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Introduction This study connects the aggregate strength of public health policies taken in response to the coronavirus disease 2019 (COVID-19) pandemic in the U.S. states to the governors’ party affiliations and to state-level outcomes. Understanding the relationship between politics and public health measures can better prepare American communities for what to expect from their governments in a future crisis and encourage advocacy for delegating public health decisions to medical professionals. Methods The Public Health Protective Policy Index (PPI) captures the strength of policy response to COVID-19 at the state level. The authors estimated a Bayesian model that links the rate of disease spread to PPI. The model also accounted for the possible state-specific undercounting of cases and controls for state population density, poverty, number of physicians, cardiovascular disease, asthma, smoking, obesity, age, racial composition, and urbanization. A Bayesian linear model with natural splines of time was employed to link the dynamics of PPI to governors’ party affiliations. Results A 10–percentage point decrease in PPI was associated with an 8% increase in the expected number of new cases. Between late March and November 2020 and at the state-specific peaks of the pandemic, the PPI in the states with Democratic governors was about 10 percentage points higher than in the states with Republican governors. Conclusions Public health measures were stricter in the Democrat-led states, and stricter public health measures were associated with a slower growth of COVID-19 cases. The apparent politicization of public health measures suggests that public health decision making by health professionals rather than political incumbents could be beneficial.

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This essay examines the policy response of the federal and regional governments in federations to the COVID-19 crisis. We theorize that the COVID-19 policy response in federations is an outcome of strategic interaction among the federal and regional incumbents in the shadow of their varying accountability for health and the repercussions from the disruptive consequences of public health measures. Using the data from the COVID-19 Public Health Protective Policy Index Project, we study how the variables suggested by our theory correlate with the overall stringency of public health measures in federations as well as the contribution of the federal government to the making of these policies. Our results suggest that the public health measures taken in federations are at least as stringent as those in non-federations, and there is a cluster of federations on which a bulk of crisis policy making is carried by subnational governments. We find that the contribution of the federal government is, on average, higher in parliamentary systems; it appears to decline with the proximity of the next election in presidential republics, and to increase with the fragmentation of the legislative party system in parliamentary systems. Our analysis also suggests that when the federal government carries a significant share of responsibility for healthcare provision, it also tends to play a higher role in taking non-medical steps in response to the pandemic.