Global health crises show that states remain the primary players in responding to emergencies. They must balance protecting public health, keeping the economy stable, and upholding civil liberties, all while dealing with global connections and maintaining public trust.
The COVID-19 crisis showed that all states do not respond in the same way and that their actions reflect deeper ideologies and varied priorities. Stricter border controls, such as Schengen-area closures (EPRS 2020), restrictions on the export of PPE by the USA under the Defense Production Act (Owen 2020), and protection of their own citizens, reflected the realist ideology of some states. This was mainly centered on national security and self-interest. The realist ideology assumes that the global world order is anarchic and that states must be self-sufficient.
This is clear from the fact that most countries implemented unilateral border closures, even as the World Health Organization advised against general travel bans, illustrating the primacy of territorial security (Fidler 2020). Despite the fact that unequal vaccine distribution can increase total cases and drive the emergence of new variants, vaccine nationalism became a hallmark of realist behavior (Wagner 2021).
In contrast, some states followed a liberal approach during the pandemic. Their only focus was not just their national interest, but also to support humanity at large. Countries like Germany & Norway contirbuted to the World Health Organization’s (WHO) COVAX initiative. This initiative aimed at fairly distributing COVID-19 vaccines to low and middle income countries. This effort highlights liberalism’s emphasis on cooperation and interdependence (Wouters, 2021).
Meanwhile, many important decisions, such as how to organize testing, enforce lockdowns, and hospital management, were defined by each country’s institutions, experts, and bureaucratic capacity. Seeing these different approaches led to the research question for this paper: How do state strategies during a public health crisis like COVID-19 illustrate the influence of governance theories (such as realism, liberalism, and public administration)? This is an important question to ask since public health crises like COVID-19 not only impact the state but geopolitics at large.
Crises like these are a stress test not only for healthcare systems but also for our governing bodies & institutions, as they are expected to handle healthcare & economic challenges while maintaining public trust.
In this paper, it is argued that no single governance theory is perfect for dealing with a public health crisis, but that many states use a mix of strategies. Understanding the influence of governance theories will help explain why some countries acted as they did and how some might have been more effective than others.
Realism during the pandemic: self and state first
The governance theory of realism revolves around the idea that leaders act to secure national interests and ensure survival, avoiding actions that would weaken their own position as a state. Typical and unsurprising behaviours and responses during the pandemic were border closures, travel bans, and prioritizing citizens for scarce medical supplies. While experts were testing the efficacy of hydroxychloroquine, a drug used to treat malaria, for COVID-19 patients, India imposed an export ban on it (Dasgupta 2020). This can be seen as a very realist response to the pandemic.
The Federal Emergency Management Agency, under the United States Department of Homeland Security, also introduced export restrictions on personal protective equipment (PPE) & medical supplies during the peak of the pandemic. They introduced a temporary rule to assign scarce PPE for domestic use only, adding that FEMA must formally approve and authorize any export of these materials from the United States.
The realist theory argues that international organizations are ineffective in times of global crisis and that self-reliance is the only way to overcome such challenges. This belief was reinforced by some scholars who argued for the delayed action and ineffectiveness of the World Health Organization (WHO). WHO’s effectiveness was limited by the priorities of its member states; it couldn’t act independently of political influence (Basrur 2021).
In another example, Taiwan, with its able government and public institutions like the Taiwan Central Epidemic Command Center (CECC), established early in 2020, acted early by screening travelers, setting up quarantine, and imposing travel and gathering restrictions (Lai, Chih-Cheng 2022). The positive effects were evident in Taiwan’s record of almost 200 days without reported domestic COVID-19 cases (Graham-Harrison 2020).
Most state actions were not seen as cooperative public health measures but as necessary steps to defend national security. The pandemic created a situation in which states viewed other states as competitors for scarce resources, such as ventilators, PPE, and vaccines, rather than as partners in a shared global crisis.
Liberalism during the pandemic: cooperation and collective good
Liberalism is a school of thought in international relations that focuses on international cooperation. Liberals believe that human progress and peace are achievable through global institutions and collaboration. A shining example of Liberalism during the Pandemic is the COVAX initiative of the World Health Organization (WHO). This initiative was established to enable equitable access to vaccines in lower- and middle-income countries. Since its launch in April 2020, 190 countries have participated in it. The initiative supported the delivery of nearly 3 billion vaccines by the end of 2022 to lower-income countries like Chad, Mali, and Burundi.
This initiative supplied nearly 550 million doses free of charge to low-income nations. The initiative was also aimed at providing technical support for the cold storage supply chain &
equipment, as well as awareness campaigns (Edmond, 2024). COVAX led to the largest deployment of ultra-cold chain equipment in history, coordinating installation and maintenance support. 73 lower-income countries received support to expand their cold and ultra-cold chain capacity during the pandemic (Gavi 2024).
Additional institutes around the world looked at more liberal and global approaches to the healthcare challenge. One such institution was the World Bank, which approved financing of 12 billion US dollars for vaccine projects in lower-income countries in October 2020. However, progress was slow; by June 2021, only 25 countries’ vaccine-related projects had been approved. Gavi saw the need for an adaptable approach here and launched the COVID-19 vaccine Delivery Support (CDS). This was a funding package to support the roll-out and scale-up of COVID-19 vaccines. CDS funding was a key contributor to the scale-up of vaccine administration in Somalia, increasing coverage from 5% to 90% (Gavi 2024).
Another excellent example of liberalism in times of public health crisis is the sharing of data between various health institutes and regulatory authorities, such as the US’s FDA, Health Canada, and the EU’s European Medicines Agency, to expedite review of COVID-19 vaccines (Welsh 2022). This kind of collaboration between regulatory authorities is a perfect illustration of collaboration amongst states and how mutual trust can lead to collective good.
The European Union, which is committed to liberal values, set the precedent for liberalism during a public health crisis. Team Europe, a joint venture of the EU, its Member States, and various European financial institutions, was formed to strengthen healthcare systems and offer socio-economic support to its partners. As part of this initiative, Team Europe secured 46 billion euros for a global response to COVID-19, of which 9.8 billion euros was allocated to Africa.
This initiative also invested 1 billion euros to ramp up health technologies and medicine production capacities in Africa. And finally, Team Europe shared 250 million COVID-19 vaccine doses via the COVAX program by the end of 2021 (European Commission 2021).
Marxism during the pandemic: socioeconomic welfare for all over capitalism
Although most countries adopted a realist approach in response to the pandemic, the state’s intervention to secure public health over economic outcomes draws parallels with the Marxist theory of International Relations. In socialist regimes like China, major health institutions are state-owned. China was one of the first countries to deploy the state-owned pharmaceutical company Sinopharm’s BBIBP-CorV vaccine to its citizens (BBC 2020). Here, the state’s control of a key industry during the global health crisis had a significant impact; the vaccine’s efficacy against hospitalization due to COVID-19 was 79% (WHO 2021). The Chinese state invested in the rapid construction of “Fangcang” shelter hospitals, highlighting its commitment to public welfare for all (Shang, L. et al., 2020).
Global South Perspectives
We’ve so far explored the Western view of IR on the COVID pandemic, but the research would be incomplete without touching on the Global South perspective. The South Asian Association for Regional Cooperation (SAARC) is one of the key international collaboration organizations of the Global South. Since its formation in 1985, its primary goal has been to catalyze regional cooperation. The COVID-19 pandemic brought together the SAARC COVID-19 Pandemic Emergency Fund. 18 million dollars were contributed by member states to tackle the public health crisis. India shared online training for emergency responders and set up surveillance platforms to help neighboring countries manage the outbreak. Several South Asian countries removed tariffs on medical devices, protective gear, disinfectants, and soap. (Alden, Chris & Dunst, Charles)
While Africa relied heavily on philanthropic efforts and aid from partner states, the African Union took liberal steps to strengthen its response against the health crisis. The Africa Centres for Disease Control and Prevention (Africa CDC) aimed at distributing one million COVID-19 test kits as part of a new programme called “Partnership to Accelerate COVID-19 Testing, or PACT” in the union. (Alden, Chris & Dunst, Charles)
On the southern left side of the Atlantic Ocean, the Latin American countries saw some mixed responses to the pandemic. Starting off with MERCOSUR, which is a regional organization consisting of member states like Argentina, Uruguay, Paraguay, and Brazil. The bloc approved a
$10 million fund to fight the pandemic; however, its policies remained ineffective, and Argentina opted for a realist approach and exited the bloc. CARICOM, the regional organization of the Caribbean had a similar response to the crisis. Molwy Joseph, the Chair of Health Ministers of the bloc emphasized on building national/regional capacity to detect, contain, and manage COVID-19. 7.3 million dollars were allocated by USAID to Latin America but the lack of a unified policy implementation did not amount to an effective response either. (Alden, Chris & Dunst, Charles)
Conclusion
The responses of nations around the world to COVID-19 have remained quite heterogeneous. This global public health crisis demonstrated that no governance theory could shape a state’s response to the crisis. A combination of realist and liberal strategies remained dominant across most states. Border closures, vaccine hoarding, and bans on the export of medical supplies were common practices seen on the realist front. It is understandable for nations to want to safeguard their interests first, in order to eventually support liberal strategies. Stronger Western economies were able to adapt faster to liberal strategies like scientific collaboration and financial support to the WHO’s COVAC initiative.
There were no states that adopted a purely Marxist approach but drew inspiration from the broader socialist strategies. China’s state-led high-speed Fangcang construction (shelter
hospitals) and state-sponsored vaccine development help curb hospitalisations to a large extent. In conclusion, no single theory of International Relations can be labelled as the one-size-fits-all solution to a global health crisis, but choosing elements from each led to the most effective responses. Most countries blended approaches to balance public health priorities & economic stability. Understanding these theoretical influences not only helps explain past decisions but also provides insights for more balanced and effective governance in future global health crises.
Expanding on these insights, it is clear that the pandemic provided a real-time laboratory for observing how theoretical frameworks guide, and sometimes limit, policy choices. For instance, the pandemic exposed the strengths of rapid, centralized decision-making in countries with strong public bureaucracies, as well as the vulnerabilities of fragmented governance systems.
States that successfully integrated scientific expertise into their decision-making processes generally saw better outcomes in terms of infection control and public trust. Moreover, the crisis highlighted deep inequalities both within and between countries, challenging the international community to consider distributive justice as a core component of global health governance. The tensions between national interests and global solidarity became especially apparent as vaccine access diverged sharply along economic lines, raising ethical questions about the obligations of wealthier nations. The lessons from COVID-19 suggest that future crises will demand even greater flexibility and innovation in governance, requiring states to transcend rigid ideological boundaries and prioritize adaptive, inclusive, and cooperative approaches. Only through such synthesis can the world hope to respond more effectively to the next global health emergency.