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Centralization vs. Decentralization in COVID-19 Responses: Lessons from China.

Researchers have begun to examine whether centralized or decentralized (or federal) political systems have better handled the COVID-19 pandemic. In this paper, we probe beneath the surface of China's political system to examine the balance between centralized and decentralized authority in China's handling of the pandemic. We show that after the SARS epidemic of 2003, China adjusted the central-local balance of authority over systems to handle both the detection and early response phases of health emergencies. In an attempt to overcome problems revealed by SARS, it sought both to centralize early infectious disease reporting and to decentralize authority to respond to local health emergencies. But these adjustments in the central-local balance of authority after SARS did not change "normal times" authority relations and incentive structures in the political system. As a result, local leaders had both the authority and the incentive to prioritize tasks that determine their political advancement at the cost of containing the spread of COVID-19. China's efforts to balance central and local authority shows just how difficult it is to get it right, especially in the early phase of a pandemic.