because more conflictive, autonomous, or beggar-thy-neighbor approaches are not able to face this kind of situation; (2) the strategic role that should be assumed by the federal government to coordinate efforts nationwide considering the territorial spread of the virus; (3) the necessity to consider equalization measures of fiscal and state capacity among states and even local governments because the asymmetry of resource become harder to get good results in intergovernmental collaboration.

POLICY PORTFOLIOS Health policy, the core policy for this book, tends to involve all levels of government, although responsibilities vary. Policy portfolio depends on constitutional design, historical public policy path and political federal dynamic, rules on the distribution of authority between national and subnational levels, as well as resources of state capacity to formulate and implement public policies to the configuration of a policy portfolio (Abrucio & Grin, 2015; Benz & Broschek, 2013; Hanson & Sigman, 2020; Philipmore, 2013; Skcopol, 2002). Considering that, in the five cases it is possible to find schemes of policy portfolio: fragmented in sectoral line or kind of clientele, shared responsibilities along territorial basis, and organized through a unified national system. These three possibilities of policy portfolio can have different weights as well as work in a merged way within an overarching design providing services and health policies.

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As for the models organized according to sectoral lines, in Mexico there are two fragmented bodies of health system based on different criteria: status of formal employment and a federal public health insurance program installed since 2019. In the United States, the federal government does supply health services to Native Americans, veterans, and the military and their families, but not to the general public. Also, there are many federal organizations involved in different activities which hamper coordination: Federal Emergency Management Agency, Centers for Disease Control and Prevention, National Institutes of Health, National Institute of Allergy and Infectious Diseases, and Food and Drug Administration. In Argentina, a private health subsystem covers unionized workers and is managed by union representatives. For the elderly population health care is controlled by a federal state agency which is financed with the contribution of workers and employers. In Brazil, besides the Unified Health System (SUS) there are two regulatory agencies (the National Health Surveillance Agency and National Complementary Health Agency) and two foundations (FioCruz disseminates technology useful for the SUS and National Health Foundation further public health and social inclusion through sanitation and environmental health actions). The models underpinned on a territorial basis also have different institutional designs in the five federations. In Argentina, health policy is a competing responsibility shared by the three levels of government with different kinds of intergovernmental cooperation between states and municipalities depending on their financial resources. The Ministry of Health controls epidemiological, vaccination, and sanitary border policies and operates nine different kinds of specialized hospitals. The provinces have historically adopted different strategies – some maintain control of all health services, others decentralize the hospitals and primary care units to the municipalities, retaining only complex hospitals. In any case, provinces take care of patients with severe illnesses by referral. Municipalities support health systems according to their budgetary capacity. The COVID-19 crisis has shown the administrative fragmentation of the health system (statistics of infections and deaths and availability of intensive care beds). In Mexico, the federal sphere leads national policy and decentralizes implementation to the states which have a great deal of autonomy for designing and managing their health systems. However, considering the most centralized characteristic of federalism, the national government has a pivotal role in implementing health policy nationwide. The federal government is responsible for: health strategic planning, definition of priorities, intersectoral coordination, and regulatory activities of attention to health care. The same structure empowers states to implement all the same functions within their

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jurisdictions. Perhaps the larger reduction in states’ “policy portfolio” was the implementation of INSABI that, since 2019, has “forced” many state governments to sign coordination agreements giving facilities and operation of health services to the national government. Also, the federal government centralized purchasing of medical supplies and medicines. This withdrawal of policy competence was even more intensified in the pandemic crisis with hospital conversion, the centralization of vaccination process in earlier stages, and the decision on the mandatory usage of the results of the “traffic light” for all states. In the United States, the federal government is a major player in health care, but primarily as an insurer (Medicare), funder (Medicaid), or regulator (Food and Drug Administration), rather than as a provider of health services. The states have been the principal players in health policy. They regulate health care, including licensing doctors and health facilities, provide a range of services, including hospital services in some states, and provide health insurance through CHIP and Medicaid. In the context of the pandemic, states are also responsible for controlling infectious diseases and contact tracing for people who have contracted a disease. Local health departments also are relevant to implement state programs, including contact tracing, and many other public health measures. Some local governments manage their own hospitals and other health facilities. In Canada, health policy is mainly a provincial responsibility since they decide on how to provide medical and hospital services based on single-payer coverage plans. Additionally, they cover other services and prescription drug and subsidized long-term and home care, especially for vulnerable groups such as the elderly population. Based on this policy portfolio, provinces were the main level of government to cope with the pandemic. Provinces implemented measures about regulated physical distance, long-term care facilities, and closed schools and businesses. They also implemented actions to increase hospital capacity, and policies to protect health-care workers. The federal government played a more limited role in both health care and public health. Despite that, federal spending powers on public health can enforce provincial agreement to implement national regulations as for health services, even if these transfers amount to only 3.5% of Canada’s total health spending. In Brazil, since 1988 there is the Health Unified System (SUS) organized according to four major groups of health management functions: formulation of policies/planning; financing; regulation, coordination, control, and evaluation (of the system/networks and providers, public or private), and provision of health services. Except for the last task, which is mainly implemented by the municipalities, the others are assumed by the three levels of government each

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in its territorial scope of action. Among the tenets of SUS, the policy portfolio for all subnational and national governments is guided by universal and free access, equity, territorial decentralization, regionally organized according to common territorial demands and based on hierarchical outpatient network services of high, medium, and low complexity. This policy portfolio sharing liabilities among the three levels of government was crucial for states and municipalities to fight the pandemic in a context marked by “conflict federalism” (Abrucio et al., 2020). The constitutional that guaranteed funding in tripartite grounds as well as the resilient institutional design of the SUS were pivotal for subnational governments to deal with this CIP. The analyses of policy portfolio show different federal routes considering constitutional rules, historical path, public policy design, and availability of state capacity at the subnational level. Also, federal government, states, and municipalities have intervened in distinct moments of the policy cycle during the pandemic crisis. In each federation activities such as formulation, funding, regulation, and service provision found distinctive solutions not always respecting the institutional design of policy portfolio in place before the health crisis. In this vein, in the five cases we identified different roles and possibilities of federal enforcement and discretion as for funding and scope of authority according to constitutional norms and the institutional design of public health policy historically assumed. Ultimately, in these federations all levels of government participate in health policy; however, the way how policy portfolio is organized in each country defines different kinds of responsibilities besides affecting the possibility of better intergovernmental coordination, mainly to cope with a CIP such as the COVID-19 pandemic.

POLITICAL AGENCY The role of political leaders (especially presidents, prime ministers, state governors, provincial prime ministers, or mayors) is also relevant to understand how the five federations behaved during the health crisis. Depending on the country or even the temporal passing of the crisis in each country, political leaders showed up prone to cooperative, opportunistic, coercive, or unilateralist roles in the IGR arena (Bolleyer, 2009; Hueglin & Fenna, 2015; Kincaid, 2015; Nugent, 2009). Analyzing these political behaviors is one way to understand the federal robustness (Bednar, 2009) to resist against the politicization or even the prevalence of political agencies pursuing their objectives (Hueglin & Fenna, 2015). In this case, opportunistic and unilateralist stances

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of political leaders (Conlan, 2006) become harder to coordinate efforts to fight this CIP represented by COVID-19. Also, political leaders can be prone to incentivize or reinforce cooperative IGR devices when facing CIPs (Agranoff, 2001). The five countries represent different experiences regarding the role and stance of political leaders. In Brazil, Mexico, and the United States in the Trump administration, the presidents aligned with rising populism, as well mobilized against science to combat the virus. However, the behavior of the three presidents was different. The politics in these three polities also was, and continue to be, hugely polarized according to political party cleavages. In Brazil, President Bolsonaro, long before the outbreak of the pandemic, started to confront governors, and mayors left to assume a coordinator role in the IGR arena. Bolsonaro confronted the Federation for two reasons. First, the rejection of Bolsonarist policies by sub-national entities. Since states and municipalities are primarily responsible for policy implementation in the social domain, they can alter the course of decisions taken in Brasilia. (Abrucio et al., 2020, p. 669) The combined compartmentalized, autocratic, and confrontational federal logic became evident with the pandemic, and the president intensified this stance in different manners: (1) he sought to impose, without success, coercive measures and to encroach on the authority of states and municipalities, which was barred by the Supreme Court; (2) he amplified the opportunistic stance asserting that how federal government was impeded to act toward states and mayors were the main responsible for spread of infection and rise in the number of deaths (a typical burden shifting and shirking behavior (Bednar, 2009); (3) without assuming any kind of federal cooperation and coordination his confrontational approach generated a hollow space of national leadership demanded to fight this CIP spread over the national territory. In Mexico, President Obrador also had put in place a recentralization of federal authority in different public policies, including the health area. The pandemic evidenced this political conception in an extreme way. The inertia of hierarchy and federal centralization were the main hallmarks in the history of the country (Ruiz, 2020). This process has been retaken and deepened in his term since 2019, represented by the reduction of subnational autonomy and the more limited federal coordination role. The president has implemented unilateral decisions to tackle COVID-19 and concentrated the adoptions of measures

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without consulting state governments (e.g., HSNC definitions). Also, coercive actions and encroachment measures (Bednar, 2009; Conlan & Posner, 2008) (for instance, hospital conversion, albeit with positive results) as well as a more confrontational stance against states’ public health experts, academics, civil society organizations, doctors, and the media were taken. After implementing the Healthy Distance National Program the federal government transferred the responsibility of managing the epidemic to the local level. This was typical opportunistic and blame-shifting behavior (Bednar, 2009; Posner & Conlan, 2008). In the United States, the trend toward centralization and coercion that increased post World War II continued with opportunistic style of federalism either through policy choices or political disputes among the president, governors, and some mayors of big cities who were willing to exercise more leadership than the president to face the pandemic. Also, the federal government sought to improve its position within the federal conflict. The American case revealed a different side of the more opportunistic behavior of political leaders. Through power grabs, states’ governors and the president sought mutually exclude the role of the other, but mainly the president confronted the action of the states in the health crisis. Load-shedding emphasized the responsibility for making decisions about closings, mask mandates, and lockdowns to state and local governments as well as difficult and unpopular decisions (typical shirking stance). Hoarding was represented by the federal decision to centralize the distribution of ventilators and personal protective equipment that to the states. Blame games sought to charge China and the Health World Organization as well as states and big cities as responsible for the situation and poor response (typical burden shifting stance). As for Argentina and Canada the political situation was different because the national government was not occupied by populist leaders with little esteem for federalism. In Argentina, even if the level of political polarization has been high since 2008, the pandemic generated an armistice in federal and political party disputes and ad hoc coordination steered by the president. But when the president concluded that his popularity was decreasing, the opportunistic strategy came to forefront of the political dynamic federalism reducing fiscal transferences to Buenos Aires and impeding the opening of schools (typical encroaching, unilateral and coercive stance). The vaccination process was decentralized to the provinces and faced political cleavages because some states kept a more centralized application to avoid giving political benefits for opposition mayors. Despite these political battles, President Alberto Rodriguez had a more collaborative role leading the dialogue with Buenos Aires mayor and state governors. However, this relationship soon was disrupted because

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the president delegated this dialogue to his ministers (typical shirking behavior) as well as having disagreements with Buenos Aires and some governors about health measures (typical blame shifting stance). In Canada, the political agency dimension was performed better since the design of executive federalism and further horizontal intergovernmental coordination. Provincial premiers usually cooperate among themselves, and in coping with the pandemic they received federal support. Political leadership at the beginning of the crisis was strong with unity among the first ministers in Canada. However, politics matters and the collaboration reached in the beginning of the pandemic waned as the health crisis required more federal funding which was not expanded (a more burden shifting and shirking stance even if the federal government was justified to invest money to buy vaccines, for instance). Another example of opportunistic behavior of political leaders –the Atlantic Bubble – illustrates potential collaboration among provinces but also how this can lead to the imposition of travel restrictions on residents of provinces excluded from the intergovernmental agreement. This is an example of opportunistic federalism. But, in general, in the Canadian case, political and policy choices adopted by political leaders were responsible interventions based on existing federal dynamics. The federal robustness (Bednar, 2009) and its institutional design considering subnational autonomy, mechanisms of coordination, and policy portfolio matter. However, the COVID-19 crisis also showed how political agency can interfere in the political federal dynamics to contribute for its functioning, but especially to harder intergovernmental coordination and cooperation. One side effect of a less collaborative presidential stance was to incentivize different kinds of formal or ad hoc horizontal cooperation, especially among state governors which was mainly the case in Brazil, Mexico, and Argentina in compensating for the absence of federal government. Also, when facing CIP challenges, the coordinator role along with subnational governments is essential, but this was not the case in Brazil, Mexico, and the United States until the end of the Trump administration, and in Argentina this role was not continuous or even not influenced by political issues. As the crisis passed, political battles were still more intensified, and even more stable federations as in institutional designs such as Canada started to face political and policy problems among federal and subnational political leaders. The span of time matters when facing negative and multidimensional effects provoked by the pandemic. On one hand, a federal safeguard served to constrain more opportunistic behaviors of national and subnational political leaders. On the other hand, political and policy choices were also relevant to define the federal landscape in the five countries.

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FINAL REMARKS Six lessons can be learned. First, federal structure is a core variable, and the absence of federal coordination or its confrontational side, even if mitigated by federal safeguards, is an aspect that hindered the fight against COVID-19. As CIP like pandemics and environmental problems will likely grow in the near future, there will be even more relevant collaborative national leaderships and/ or institutional mechanisms that compel them to act in this way. However, the relevance of the federal role should be considered within the political federal dynamic (for example, the five federations have different levels of decentralization which affects the way the federal government could act). Crisis such as the pandemic allow evaluation of the function of governance institutions when external shocks affect the whole country, and national leadership does not exert its coordinator role. Since federalism generally shares responsibilities among more than one level of government, it works by redundancy. To that extent the context of each federal institutional design matters it would be possible to know different routes do deal with CIPs such as the COVID-19 pandemic. The second is that well-structured federal cooperation mechanisms to address CIPs can generate better governmental solutions and innovations. Although informal or ad hoc intergovernmental alliances have been implemented, this process was clearer in the formal models of horizontal and vertical cooperation. Therefore, encouraging this format can be a way to improve the performance of public policies in the federations. Thirdly, it is important to remember that intergovernmental politics and the need for coordination extends beyond the state or provincial level. Local governments were important actors in coping with the pandemic, and when this level of government and its health agencies were better connected with the state level there seemed to be greater success in producing effective outcomes. Further, these intergovernmental relationships are best developed before a crisis rather than in response to the crisis. Fourth, the issue of territorial inequality and lack of equalizing schemes requires greater coordinating action by the federal government. In a pandemic situation, this is even more important. This issue affected the capacity to cope with the pandemic in all countries, and it should be included as a research agenda to analyze its effects on CIPs such as COVID-19. The lack of state capacity and the unequal resources reinforce the design of fiscal federalism to gear subnational governments to act more autonomously, faster, and with technical readiness.

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Fifth, regardless of the different kinds of de jure and de facto subnational autonomy, all cases showed how these federal characteristics were relevant to generate innovations and implement faster and more fitted responses according to local needs. Furthermore, this kind of action reinforced federal safeguards against intergovernmental confrontation and incoordination from the federal government. Sixth, national politics, and ideologies or political parties, can affect federal coordination. For different reasons this was the situation in Argentina, Brazil, Mexico, and the United States. Populist leaders as well as polarized politics can hamper or virtually impede any collaborative process. If this is a huge problem in normal times, it charges a tremendous price in periods of crises when everyone rallying around the flag should be toward the common goal of national and subnational political leaders. In this case, federalism can be shown as one of the most challenging sides when compared to unitary countries. The pandemic has showed its profound impact in many countries whose political system and organization of national territory are different. For all nations COVID-19 has perhaps been the most challenging in the last century. This is the same for federations, but for those countries the efforts to fight the pandemic are more demanding because the divided power requires coordination between more autonomous territories (provinces, states, or Laender, for instance). The five federations analyzed in this book showed the strengths and weaknesses of federalism, but it would be very difficult to think that these countries would have it another way to organize the national state. All five countries are heterogenous (Burgess, 2006) and complex nations, and federalism seems to be a better model to accommodate different territories and other cultural, ethnic, or religious issues. Considering that, the question is not whether federalism is the right model to face the pandemic even because there is no other option out for these countries. But COVID-19 showed limits in the federalist functioning, of different manners, in both its institutional design as well as in the capacity to refrain from bad political leaders. The pandemic presents new challenges that can be useful for updating the federalist theoretical approaches and for improving the organization and functioning of federations. REFERENCES Abrucio, F. L., Grin, E. J., Franzese, C., Couto, C.G., & Segatto, C. I. (2020). Combating COVID-19 under Bolsonaro’s federalism: A case of ´ intergovernmental incoordination. Revista de Administração Publica, 54(4), 663–677. doi:10.1590/0034-761220200354x

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Abrucio, F. L., & Grin, E. J. (2015). From decentralization to federative coordination: The recent path of intergovernmental relations in Brazil. Paper presented at the II International Conference on Public Policy, Milan. Agranoff, R. (2001). Managing within the matrix: Do collaborative intergovernmental relations exist? Publius: The Journal of Federalism, 31(2), 31–56. doi:10.1093/oxfordjournals.pubjof.a004895 Bednar, J. (2009). The robust federation. Principles of design. Cambridge: Cambridge University Press. Benz, A., & Broschek, J. (2013). Federal dynamics continuity, change, and the varieties of federalism. Oxford: Oxford University Press. Bolleyer, N. (2009). Intergovernmental cooperation: Rational choices in federal systems and beyond. Oxford: Oxford University Press; EPCR. Broscheck, J., Petersohn, B., & Toubeau, S. (2017). Territorial politics and institutional change: A comparative-historical analysis. Publius: The Journal of Federalism, 48(1), 1–25. doi:10.1093/publius/pjx059 Bulman-Pozen, J., & Gerken, H. K. (2009). Uncooperative federalism. Yale Law Journal, 118(1256), 1256–1310. Burgess, M. (2006). Comparative federalism: Theory and practice. London and New York, NY: Rouledge. Conlan, T. (2006). From cooperative to opportunistic federalism: Reflections on the half-century anniversary of the commission on intergovernmental relations. Public Administration Review, 66(5), 663–676. doi:10.1111/ j.1540-6210.2006.00631.x Conlan, T. J., & Posner, P. L. (2008). Introduction: Intergovernmental management and the challenges ahead. In T. J. Conlan & P. L. Posner (Eds.), Intergovermental management for the 21st century (pp. 1–12). Washington, DC: The Brookings Institute. Elazar, D. J. (1987). Exploring federalism. Toscallosa, AL: University of Alabama Presss. Hanson, J. K., & Sigman, R. (2020). Leviathan’s latent dimensions: Measuring state capacity for comparative political research. Retrieved from https://calhoun.nps.edu/bitstream/handle/10945/64717/ Hanson-Sigman_Leviathans_Latent%20Dimension.pdf?sequence5 1&isAllowed5y

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Hueglin, T. O., & Fenna, A. (2015). Comparative federalism: A systematic inquiry. Toronto, ON: University of Toronto Press. Kincaid, J. (2015). Policy coercion and administrative cooperation in American federalism. In F. P. E. Alber (Ed.), Federalism as decision-making: Changes in structures, procedures and policies (pp. 62–76). Leiden: Koninklijke Brill. Loughlin, J., Kincaid, J., & Sweden, W. (2013). Handbook of regionalism and federalism. London and New York, NY: Routledge Taylor and Francis Group. Nugent, J. D. (2009). Safeguard federals: How states protect their interests in national policymaking. Oklahoma, OK: University of Oklahoma Press, Norman. Obinger, H., Leibfried, S., & Castles, F. G. (2005). Federalism and the welfare state: New world and European experiences. Cambridge: Cambridge University Press. Paquet, M., & Schertzer, R. (2020). COVID-19 as a complex intergovernmental problem. Canadian Journal of Political Science, 53(4), 343–347. doi:10.1017/S0008423920000281 Philipmore, J. (2013). Understanding intergovernmental relations: Key features and trends. Australian Journal of Public Administration, 72(3), 228–238. doi:10.1111/1467-8500.12025 Ruiz, J. M. (2020). El desequil´ıbrio entre las salvaguardas federales y la inercia de jerarquia en M´exico. In J. M. Ruiz & E. J. Grin (Eds.), ´ relaciones Federaciones de las Am´ericas: descentralizacion, ´ (pp. 295–378). Ciudad de M´exico: intergubernamentales y recentralizacion ´ Publica. ´ Instituto Nacional de Administracion Schnabel, J. (2020). Managing interdependencies in federal systems: Intergovernmental councils and the making of public policy. S.I.: Pallgrave Mcmillan. Skocpol, T. (2002). Bringing the state back in: Strategies of analysis in current research. In P. B. Evans, D. Rueschmeyer, & T. Skocpol (Eds.), Bringing the state back in (pp. 3–43). Cambridge: Cambridge University Press.

INDEX Accessibility, 93 Administrative capacity, 12 Affordable Care Act, 26–27, 29, 34 American federalism, 23–24 formal aspects, 25 pandemic, 28, 33, 37 after pandemic, 37–38 American federations, 129 Analytical model, 7 Argentina, 44 Argentine federalism, 44 coordination mechanisms, 52–57 policy portfolio, 47–52 political agency, 57–60 subnational autonomy, 44–47 AstraZeneca, 81 Atlantic Bubble, 95–96 Autonomous City of Buenos Aires, 45, 58–59 Autonomy of subnational governments, 68–70 “Beggar thy neighbor” approaches, 36 Bicameralism, 67 Biden, Joe, 24–25, 29, 37 Blame game, 32–33 Blind spots, 90, 100–101 Bolsa Fam´ılia, 73 Bolsonaro’s federalism, 76–77 Bolsonaro’s model, 76–78 Brazil, 64 Brazilian democratization, 67

Brazilian federalism, 65 COVID-19 pandemic under Bolsonaro, 78–82 decentralization with federative coordinative, 66–75 dynamic, 66 functioning and performance, 65 turnaround in, 76–78 Brazilian Federation, 67 Brazilian federative model, 69 Buenos Aires Metropolitan Area, 44 Canada, 89–90 health-care system, 90, 93 Canada Emergency Response Benefit (CERB), 96 Canada Health Act, 93 Canada Health and Social Transfer (CHST), 93–94 Canada Health Transfers (CHTs), 93–94 Canada Social Transfers (CST), 93–94 Canadian federalism, 90 intergovernmental coordination, 93–99 political agency, 99–100 subnational autonomy and policy portfolio, 90–93 CanSino, 118 Centers for Disease Control and Prevention (CDC), 26 Children’s Health Insurance Program (CHIP), 26–27 Chinese virus, 81–82

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Co-operative Commonwealth Federation (CCF), 91 Coercive federalism, 17 Collaborative federalism, 134 Comissões Bipartites (CIBs), 73–74 Comissões Tripartites (CITs), 73–74 Committee of Experts, 48–49 Competitive framework, 94 Complex intergovernmental problem (CIP), 1, 7, 65, 130 Complexity of issues, 2 Comprehensiveness, 93 Conflict federalism, 130–131, 138–139 Constitutional autonomy, 9, 131 Constitutional landmarks, 1 Constitutional Reform (1994), 45 Constitutionally Autonomous Organizations (OCA), 109 Contribution Fund for Health Services (FASSA), 113 Cooperative federalism, 65, 70 Cooperative model, 129–130 Coordination. See also Intergovernmental coordination, 109–110 mechanisms, 13, 16, 52, 57, 73, 75 CoronaVac, 81 Council of Municipal Health Secretaries (Conasems), 73–74 Council of State Health Secretaries (Conass), 73–74 Countryside Crisis, 57 COVAX mechanism, 118 Covid Vaccination Technical Advisory Group, 119–120 COVID-19 pandemic, 1, 3, 7, 10, 14, 28, 33, 52–53, 90 under Bolsonaro, 78–82 COVID-19, 14–15 cases, 48–49 crisis, 137

death rate from, 24–25 effects, 44 struggle against, 25 vaccines, 98 Crack, 57 Crises, 33 “CUIDAR Verano” app, 57 Decentralization with federative coordinative, 66–75 Defense Production Act, 31 Delegations of Development Programs, 113 Democratic federal political systems, 1 Dual federalism, 129 Dual sharing model, 94 Dualist federalism, 65–66 Emergency Aid, 80 Emergency Assistance to Work and Production Program (ATP), 50 Emergency coordination, 99 Emergency Family Income (IFE), 51 Emergency Keynesianism, 96 “Epidemiological Traffic Light” programs, 114, 117 Executive federalism, 130–132 Federal arrangements, 2 Federal Constitution, 44–45, 68 Federal coordination, 8 Federal Emergency Management Agency (FEMA), 26 Federal government, 10, 25–26, 32, 38, 45, 48–50, 52–53, 64, 71, 93–94, 96, 136, 138 Federal health authorities, 114–115 Federal Health Council (COFESAL), 53 Federal institutions, 1 Federal politics, 2 Federal shared-cost programs, 93–94 Federal Supreme Court, 77

Index

Federal systems, 1, 6, 16, 18 coordination mechanisms, 13–16 policy portfolios, 10–12 subnational autonomy, 8–10 Federalism. See also Opportunistic federalism, 6, 15, 64, 90, 134–135 in action, 28–33 in Mexico, 116 in pandemic, 36–37 structure, 25–28 styles, 24 Federations, 129–131 Food and Drug Administration (FDA), 26, 72 Food Card, 51 Funder, 25–26 General Health Council (GHC), 111 Governors, 29 Governors’ Forum, 75 Great Depression, 90–91 Gross domestic product (GDP), 44, 122 H1N1 pandemic, 100 Harper governments, 94 Health care, 25, 48, 90 Health Federal Council, 134–135 Health Pact, 71 Health policy, 10, 111, 136–137 Health Security National Committee (HSNC), 111–112 Health System, 72 Health Unified and Decentralized System (SUDS), 70 Healthy Distance National Program (HDNP), 117 Hoarding, 31 Horizontal cooperation, 134 Hospital conversion, 117–118 Hurricane Katrina, 28–29

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Immunization National Program, 71 Impact of COVID-19 on Education, 121 Incoordination, 64, 76 Institute of Health for Wellbeing (INSABI), 113 Institutional capacity, 12 Insurer, 25–26 Integrated Health Actions (AIS), 70 Integrated Health-Care Networks, 71 Intensive care units (ICUs), 27, 48, 108 Intergovernmental capacities, 99–100 Intergovernmental committees, 10–11 Intergovernmental coordination, 93–99 mechanisms, 133–136 Intergovernmental relations (IGR), 10, 13, 15, 90, 130 forums, 15–16 systems, 1 Kirchnerismo/anti-Kirchnerismo cleavage, 57 Laboratories of democracy, 6 “Learn at home” program, 121 Load-shedding, 31 Local governments, 27, 92 Logistics Advisory Committee, 95 Mayors, 55–56 Medicaid, 26–27, 29, 34 Medicare, 26–27 Mexican federalism, 109–110 lessons, 123–125 limited use of instruments to stop economic decline, 121–122 policy portfolios and limits of policy instruments, 116–122

150

political agency of actions and communications, 114–116 states’ autonomy and limited coordination, 111–113 structure, 110–111 Mexican Petroleum (PEMEX), 112–113, 118 Mexican Social Security Institute (IMSS), 112–113, 118 Ministry of Finance and Public Credit (SHCP), 113 Ministry of Health, 79 Ministry of Public Education (SEP), 121 “More Brazil, Less Bras´ılia” slogan, 76 Municipalities, 68 of hope, 117 of Moreno, 52 “Municipalization” process of policies, 68–69 National Complementary Health Agency, 72 National Congress, 77 National Council of State Health Secretaries, 75, 79 National Guard, 110 National health strategy, 48–49 National Health Surveillance Agency, 72 National Health System (NHS), 111 “National Healthy Distance” programs, 114 National Institute of Allergy and Infectious Diseases, 26 National Institute of Statistics and Geography (INEGI), 122 National Institutes of Health, 26 National Institutes of Health and High Specialty Hospitals (CCINSHAE), 118 National leadership, 77–78 National Ministry of Health, 48–50

Index

National Ministry of Science, Technology, and Innovation, 51 National public policy systems, 67 National Vaccination Policy, 118–120 New Democratic Party (NDP), 91 Northeast Consortium, 75 “Open federalism” approach, 94 Opportunism, 17 Opportunistic federalism, 17, 28–29 strategies in, 30–32 Oswaldo Cruz Foundation, 81 Oxford-AstraZeneca vaccines, 118 Pan-Canadian Public Health Network (PHN), 95, 134 Pandemic denial, 24 Pfizer and Janssen vaccines, 81 Pfizer-BioNTech vaccines, 118 Police powers, 27 Policy portfolios, 10, 12, 47, 52, 70, 73, 90, 93, 136, 139 Policy preemptions, 16–17 Political agency, 16, 18, 57, 60, 99–100, 139, 142 Political capacity, 12 Political complexity, 2 Political confrontations, 16–17 Political leadership, 99 Popular Insurance Federal Program (PIFP), 112–113 “Popular insurance” program, 110–111, 114 Portability, 93 Power Grabs, 30 Presidential leadership, 60, 79 Previaje Program, 50–51 Private health service, 48 Productive Recovery Program II (REPRO II), 50–51 Project Warp Speed, 24–25, 32–33 Provinces, 93

Index

Provincial Financial Emergency Program, 54 Public administration, 93 Public circulation, 48–49 Public health, 23–25, 67 Public Health Act, 25–26 Public Health Agency of Canada (PHAC), 98–100 Public Health Governance, 65 Public Health Network Communications Group, 95 Public Health Working Group on Remote and Isolated Communities, 95 Public policies, 2 Public policy environments, 11 Public Services and Procurement Canada (PSPC), 98 Public Vaccination Monitor, 49–50 Quebec nationalism, 91–92 “Rally around the flag” effect, 36 Regional Management Boards, 71 Regulator, 25–26 “Rivademar against the Municipality of Rosario”, 46 “Roadrunners” cells, 120 SARS-CoV-2 detection kits, 51 virus, 119 Self-coordination process, 15 Senate, 45–46 Shared management, 74–75 Sharing expenditures, 10–11 Sinovac, 118 Small Business Administration, 26 Social Assistance and Water Resources, 70 Social distancing, 114–115

151

“Soft law” approach, 31–32 Spanish flu, 25 Sputnik V, 118 State Workers Social Security Institute (ISSSTE), 112–113, 118 Subnational autonomy, 8, 10, 44, 47, 90, 93, 131, 133 Subnational governments, 6 Substantial evidence, 3 Substantive complexity, 2–3 Super delegates, 110 Supreme Court, 46, 60, 72 Supremo Tribunal Federal (STF), 65 Technical Advisory Committee, 95 Technical Advisory Group, 119 Technical capacity, 12 Territorial approach, 49 Territorial dynamics, 3 Theoretical model, 7 Trump, Donald, 29, 31 administration, 24, 29–30 Uncooperative federalism, 34, 134 Undersecretary of Prevention and Health Promotion (SPSS), 111–112 Unified Health System (SUS), 65, 69–70, 72, 137–139 Unilateralism, 10 Unitary regimes, 36–37 United Nations Office for Project Services (UNOPS), 110–111 Universality, 93 Vaccine war, 71, 81 VIP Vaccination, 59 World Health Organization (WHO), 32, 114

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