State Capacity and Policy Bubbles Shape Brazil's Pandemic Response

The effectiveness of a government's response to a health crisis is determined long before the emergency begins. Research comparing Brazilian states during the COVID-19 pandemic reveals that state capacity—defined as the collection of resources, structures, and skills necessary to handle public health crises—was the primary differentiator. This capacity cannot be improvised during moments of urgency; it must be accumulated over time.

States that historically invested in public health entered the pandemic with functioning institutional structures. This accumulation allowed them to strengthen existing policies and offer coordinated responses oriented by scientific evidence. In contrast, states with lower institutional capacity adopted irregular responses. Without robust data bases, these governments gave greater weight to information from the productive sector and committees focused on economic impacts, resulting in strategies less centered on sanitary logic.

The specific advantages of high-capacity states included:

• Consolidated routines of epidemiological surveillance
• Experienced technical teams
• Stable and reliable channels for the production and use of information

These elements allowed states like São Paulo and Ceará to interpret the crisis through a distinct logic compared to those with less institutional accumulation.

The study introduces the concept of policy bubbles to explain how these disparities in capacity form. Unlike financial bubbles, which are ephemeral, policy bubbles form when governments concentrate resources intensively and recurrently in specific areas, particularly during urgent contexts. When the crisis ends, these bubbles do not dissipate; instead, they leave behind durable institutional legacies.

These legacies structure administrative capacities, decision-making circuits, and the sources of information mobilized in future crises. In Brazil, previous epidemics such as Zika and dengue led some states to invest continuously in strengthening their sanitary infrastructure. This created a feedback cycle:

1. Expansion of technical capacity favored organized responses.
2. Successful responses sustained new investments in the health sector.
3. The relative weight of other information sources (such as economic data) was reduced.

As a result, the policy bubbles created in the health sector conditioned the diversity of scientific evidence that guided decision-making processes during the COVID-19 pandemic.

Differences in investment were directly reflected in the composition of government committees created to guide the pandemic response. In states with higher epidemiological capacity, such as São Paulo and Ceará, these bodies were composed mostly of public health experts.

For example, the Contingency Committee for COVID-19 in São Paulo brought together epidemiologists and health technicians who exercised direct influence over the state's political agenda. This prioritization of sanitary logic ensured that decisions were driven by technical expertise.

In contrast, states with lower epidemiological capacity, such as Acre, Amapá, and Goiás, utilized more diversified arrangements. These governments incorporated representatives from other sectors, including actors from agriculture and commerce. In Goiás, the Socioeconomic Committee for the Fight Against Coronavirus illustrated how economic concerns gained centrality in pandemic management. Similarly, in Acre, working groups sought to articulate sanitary issues with economic and social impacts, reflecting an approach less focused exclusively on health.

The study emphasizes that while financial bubbles are temporary, policy bubbles are difficult to form but tend to persist once consolidated. In Brazil, the recurrent concentration of resources in health—specifically in epidemiological surveillance—has materialized in more robust budgets, specialized technical staff, and decision-making committees where sanitary expertise holds central authority.

These arrangements influence trajectories and create regulatory frameworks that define which information enters the governmental agenda and who has the authority to interpret it. Over time, this reinforces the position of specific sectors in state politics. The effect is not neutral: maintaining these bubbles tends to amplify the capacity to respond to health emergencies, while their weakening can lead to a loss of institutional capacity and a return to improvisation.

The COVID-19 crisis highlighted how the formation of policy bubbles and the unequal distribution of resources affect the responsiveness of states. Understanding how these bubbles form is fundamental to analyzing public policy in Brazil and anticipating who will have a voice when the next emergency arrives.