Giants On Clay Feet – COVID-19, infection control, and public health laboratory networks in England, the US, and (West-)Germany (1945-2020)

COVID-19 has exposed significant differences in public health systems’ ability to mount effective test and trace responses. This article analyses the historical and structural reasons behind the relative success of Germany and the problems experienced in Britain and the US during the first wave of the pandemic. It also asks why recent international surveys overestimated Anglo-American preparedness. The article argues that the answer lies in the different evolution of public health systems as well as varying public health capacities at the local level. In Germany, post-1994 reforms of the decentralised public health system managed to overcome decades of political neglect and underinvestment and strengthen federal integration without compromising public health capacity at the state and communal level. This joint strengthening of the centre and hinterland allowed the Robert Koch Institute to function as an effective coordinating hub for locally tailored COVID-19 responses. By contrast, the decades after 1970 saw world-renowned Anglo-American public health systems face increasing challenges posed by funding cuts, privatisation, overambitious reforms, and increasing loss of political autonomy. Both the US Centers for Disease Control and Prevention and Public Health England retained significant prestige, which resulted in an overestimation of capacity by international reviews. However, once centres in Atlanta and Colindale had been overwhelmed, there was little local and state public health capacity to fall back on.
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