Coordination and health policy responses to the first wave of COVID-19 in Italy and Spain

The Italian and Spanish healthcare systems are ranked among the best in the world, according to the Lancet Ranking and the Global Health Security Index (2019). Yet Italy and Spain were the first European countries hit by the coronavirus and did not have the benefit of hindsight and policy learning. A further complication for crisis management and associated policy measures to be adopted and implemented was the highly decentralized policy system. The article analyzes the main policy responses by national governments in Italy and Spain, focusing on their innovative character and on the coordination challenge of these measures for central–regional multilevel governance. The findings suggest that central governments assuming emergency powers need to balance more carefully their policy decisions against the constitutional shared responsibilities acquired by regional governments in highly decentralized policy systems.