Brazilian Subnational Pandemic and Everyday Health Politics

Adan S. Martinez


Despite historical experience and health state capacity, Brazil struggled to address the COVID-19 pandemic. Whereas past administrations have proactively mobilized resources to combat epidemics, Bolsonaro’s administration took a more passive role. The federal government’s relative absence forced state and municipal governments to plan and manage the pandemic response. At the state level, governors, across different political parties and varying loyalties towards Bolsonaro, banded together to procure vaccinations for their citizens. At the municipal level, mayors enacted a series of social and public health support measures. However, these responses were not universal, and there has been significant variation between and within municipalities.

What explains municipal variation in the enactment of pandemic-related public policies? Current studies focus on three explanations – political alignment, health state capacity, and diffusion – to explain policy implementation variation across and within countries at various levels of governance. While these studies are important to our knowledge of pandemic responses at the federal and state levels, there have been few studies examining these explanations at the local level. Using quantitative and qualitative evidence, this article argues that, while conventional wisdom holds in explaining pandemic responses, the mayor’s health training and population size mediate conventional explanations such as state capacity and political polarization.

This article makes two key contributions. First, it tests the conventional wisdom of pandemic responses at the municipal level, which is important to our understanding of local city dynamics and highlights key mechanisms that mediate the implementation of COVID-19 policy. Second, it provides alternative hypotheses, such as the mayor’s health training and population size, which are idiosyncratic to the level of analysis. This project is part of a larger project exploring the political motivations of COVID-19 implementation in Brazilian municipalities.

Key Words: COVID-19, Brazil, polarization, state health capacity, city governance, diffusion