The Politics of Pandemic Response and the Opportunities for Health Policy Reform
Co-sponsored by Division 48: Health Politics & Health Policy
Full Paper Panel
(Discussant) Colleen M. Grogan, University of Chicago; (Discussant) Eric M. Patashnik, Brown University; (Chair) Philip B. Rocco, Marquette University
The COVID-19 pandemic provides an important opportunity to rethink and restructure the public health and health care sectors of both the Global North and Global South. In order to improve policy responses to future public health emergencies, as well as to repair and improve the health care systems that have been (further) fractured by the pandemic, it will be necessary to critical assess and learn from the factors that have shaped the often failed and fragmented response to COVID-19. In their paper, Rozenblum, Greer, and Jarman investigate why the well-established and well-funded public health agencies of France and the United States were sidelined in policy discussions at the exact time their expertise and input was most needed. In mapping out the role of public health professionals and institutions during COVID-19 in France and the United States, the authors find that the advice of public health professional was ignored by policymakers because public health professionals lacked adequate policy tools and occupied a contested professional domain. Kuo and Kelly investigate the comparative COVID-19 policy response across counties and regions with California. In moving beyond a consideration of formal state and public health capacity, Kuo and Kelly argue that the more robust policy response of the Bay Area was, in part, a product of partnerships between state and community-based actors. Drawing on the concept of “embedded autonomy,” Kuo and Kelly reconceptualize public health capacity and consider it within broader issues of state capacity and democracy. In their paper, Trujillo and Motta theorize how vaccine hesitancy and the politically contentious nature of vaccines during COVID-19 may “spillover” into the post-pandemic era and increase negative attitudes towards childhood vaccine mandates, elective adult vaccines, as well as vaccines still in development. In finding that such spillover effects are present, Trujillo and Motta also consider how strategic communication may encourage future vaccine uptake. Finally, Vitale examines the complex interaction of national social policy and international interventions during COVID-19. In focusing on the Haitian-Dominican border, Vitale finds that diverted resources, unstable funding structures, hidden or misaligned donor priorities have kept some populations in intense precarity. The transnational and national pandemic response has produced ill health through fragmenting and financializing the health care sector.
Strange Defeat: Knowledge, Delegation, and COVID-19 in France and the U.S.
Sarah Denise Rozenblum, University of Michigan; Scott L. Greer, University of Michigan; Holly Jarman, University of Michigan
Making an issue “above politics” is a tremendous political victory. The establishment and maintenance of such claims to expertise and intellectual monopolies in different policy areas are a goal and a source of political contestation in many policy fields, from central banking to trade policy to public health. Constraining a policy agenda and scope of conflict to the concerns of a particular intellectual community is an act of politics- delegation- and shapes politics. What does it take to establish organizational and professional dominance of a policy area? Drawing on the sociology of knowledge as well as the comparative politics of delegation, we argue that generalist politicians will delegate authority to specialists, such as an organized profession or expert agency, when the profession combines an established professional domain with organizations under their control which control key policy tools. Our cases are two ambitious but different public health professional projects in France and the United States that were both sidelined by their executives in a crisis seemingly tailored to the expertise of public health agencies and experts. The United States and France faced COVID-19 after making large investments in communicable disease control, with both governments maintaining prominent public health agencies, but in both countries, their public health agencies and professionals were sidelined by the executive exactly when they faced an unprecedented public health crisis. We use data from governmental and international policy documents, from the scientific literature, and secondary source documents to map out the role of the public health profession and institutions during the COVID-19 pandemic in France and the United States. In both cases, their ability to contain the scope of conflict was limited by a contested professional domain and limited or no control over key policy tools. As a result, generalist policymakers were free to ignore their advice, and in both countries frequently did.
State Capacity and Public Health: California and COVID-19
Didi Kuo, Stanford University; Andrew S. Kelly, California State University, East Bay
On March 17, 2020, six counties in the Bay Area jointly issued the nation’s first shelter-in-place orders in response to the COVID-19 crisis. Cities and states across the United States quickly followed suit, with varying degrees of success. Public health officials have been critical in setting policies, enforcing behavioral and non-pharmaceutical interventions, and communicating with the public. This paper explores the determinants of public health capacity, distinguishing between formal institutional capacity (ie budget, staff) and informal embedded capacity (ie community ties, insulation from political pressures). It argues that informal embedded capacity is critical to public health capacity, but difficult to measure empirically. It concludes by relating public health capacity to broader issues of state capacity and democracy.
COVID-19 Vaccination “Spillover” Effects onto Post-pandemic Vaccine Hesitancy
Kristin Kay Lunz Trujillo, Northeastern University and Harvard University; Matthew P. Motta, Oklahoma State University
Even amid the unprecedented public health challenges attributable to the COVID-19 pandemic, opposition to vaccinating against the novel coronavirus has been both prevalent and politically contentious in American public life. In this paper, we theorize that negative attitudes toward COVID-19 vaccination might “spillover” to shape confidence and participation in post-pandemic vaccination programs for years to come. In a nationally representative longitudinal survey of American adults across 2021 we find that — consistent with our theoretical expectations — people who opted to forego COVID-19 vaccination, who are more hesitant toward the COVID-19 vaccine, who endorse COVID-19 misinformation, and who oppose COVID-19 vaccine mandates, subsequently tended to become more negative toward childhood vaccination mandates and toward elective adulthood vaccines. In a separate series of cross-sectional surveys, we also show that these findings extend to the rejection of vaccines that are still in development (e.g., Alzheimer’s and personalized cancer vaccines), which highlights both the substantive scope and robustness (i.e., because these vaccines are still in development, attitudes toward them cannot possibly be confounded by personal vaccination experiences) of COVID vaccination spillover effects. Interestingly, while we find that vaccine spillover effects are more common on the ideological right, both the longitudinal and cross-sectional data suggest that those who hold (or come to hold) negative views toward COVID-19 vaccination are equally likely to express opposition to downstream vaccination programs, irrespective of partisan persuasion. We conclude by discussing how Americans’ personal, and often deeply political, experiences with the COVID-19 pandemic may shape public health outcomes for years to come. We also consider how strategic political health communication might attempt to encourage vaccine uptake in the future.
Neoliberal Health: Sub-Citizenship during COVID along the DR-Haitian Border
Lucia Vitale, University of California, Santa Cruz
This paper takes up the complex health systems of the Global South, which are comprised of important and revealing interactions between national social policy and international intervention. It highlights how COVID exposes the fragmentation and financialization of healthcare by showing how “biological sub-citizenship,” or the ways in which neoliberal policy becomes embodied as ill health, becomes real. While this embodiment occurs in distinct ways depending on where a particular health event originates—for example, from public-private partnerships, from non-governmental organizations (NGOs), or from international aid agencies—the cumulative outcome is that local populations, often women heads of household, must constantly navigate between the myriad of healthcare providers in order to piece together some semblance of primary healthcare for themselves and their families. The Dominican-Haitian border represents a rich opportunity to illuminate not just interactions between international interventions and national policy, but also to observe the meaningful categories of citizenship and how regimes of sub-citizenship are determined. Using empirical evidence from rural areas along the border, this article uses a multiscalar approach to analyze how transnational and national pandemic responses land locally to produce ill health through fragmenting and financializing the health sector. It finds that diverted resources, unstable funding structures based on donations, and hidden or misaligned donor priorities all land locally and keep certain populations in situations of intense precarity. By presenting routinized, everyday examples of health system navigation from the local scale, this paper hopes to push forward timely conversations on how neoliberal health policy at the transnational and national scales debilitates progress towards primary healthcare for all.