Argument and Contribution

At the national level, the United States struggled to effectively respond to the COVID-19 pandemic: federal policy was delayed and inconsistent, supply shortages were widespread, and political pressure undermined accurate public health guidance. At the state and local levels, however, there was a great deal of variation in terms of the capacity to respond to COVID. While indicators of state capacity often focus on “formal” indicators like institutional resources, staffing, and finances, translating formal capacities into effectively implemented policies is neither a simple nor an automatic process. 

In “Building the Plane While Flying,” Didi Kuo and Andrew S. Kelly draw our attention to the importance of informal indicators of public health capacity. These include strong relationships within and across government agencies, the embeddedness of health officers in local communities, and prior experience with responding to disasters, among other factors. The authors argue that local governments with strong informal capacity were better able to communicate with and learn from one another, as well as to gain the trust of community members, during the pandemic. Conversely, localities with otherwise strong formal capacities often failed to respond to the challenges at hand. This is because they were unable to effectively leverage their relationships and organizational networks.
 

Kuo and Kelly’s paper is informed by qualitative analysis of California’s public health institutions as well as in-depth interviews with health officers across seventeen Northern, Central, and Southern California counties. The interviews illuminate the concrete processes by which local governments responded (or struggled to respond) to the COVID-19 pandemic. One of the paper’s key contributions is to push us to conceptualize state capacity more broadly and to focus on the factors that drive not just policy development, but policy implementation. 

The Importance of Informal Capacity

The bulk of the paper disaggregates informal capacity into its various mechanisms and processes. Each of these proves to be crucial in explaining different pandemic outcomes at the local level. One such mechanism is coordination within local governments. To illustrate this, consider public health officers, who enjoy broad legal powers to protect public health as well as financial resources and personnel at their disposal. By law, officers possess significant capacities to mitigate health crises. Yet across the interviews, health officers reported that effectively implementing COVID-19 policy required their cooperation and communication with a host of actors, including the County Counsel (the county’s top lawyer), Chief Administrative Officer, and Board of Supervisors, which is charged with appointing health officers.
 

Closely related to intra-governmental coordination is the importance of autonomy, particularly in the face of political pressure. For example, boards of supervisors sometimes undermined the public guidance provided by health officers. (This guidance could range from the need to close schools to officers simply communicating truthfully with localities about COVID-19 risks.) Overcoming efforts by board members to ignore or muzzle officers required coordination between those actors who were more insulated from political pressure.

Another key component of informal capacity was prior experience responding to emergencies and California’s myriad of natural disasters, such as fires, floods, or mudslides. Health officers from more experienced counties noted their ability to draw upon established emergency procedures and partnerships. For example, some counties had previously cooperated with each other, as well as with independent agencies like the Red Cross, to provide aid and shelter to those affected by wildfires. These experiences — for which no amount of financial resources or personnel can substitute — served as templates to help coordinate COVID-19 policy responses.

Informal capacity also depended upon health departments effectively communicating with the public. Many departments initially lacked the infrastructure to do this, and therefore relied on cooperation with other actors like school superintendents, sheriffs, and community leaders. Some counties created toolkits to improve their community’s understanding of personal protective equipment (PPE) or even produced local TV shows. Still others scheduled conference calls with local hospitals, faith leaders, and nursing homes. Given that many of these communication efforts were improvised, public health officers stressed the importance of formalizing coordination between state and nonstate actors so as to improve emergency preparedness in the future.
 

In addition to coordination within local governments, effective policy-making and communication required coordination across governments. One such institution was the Association of Bay Area Health Officers (ABAHO), founded in the 1980s during the HIV/AIDS epidemic. ABAHO members had also coordinated policy responses to the H1N1 outbreak. These cross-county partnerships enabled early, rapid, and unified responses to the COVID-19 pandemic. By contrast, the authors find that regions without such networks faced greater challenges in developing and implementing public policy.

A final aspect of informal capacity is the social embeddedness of health officials in their communities. This includes partnerships with leaders of businesses and faith groups, teachers, and restaurant owners. Not only did these partnerships increase the scope of outreach, but they also often established relationships that had not existed beforehand. Gaining a foothold in local communities thus increased the likelihood that community members would support policies and enabled local governments to access hard-to-reach populations.
 

Kuo and Kelly’s analysis of informal capacity should give us pause when considering existing indices of public health preparedness; some of these have ranked the United States quite high despite its often ineffective responses to the COVID-19 pandemic. That this mismatch occurs is arguably a function of observers prioritizing formal capacities. For federal, decentralized countries like the US, informal capacities and relationships are essential not only for delivering services but for generating legitimacy and trust among those receiving services.

*Research-in-Brief prepared by Adam Fefer.

The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite applications for a suite of fellowships in contemporary Asia studies to begin in fall quarter 2026.

The Center offers postdoctoral fellowships that promote multidisciplinary research on Asia health policy, contemporary Japan, and contemporary Asia broadly defined, as well as postdoctoral fellowships and visiting scholar positions with the Stanford Next Asia Policy Lab and a visiting fellow position on contemporary Taiwan. Learn more about each opportunity and its specific application requirements:

2026-27 Asia Health Policy Program Postdoctoral Fellowship

Hosted by the Asia Health Policy Program at APARC, the fellowship is awarded to one recent PhD recipient undertaking original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.

2026-27 Japan Program Postdoctoral Fellowship

Hosted by the Japan Program at APARC, the fellowship supports research on contemporary Japan in a broad range of disciplines, including political science, economics, sociology, law, policy studies, and international relations. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.  

2026-27 Shorenstein Postdoctoral Fellowship on Contemporary Asia

APARC offers two postdoctoral fellowship positions to junior scholars for research and writing on contemporary Asia. The primary research areas focus on political, economic, or social change in the Asia-Pacific region (including Northeast, Southeast, and South Asia), or international relations and international political economy in the region. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025. 
 

2026-27 Taiwan Program Visiting Fellowship

Hosted by the Taiwan Program at APARC, the fellowship is awarded to one mid-career to senior-level expert with extensive experience studying contemporary Taiwan. The fellowship research focus is on issues related to how Taiwan can meet the challenges and opportunities of economic, social, technological, environmental, and institutional adaptation in the coming decades, using a variety of disciplines, including the social sciences, public policy, and business. The application deadline is March 1, 2026.  
 

Motivation & Contribution

Over the past 10-15 years, both longstanding and relatively new democracies have suffered from backsliding and erosion, including India, the United States, Brazil, Turkey, and many others. Many social scientists have explained this wave of backsliding in terms of either (a) elected autocrats who undermine democracy from within or (b) declining popular support for democrats who have failed to deliver economic growth and prosperity. However, recent scholarship by Thomas Carothers and Brendan Hartnett has questioned the wisdom of the latter. For example, India enjoyed strong economic growth prior to its backsliding under Narendra Modi.

In “Delivering for Democracy,” Francis Fukuyama, Chris Dann, and Beatriz Magaloni set out to more systematically evaluate the evidence connecting popular support for democracy with delivery, examining both backsliding and non-backsliding countries. After finding preliminary evidence for the democracy-delivery relationship, they offer an explanation of why delivery is simultaneously so important and so elusive under democratic governance.

Evidence

Using ten data sources covering 650,000 people in both old and new democracies, the authors find a strong, positive correlation between satisfaction with democracy and economic performance. This relationship holds not only for many countries at one point in time but for pairs of countries over time. In two developing democracies — Argentina and Brazil — as well as in two developed democracies — Greece and Spain — satisfaction and delivery have been closely connected since 2005, plummeting during economic crises and rising during periods of prosperity. These patterns call for an explanation for why voters care so much about delivery, such that they may be willing to sacrifice their democratic freedoms for it.
 

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The Argument

Delivery is Important

The authors begin from the axiom that stable political life depends upon citizens perceiving their governments as legitimate. Legitimacy can be thought of in terms of both performance — the effective delivery of goods and services — and procedure, which encompasses policies that reflect the democratic will of the people. As the examples of China, Turkey, Saudi Arabia, and Singapore show, however, plenty of autocracies and backsliding democracies have not only delivered, but have also arguably outperformed their democratic peers. From China’s Belt and Road Initiative to Turkey’s Yavuz Sultan Selim Bridge, authoritarian leaders and ruling parties have achieved remarkable performance legitimacy. 

Although autocracies, by definition, cannot be procedurally legitimate, this may carry little weight for democratic citizens who experience prolonged unemployment or must deal with dilapidated infrastructure. Indeed, public engagement through procedural channels — such as voting or jury service — has steadily declined across the democratic world. Democratic voters are increasingly willing to support outsider candidates who build new infrastructure or promise to fight crime, but who nonetheless restrict their political freedoms. Many citizens of El Salvador — which now claims the world’s highest incarceration rate — continue to view Nayib Bukele’s administration as the surest way of delivering security, despite a years-long state of emergency that has seriously eroded democratic freedoms. 

Meanwhile, established democracies built much of their infrastructure decades ago, so investments primarily maintain these systems, rather than showcasing new projects that can garner public support. In some cases, democracies have struggled to even maintain their existing infrastructure, perhaps best exemplified by the collapse of Baltimore’s Francis Scott Key Bridge. All of this creates the conditions for voters to support far-right, anti-democratic parties, which often blame immigrants for economic problems and propose illiberal solutions.

Yet Democratic Delivery is Difficult

Elected democrats seeking to deliver may find themselves hamstrung in ways that autocrats are not. For one, democratic institutions are composed of ‘veto players’ who can stymie the introduction of badly needed policies: national and subnational governments, multiple legislative chambers, judges who review and overturn executive action, and so on. At the same time, democrats must worry about election cycles and term limits, decreasing their incentives to deliver for the long term when later politicians may take credit. Meanwhile, legal and regulatory systems, such as those intended to protect the environment, may prevent the building of critical infrastructure. Property rights prevent the forcible displacement of communities for development, while civil liberties prevent the repression of those who refuse to be displaced. Rules meant to prevent regulatory capture often become arenas where powerful interest groups block and delay government action. 

Independent news media present another potential impediment to delivery, as criticism from journalists can make incumbents wary of undertaking new projects. In addition, media bias can convince voters to remove politicians who do, in fact, deliver. By contrast, autocrats who censor media and arrest journalists can focus on delivery alone, even while their development schemes often rest on corrupt and nepotistic practices. Popular discontent with democratic government ultimately creates a damaging feedback loop: voters are unwilling to fund government projects, in turn leading government to function worse, generating further discontent.
 

Prospects

Autocrats have figured out ways to deliver the goods and services their citizens want, but this does not make autocracy a just political system. By the same token, democracies may struggle to deliver, but their procedural legitimacy — especially voters’ ability to hold representatives to account — entails a powerful means of generating fair and inclusive delivery. As such, the authors call on democracies to examine their past and that of their peer countries — both developed and developing — for inspiration. For example, the U.S. New Deal was exemplary in building ambitious and popular infrastructure, as well as providing broad social and economic protections. (Of course, most of these projects would be hamstrung by modern-day regulatory frameworks.)

Meanwhile, Australia’s citizens have both benefited from a recent infrastructure boom and have demonstrated strong support for democracy. Finally, many Latin American countries have implemented popular and effective programs like conditional cash transfers. For the authors, addressing the issues most pressing to voters — such as job creation, which is especially salient to young people, who are most dissatisfied with democracy — will require democratic governments to strike the right balance between democracy and delivery.

*Research-in-Brief prepared by Adam Fefer.

About the Authors
 

Ruixue Jia is Professor of Economics at the School of Global Policy and Strategy, University of California, San Diego.

Hongbin Li is Co-director of Stanford Center on China's Economy and Institutions, and a Senior Fellow of Stanford Institute for Economic Policy Research (SIEPR) and the Freeman Spogli Institute for International Studies (FSI) at Stanford University.

Claire Cousineau is a writer and former researcher at the Stanford Center on China’s Economy and Institutions, she is currently pursuing her MBA at Duke University.

Availability

The Highest Exam: How the Gaokao Shapes China is available now for purchase from Amazon and elsewhere.  

Upcoming Book Event

Join us on Tuesday, October 21 at 4 PM (Pacific) for a fireside chat with co-authors Ruixue Jia and Hongbin Li. The fireside chat will be held in-person in the Bechtel Conference Center and livestreamed for virtual attendees. Learn More & Register