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Political Accountability and the 1918 Influenza Pandemic

Why do some political incumbents adopt aggressive measures to slow the spread of infectious diseases while others do not?

Jake and I were particularly interested in what the experience of 1918 can tell us about political accountability. Not all jurisdictions have the same capacity to act. Epidemics require competent public health experts, responsive bureaucracies, and the machinery to enforce regulations. Yet even capable governments may fail to act. Why? If we assume that incumbents generally pursue policies that they expect to maximize their chances (or their party’s chances) of staying in office, then there are two potential answers to this question.

One possibility is that incumbents implement more aggressive public health measures when they face relatively less political competition. In the trade-off between closing the economy and mitigating disease, politicians and voters may have different time horizons on their preferences. NPIs are economically and socially disruptive in the short term, but their public health and economic benefits may not be realized until much later. Voters may be unaware of these future benefits (or may not attribute them to NPIs), but they certainly know that lockdowns are costly to endure. Vulnerable incumbents may therefore prioritize minimizing economic and social disruptions, by taking a more “hands-off” approach and adopting fewer NPIs. By this logic, NPIs are a luxury that only autocrats and entrenched machine politicians can really afford.

An alternative possibility is that political competition increases incentives to intervene. When incumbents’ risks of losing office are relatively low, their incentives to change policy to maximize constituents’ well-being are also relatively low. Political competition changes this calculus. The threat of losing office drives incumbents to more faithfully represent their constituents by implementing policies that are responsive to public demands. In competitive environments, challengers are likely to publicize actual or perceived missteps, making constituents more aware of failed policies. To the extent that the marginal voter might punish incumbents for inaction, political competition should increase incentives for politicians to act (or at least appear to do so).

What the data tell us

Which of these two patterns more closely aligns with the historical record? To assess the impact of political competition on local policy responses (and local severity of the outbreak), we collected municipal and county-level data on four types of public health outcomes in 1918: (1) NPIs and PIs, including the timing of adoption, duration, and enforcement, (2) daily reported cases and deaths, (3) excess mortality, and (4) secondary infections like bacterial pneumonia, which accounted for the majority of flu-related deaths in 1918. We combined these data with information on local electoral competitiveness, based on the outcomes of pre-pandemic congressional, gubernatorial and mayoral elections in the United States. We collected a parallel set of data on Covid-19, to enable comparisons between then and now.

Our analysis, which you can read in full here, suggests that more vulnerable incumbents face stronger political incentives to slow a virus’ spread. How incumbents have responded to these incentives, however, has changed in the last 100 years.

Data from the 1918 H1N1 influenza outbreak suggest that more politically competitive constituencies (i.e. those where winning margins tend to be small, and incumbents are less secure) imposed more nonpharmaceutical interventions, kept them in place longer, promoted them more aggressively and enforced them more often. More competitive localities also saw fewer deaths directly attributable to the flu, fewer overall excess deaths in 1918, and fewer cases of pneumonia.