The coronavirus pandemic has affected nearly every nation in the world, with results as variable as each government's response. While some countries rapidly harnessed the powers of science and good governance to contain the virus, others shunned the advice of health experts and failed to slow the spread of the disease. Eight months into the pandemic, the United States finds itself in the latter category, leading the world in COVID-19 deaths, both in absolute terms and as a proportion of population. But if the U.S. response deserves to be called a failure at the national level, the picture is more complicated in the 50 states: certain U.S. states have brought their rates of infection under control, leveraging their own resources to compensate for federal ineffectiveness.
In the United States of America, two nations are responding to one virus. The national government has largely abdicated responsibility for the pandemic response. But in a country with a federalized public health system, states that embrace science and the advice of health experts have largely succeeded in containing the virus, while infection rates have spiraled out of control in those that do not. The divergence of these two Americas reveals the strengths as well as the weaknesses of the U.S. federal system in the midst of the deadliest disease outbreak in a century.TWO NATIONS, ONE COUNTRY
The U.S. federal government's response to the pandemic has been feckless and largely ineffective. In lieu of a national containment effort, the administration of U.S. President Donald Trump left states to fend for themselves, while at the same time spreading misinformation and stoking anti-lockdown animus. The U.S. federal system, which reserves for the states those powers not explicitly granted to the national government under the Constitution, has enabled individual states to chart their own paths through the pandemic. And in the absence of responsible national leadership, one group of states has taken a decidedly antiscience approach, ignoring evidence and epidemiology. Another loose coalition of states has moved in the opposite direction, letting science drive policy. The difference in outcomes could not be starker. States that have chosen to ignore scientific consensus have endured large outbreaks, becoming global epicenters of the pandemic and rivaling the worst-performing nations, such as Brazil. The science-driven states, by contrast, have brought their outbreaks largely under control, with lingering patterns of infection that resemble those of Germany and other European nations that have successfully contained the virus.
The data on mobility, testing, and new infections illustrate differences between science-driven and non-science-driven responses, both within the United States and internationally. Between mid-March and early May, many U.S. cities and states imposed partial lockdowns, shuttering schools and nonessential businesses. Data assembled by Google suggest that mobility in most areas dropped by between 30 and 50 percent because of these restrictions. But in Boston and New York City, for example, mobility decreased by nearly 75 percent at the height of the lockdown-a figure on a par with many European nations that imposed much harsher restrictions. Italy, for instance, imposed a ten-week national lockdown that resulted in a 90 percent reduction in mobility in many areas. Italy'sinfection rate fell dramatically after that and has remained mostly under control, even as cases in France and Spain have soared.
The data on testing and tracing shows a similar variation. Massachusetts and Rhode Island, for example, have scaled up daily testing capacity to more than five tests per 1,000 people, more tests per person than Germany is conducting and five times as many as antiscience states such as Floridahave mustered. Science-driven U.S. states-Connecticut, Delaware, Illinois, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont-and the District of Columbia are employing aggressive tracing and isolation strategies. Massachusetts in particular has worked with the nonprofit Partners in Health to build an effective contact-tracing infrastructure and to support quarantined residents with food and grants to help cover rent. These interventions have had a clearly positive effect: new case rates in Massachusetts and other science-driven states are now similar to those in the European Union.
Unfortunately, many U.S. states have chosen a very different approach, refusing to invest in contact tracing and resisting what some of their residents see as onerous health restrictions. The governors of Arizona, Florida, Georgia, South Carolina, and Texas have largely ignored the calls from scientists for universal mask laws, an end to indoor gatherings, and improved testing. Across the country but especially in these states, scores of state and local public health officials have resigned after receiving threats or being sidelined. Even as children returned to school and the number of new cases spiked, Governor Brian Kemp of Georgia declined to mandate masks in the classroom and blocked efforts by municipal governments to require masks. In Georgia and other U.S.states where leaders have downplayed the virus, COVID-19 cases and deaths surged over the summer. Levels of infection have come down somewhat since then, but they remain high, setting the stage for a possible resurgence in the coming weeks.
Whereas the science-driven states are now on a trajectory similar to Europe's, the antiscience states are looking more and more like Latin America's hardest-hit country. Brazil's national public health agency-like the Centers for Disease Control and Prevention (CDC) in the United States-had an excellent reputation prior to the pandemic and a successful track record in managing outbreaks of diseases, such as Zika and dengue. But in Brazil as in the antiscience U.S. states, the public health infrastructure was no match for catastrophically bad national leadership. Like his American counterpart, Brazilian President Jair Bolsonaro undermined his country's response from the beginning, spreading misinformation, downplaying the threat posed by the disease, and contriving excuses for the inaction of his government. Brazil entered May with fewer than five daily cases per 100,000 people but saw case rates double in May and double again in June. Florida and Texasfollowed a similar trajectory, and by the end of the summer, Florida was seeing 20 new daily cases per 100,000 people and Texas was seeing upward of 30.
THE LIMITS OF FEDERALISM
Support for U.S. federalism has historically fallen along political lines, with conservatives supporting the system for the most part and liberals feeling less enthusiastic. This ideological and now partisan divide predates the Civil War, when Southerners defended slavery as an issue of "states' rights"-that is, one that the states should be able to decide for themselves. More recent debates over states' rights have concerned the desegregation of schools in the 1960s and the continuing litigation around abortion rights. In these and other instances, conservatives defended the authority of states while liberals sought to enlarge the powers of the national government.
The pandemic may well reverse this long-standing political alignment. With a president at odds with the scientific community, state governors have had to decide for themselves how best to promote public health, and they have chosen starkly different approaches that have led to the divergent outcomes described above. Most of the states that have broken with the federal government to quickly impose strict containment measures are traditionally "blue" states, dominated by liberal voters who have long looked askance at states' rights. Michigan is a perennial swing state, but its Democratic governor, Gretchen Whitmer, kept the state's lockdown in place even after Trump encouraged his Twitter followers in April to "LIBERATE MICHIGAN."
Democrats are now grappling with an uncomfortable truth: without states' rights, there would have been one American response to the pandemic-not two. Without the authority to craft and implement localized science-driven public health strategies, the entire country would have been at the mercy of federal inaction, gamesmanship, and ineptitude. States such as Massachusetts and New York would not have had the ability to mitigate their severe early outbreaks in the spring, and over the summer the entire country might have suffered the same high rates of infection that Arizona, Florida, and Georgia suffered. Federalism, in other words, at least partially insulated some states from the most irresponsible decisions of federal leaders, allowing them to act independently to bring the virus under control. In this way, the U.S. federal system has allowed states to serve as "laboratories of democracy," to use the term popularized by Supreme Court Justice Louis Brandeis. States that have embraced science have developed strategies and policies for fighting the virus that can be applied beyond their borders. Whether these successful experiments can benefit the rest of the country will depend on the decisions of leaders in the antiscience states, where case rates remain uncontrolled.
But if federalism allowed some states to overcome the worst failures of the national government, it could never solve the problems of the country as a whole. There are limits to what individual states, working independently, can achieve. That is why the federal government has historically coordinated efforts to address problems affecting the entire nation. In the absence of federal leadership, states have struggled to coordinate their responses, making each state's efforts only as effective as those of its least successful neighbor. The country's capacity to test for the virus-still the most effective tool available to combat the disease-has been fatally undermined by the absence of robust federal leadership and coordination. Eight months into this crisis, the number of novel coronavirus tests in the United States is not increasing fast enough to keep pace with the growing outbreaks in much of the country.
The lack of federal leadership has also pitted states against each other and driven up prices for critical supplies. When individual states compete for limited resources-whether testing swabs and reagents, ventilators, or personal protective equipment-wealthier states outbid poorer ones. If the federal government coordinated demand from states, it could avoid bidding wars and even entice private-sector genome sequencing labs such as 23andMe-capable of processing one million test samples daily-to revamp their operations to fight the pandemic. Groups of states are finally starting to band together to coordinate policy and aggregate demand and purchasing power, but the federal government's failed leadership has left a yawning vacuum for them to fill.
MORE THAN A FEDERATION
What is the likely upshot of this high-stakes experiment in U.S. federalism? There are two possible-although not necessarily mutually exclusive-outcomes. States may come to see the federal government as an unreliable partner and start building their own infrastructure for disease control and response. Governors could decide they need their own strategic stockpiles of medical supplies, beefed-up public health agencies, and so forth, precipitating a shift of resources from the federal government to the state governments. This kind of go-it-alone approach would be expensive and inefficient, and it would exacerbate inequalities among the states. But it would provide a measure of reassurance to states still shaken by the disastrous federal response to the COVID-19 pandemic.
A second, more hopeful possibility is that Americans recognize the limits of federalism to meet national and global challenges and work to rebuild the capacity and standing of the federal public health infrastructure. The CDC was until recently the premier public health agency in the world, combining unparalleled scientific expertise with a network of labs and public health partners working across the country to detect, monitor, and respond to health threats. The United States might emerge from the pandemic resolved to rebuild the authority of the CDC and other federal public health institutions by assuring their political independence, restoring adequate funding, and revitalizing partnerships with state and local public health agencies-in other words, bolstering the federal government's ability to respond to health crises while at the same time building a stronger firewall between science and the political process. The promise of the United States has always been that the whole is greater than the sum of the parts. To weather future pandemics, Americans must believe not just in the 50 states but in the United States.
This article was originally published on ForeignAffairs.com.
