Divided We Survive? Multilevel Governance during the COVID-19 Pandemic in Italy and Spain.

The Pandemic in Italy and Spain Italy and Spain share common institutional backgrounds (e.g. decentralized healthcare systems), but adopted a different model of governance during the first wave of the COVID-19 pandemic ([5]). Comparing the reactions to the pandemic in two countries (Italy and Spain) allows us to study whether hierarchical centralization in Spain fared better than informal decentralized coordination implemented in Italy. Nonetheless, the institutional design of the health system to address the needs of the COVID-19 pandemic was corrected in the second wave of the pandemic, when Spain followed Italy's lead and kept the pandemic governance decentralized. Results (not reported here for brevity) confirm a higher concentration of the COVID-19 pandemic in Italy than in Spain, which implies that centralized governance allows for more homogeneous outcomes across regions, while a decentralized solution allows to identify best practices from those regions that have adopted unsuccessful choices. [Extracted from the article]