Damned if you do,damned if you don’t: The politics of pandemic preparation as a grand challenge

Abstract

In this article, we shed light on the politics of preparation for a pandemic. We show why the existing literature fails to explain the puzzling case of France, which became one the best prepared countries in the world, only to discontinue its efforts to find itself unprepared when COVID hit. To investigate what happened, we conduct a qualitative process-tracing analysis of pandemic preparation efforts for two decades. From this, we induce the causal mechanisms at work during this period and we develop new insights on adverse events preparation and mitigation. Our main contribution is to conceptualize pandemic preparation as an insurance which would reduce future costs only in certain conditions. Given this particularity, we contend that governments take significant electoral risks when they engage in such an endeavour. If preparation is successful, it is likely to remain largely invisible and bring no electoral credit. If in contrast, the feared event does not happen or if its effects have been overestimated, a mechanism of blame generation for having wasted public money will be at play. Finally, if governments discontinue preparation and the dreaded event occurs, they will be blamed (again) for this discontinuation. Hence, governments risk being blamed twice when engaging in pandemic preparation, which explains why governments rarely prepare enough.

Keywords

France insurance long-term pandemic preparation

Points for practitioners

It is essential that experts, policy-makers and members of parliament take part in the decision to maintain future-oriented investments.

Policy-makers should lock in preventive policies through legal mechanisms or through the empowerment of political actors who would be vocal if the prevention efforts were discontinued.

Governments should establish independent agencies with protected budgets to oversee long-term prevention policies.

Public reporting systems should be put in place to demonstrate the value of preparedness.

Introduction

Societies are confronted with health challenges connecting nature, animals and humans, such as the risk of a lethal pandemic. Preparing for such occurrences is a complex and uncertain process: for instance, the COVID-19 pandemic has shown that most countries were insufficiently prepared to face major health risks.

In this article, we study the curious case of pandemic preparedness in France, a case that cannot be explained by previous research. Why did the country go from being an exemplary case of careful pandemic preparation from 2002 to 2008 to a case of complete lack of preparedness to face the COVID-19 crisis? Why is it so hard for governments to maintain preparedness efforts for a long period? Our main claim is that spending for (pandemic) preparation or mitigation can politically backfire. Indeed, we show that in the case of France, the government—and in particular the French Health minister—was blamed for allegedly overreacting to the H1N1 crisis, a flu that was milder than expected, and wasting public money to the benefit of powerful industries. This subsequently led to an unwillingness among risk-averse politicians and civil servants to dedicate resources to pandemic preparation in a context of budgetary constraints, therefore not renewing expired individual protection equipment and simulation exercises.

By studying the case of France, we make a significant contribution to the literature on preparation for grand challenges. Recent research on disaster preparedness usually assimilates such preparation to a public investment, allowing the state to save money in the future (e.g. Healy and Malhotra, 2009; Jacques and Noël, 2022). Instead, we contend that it is more accurate to consider preparation for the future as an insurance. In contrast to investments, which theoretically generate returns in the future, insurance is often about reducing future costs. However, insurance sometimes just costs money. This happens when the feared event does not happen, or if it occurs when the insurance has been discontinued, or when its impacts have been overestimated and incur costs that remain lower than the price of the assurance premium. Preparation conceived as an insurance illustrates why risk-averse policy-makers might prefer not to spend money for this purpose.

Contributions to research

In the last two decades, several scholars have analyzed the political obstacles against the implementation of policies oriented towards the future—analyzing long-term investments but also policies aimed at preventing or mitigating the effects of a (potential) future adversity. While most studies focus on impediments to such long-term policies, a few of them have analyzed the conditions favoring them. However, few of these studies help to explain the backlash against the government, which characterizes the case of France. In this section, we examine these points in turn to highlight our contribution.

Long-term policies involve an intertemporal trade-off: the allocation of scarce resources in the present to generate benefits unfolding only in the long-term (Boston, 2016; Jacobs, 2016; Jacques and Noël, 2022). This intertemporal trade-off poses a series of obstacles to decision-makers. First, it involves a “credible commitment problem” in the sense that voters, policy-makers and interest groups must believe that the sacrifices they make in the short term to fund the investment will not be diverted. Indeed, voters often oppose future-oriented policies because they face uncertainty about their efficacy (see for example Brunner and et al., 2012) or because they fear that politicians will misuse funds allocated to prevention (Andrews and et al., 2023; Gailmard and Patty, 2019).

Intertemporal trade-offs also imply that long-term spendings are less electorally appealing than other kinds of expenditures. One first reason is that long-term policies adopted by a given party produce benefits that may be credited to its successors (Moury and Cardoso, 2020). Another reason is that individuals generally prefer immediate rather than delayed gratification (Boston, 2016; Jacobs and Matthews, 2012) and, as a consequence, politicians generally believe that voters are myopic and demand policies with immediate and visible benefits (Lucas et al., 2024). In that line, it has been shown that voters reward governments for visible spending on disaster relief rather than for disaster prevention or mitigation (Healy and Malhotra, 2009) regardless of citizens’ previous exposure to previous disasters (Bechtel and Mannino, 2021).

While long-term investments, in education and infrastructure for example, may generate benefits for specific constituencies in the short term (Jacques, 2021), it is not the case for disaster prevention. Instead, prevention and mitigation often produce invisible and diffuse benefits that may be opposed for short-term gains. For instance, there might be a contradiction between preventive regulation and economic growth (Boin and ’t Hart, 2003). Moreover, voters cannot observe the counterfactual (the impact of the disaster in the absence of preparedness) and therefore do not credit the government for their action (Andrews et al., 2023; Gailmard and Patty, 2019). Successful crisis prevention and mitigation are thus non-events: occurrences that do not generate media attention and hence cannot engender political credit claiming (Boin and ’t Hart, 2003). They imply “zero-credit politics” (Patashnik et al., 2018).

Inter-temporal policies, furthermore, involve a high degree of complexity and uncertainty: forecasting cannot deliver “hard evidence” (ESPAS, 2019) and long-term policies are typically complex and their outcome difficult to foresee (Veenman, 2013). When problems are unpredictable and uncertain, bureaucracies must be flexible, creative and ready to partner with outsiders (Sørensen and Ansell, 2023). Related to this, risk-averse citizens might be cautious about innovative policies, refusing to be guinea pigs and resisting technocratic solutions (Biesbroek et al., 2014).

Those political and technical risks contribute to making prevention a wicked policy problem unlikely to be solved (Esposito and Terlizzi this volume; Hood, 2010). This is because such problems rarely have a simple solution, and also because politicians are risk-adverse: they know that voters (and the media) put more weight on policy failure than on success (Boin and ’t Hart, 2003; Hood, 2010; Weaver, 1986). All those obstacles mean that political actions are not likely to be adequately oriented towards the future. Howlett (2014: 401) summarizes the issue when describing the politics of climate change preparedness: “Risk-averse governments are often happier to do nothing or little rather than do something which might lead them to be blamed for a failure.”

Those obstacles, of course, are sometimes overcome. Citizens’ trust in governments help to solve the credible commitment problem (Moury and Cardoso, 2020). Institutions can play a critical role in mitigating citizens’ lack of trust. Mechanisms such as independent agencies, “guardian institutions” binding agreements, and dedicated trust funds could enhance policy durability by limiting policymakers’ discretion and hence increase trust and acceptance of future-oriented spending (Andrews and Ryan, 2022; Hovi and et al., 2009; Jacobs and Matthews, 2012). However, if they are too weak or too strong, they risk being dismantled after their creation (Rose, 2024).

Long-term policies are more likely in consensual democracies as they give parties greater electoral safety, as they are more insulated from blame in case the measure is unsuccessful (Hood, 2010), and parties have stronger probabilities of being in power when the benefits of their investment start to show (Jacques, 2022). Moreover, in power-sharing systems, socio-economic policies are often negotiated by employers and employee representatives who have a longer time horizon than the typical voter (Jacobs, 2016).

Also, crises can serve as windows of opportunity for advancing future-oriented policies (Boin and ’t Hart, 2003). If citizens fear a possible future adversity, they will pressure policy-makers to protect them from it (Sunstein and Zeckhauser, 2011). For instance, after a flood, policy-makers generally increase spending on natural disaster prevention (Lodi et al., 2023). As recent papers comparing reactions to COVID and to climate change have shown, however, actions are more likely to happen when the feared event is imminent, visible and reassuring and temporary solutions exist (Van der Ven and Sun, 2021). Since fear is not purely objective, it is subject to political construction (Klopf and Nabers, 2024). In fact, sometimes, policy-makers “over-learn,” in the sense that policies are taken to prevent future crises without a rational debate about the full societal cost–benefit associated with such policies (’t Hart, 2013). Finally, long-term spending is likely to be cut back during periods of fiscal consolidation as governments protect programs beneficial in the short term for their constituents and cut less visible programs (Jacques, 2021; Jacques and Noël, 2022). Hence, prevention is more likely to be sustained during fiscal expansions.

All of this research has gone a great way to explain the general lack of future-oriented policies, and their variation over countries, but fails to fully answer the puzzles raised by the case of France—which became one the best prepared countries in the world, despite the many obstacles identified above (lack of electoral incentives, concentration of power in a majoritarian democracy, relatively low trust in institutions, etc.). The existing literature also fails to explain why and how both preparedness efforts and lack thereof can backfire against governments—as it happened in France. In the next section, we try to answer those questions.

From best-prepared to unprepared: the case of France (2000–2021)

This section presents the findings of our study on France's pandemic preparedness from 2000 to 2021. France was selected as a critical case for understanding the dynamics of pandemic preparedness because it transitioned from being a global exemplar of readiness to experiencing significant shortcomings during COVID-19. This extreme variation makes the case particularly valuable for theory-building.

We employ single-case qualitative study, applying theory-building process tracing (Beach and Pedersen, 2016). Process-tracing consists in putting together evidence about policy making, while being attentive to both chronological evolution and causal mechanisms (Collier, 2011). This focus on causal mechanisms distinguishes process-tracing from historical narratives that have other purposes (Biesbroek and et al., 2017; Blatter and Blume, 2008).

The empirical material was gathered by triangulating different types of data. We rely on a content analysis of official documents from the media, international organizations, government and parliaments. To complete or validate those sources, the first author of this article conducted seven face-to-face interviews with actors who were identified as important by the content analysis. All our methodological choices are detailed in the Appendix.

Our first goal is to identify the causal mechanisms explaining four outcomes: France being “one of the best prepared countries in the World against a pandemic” according to WHO (outcome 1); the backlash against government for such a preparation (outcome 2); the dismantling of those efforts that brought France to be one of the worst-performing European countries in handling the outbreak of the COVID-19 pandemic in 2020 (outcome 3); and a second backlash against government for being unprepared (outcome 4). Our second objective is to induce from the discovery of those mechanisms new theoretical insights on preparedness. To anticipate, we identified four mechanisms and their related favoring variables that we present in Table 1.

Table 1.

Summary of the empirical findings.

Outcome	Events	Mechanisms	Favoring variables
1: The preparation for the pandemic, 2000–2009	Adoption of pandemic preparedness plans, significant mask and antiviral stockpiling, regular foresight exercises Implementation of H1N1 vaccination campaign	Political entrepreneurship	Political attention, foresight capacity, fiscal leeway, inclusion of various stakeholders
2: Backlash I, 2009–2010	Political backlash, accusations of overreaction and waste of public money	Blame generation	Centralized decision-making, media divulgation
3: Dismantlement of preparation, 2001–2020	Fear of overreaction, reduction in stockpiles, budgetary constraints, decentralization of decision-making, and dismantlement of prevention capacity.	Blame avoidance/political learning	Budgetary constraints, seclusion of decision-making
4: Backlash II, 2020–	COVID-19 unpreparedness, severe resource shortages, legal inquiries and public criticism	Blame-generation	Media divulgation

Phase 1: the preparation (2000–2008)

The beginning of the twenty-first century was characterized by a global preoccupation with infectious diseases (Interviews 1, 2, and 5). In the preceding decade (1990–2000), the number of deaths linked to AIDS had peaked in the USA and Europe, and new deadly viruses (e.g. Ebola, H5N1) had been discovered. Following this, there was a surge in academic publications, conferences, and projects on the topic (Interview 2), and international organizations requested their members to prepare themselves (WHO, 2003).

In France, Philippe Douste-Blazy, a professor of medicine specializing in prevention and epidemiology, was appointed in March 2004 as Minister of Health in the center-right Raffarin government, during the H5N1 avian flu epidemic outbreak in Southeast Asia. The Minister promptly initiated the development of a “flu pandemic plan,” which was presented to the Council of Ministers in October 2004 (Sénat, 2010). A few months later, in April 2005, an outbreak of the infectious tropical disease chikungunya struck La Réunion Island, a French overseas department, causing more than 200 deaths within a year.

Following this, several institutions, scientists, and members of parliament (often medical doctors) warned the government (both publicly and confidentially) about the dangers of a global pandemic caused by a new, virulent virus (Assemblée Nationale, 2006; Institut de veille sanitaire, 2005). The reports urged governments to immediately stockpile masks and antiviral drugs, secure additional funding for research, and expand the domestic mask-manufacturing industry (Sénat, 2010). At that time, however, Douste-Blazy recalled that his colleagues in the Council of Ministers did not seem to share his concerns (Douste-Blazy, quoted in Lhomme and Davet, 2020).

In June 2005, Xavier Bertrand was appointed Minister of Health. Soon after, he attended a simulation of “a primary outbreak of highly pathogenic avian influenza with high mortality.” This exercise left him deeply concerned about the risks of a pandemic (Xavier Bertrand quoted in Lhomme and Davet, 2020). One month later, Bertrand decided to meet two prominent scientists who had been publicly warning about the government's lack of preparedness. They convinced him that France was not ready and that more needed to be done to prepare for a potential pandemic (Interview 5; Xavier Bertrand cited in Sénat, 2010). Bertrand subsequently appointed Didier Houssin, the head of the French Health General Directorate, as the “interministerial delegate for avian flu” (Journal Officiel, 2005). For 5 years, Houssin led a weekly ministry-level meeting called “Tuesday Flu” and ordered hundreds of millions of masks and pre-pandemic H5N1 vaccines (Sénat, 2010: 25).

Bertrand also visited the countries most affected by the H5N1 outbreak. During these visits, Chinese authorities warned him that they could not guarantee the supply of masks in the event of a pandemic. As a result, Bertrand decided to establish a national production capacity (Assemblée Nationale, 2020), and by the end of 2006, France had stockpiled 600 million FFP2 masks. In March 2007, after a visit to the US Centers for Disease Control and Prevention, Bertrand also adopted a “law on the preparation of the health system for large-scale health threats” (Houssin cited in Lhomme and Davet, 2020). The law included the creation of an “Institute for the Preparation and Response to Health Emergencies” (EPRUS), which was responsible for managing medical equipment and forming a body of health professionals who could be mobilized at any time. With appropriate resources, EPRUS maintained considerable stockpiles, including 81.5 million antibiotics, 70 million vaccines and 11.7 million antiviral treatments (Syndicat des infirmières libérales, 2020). By the end of 2008, the stock of masks had reached 1 billion surgical masks and 723 million FFP2 masks (Bachelot-Narquin, 2009). The cost of these measures was estimated at €592.3 million in January 2009 (Sénat, 2010), a cost that the Prime Minister and the President accepted to bear (Hearing of Xavier Bertrand, Sénat, 2005), as France was in a period of fiscal expansion. At that time, France was considered one of the best-prepared countries in the world, according to the World Health Organization (WHO, 2006), and was therefore very well prepared to face, a few years later, the emergence of influenza A virus originating from Mexico, later named H1N1 (WHO, 2009).

In this section, we observe that preparedness was made possible thanks to the actions of the two Ministers of Health and the General Directorate of Health, which followed the policy recommendations of a series of experts. We thus witness a “political entrepreneur mechanism” (Hogan and Feeney, 2012; Kingdon, 1984) through which political entrepreneurs act as intermediaries between (1) policy entrepreneurs (in this case, scientists, technicians, and some MPs proposing specific policies) and (2) the State, thereby facilitating policy change. The budgetary leeway available at the time, the political attention owing to the perception of a crisis, foresight capacity and inclusive decision-making were favoring conditions for this mechanism to occur.

Phase 2: the backlash (2009–2010)

Faced with the H1N1 pandemic, Roselyne Bachelot, the Minister of Health appointed by Sarkozy in May 2007, did not wait to activate a crisis unit (Sénat, 2010). Counting on the full support from the president, she took a wide range of precautionary measures, including border controls with temperature taking, equipping nursing homes with masks, the free provision of a kit of antiviral treatments and masks, the purchase of respirators and equipment for resuscitation services in hospital, and the mandatory solitary confinement of infected populations. She renewed the stock of FFP2 masks and quickly planned a mass vaccination program for the entire population, starting before the Fall of 2009, when the outbreak of the virus was expected, at a cost of €600 million (Bachelot-Narquin, 2009; Buton and Pierru, 2011; Sénat, 2010). On 12 November, the vaccination campaign kicked off, starting with the medical staff and the vulnerable population, but very few people got vaccinated (7% of the population and 10% of medical staff, Buton and Pierru, 2011), in great part because the case-fatality rate was close to that of the seasonal flu, despite persistent uncertainties about possible mutations of the virus (Sénat, 2010).

The organization and price of the vaccination campaign led to strong criticism from the media, the opposition and even some members of the majority. For example, already in October 2009, Gérard Bapt, an MP from the opposition (PS), rapporteur on the social security budget, accused Roseline Bachelot of hiding contracts regarding vaccines (La Dépeche, 2009). She was also accused of having purposely exaggerated the severity of the virus to “sell stocks” (Benoit Hamon, La Tribune, 2010) or having succumbed to the “fantastic financial pressure” put by the pharmaceutical industry (Les échos, 2009). Political actors remember frequent “bashing of Bachelot” (Interview 3) and “violent attacks” (Interview 4, 7). Roselyne Bachelot herself recalled, in front of the Parliament a decade later, “having found herself alone” to face violent accusations with sometimes “sexist overtones” in parliament and on television (Assemblée Nationale, 2020). A conclusion that she drew from her experience is that: “for us, politicians, the risk of doing too much has become greater than not doing enough” (Ouest-France, 2020).

Two commissions of enquiry were set up in the Senate and the National Assembly, in February and March 2010. The Parliamentary report delivered a few months afterwards highlighted a vaccination campaign with “disappointing results,” that was “planned for a more serious pandemic,” but the report, led by a majority member, presents a generally positive evaluation of the government's actions (Assemblée Nationale, 2010). Three weeks later, the Senate presented its own report (Sénat, 2010) which was much more critical, deploring amongst other things the government's “authoritarian attitude” towards public hospital members and its “alarmist claims” which “bred anxiety about viruses.” The report also questioned the opacity of the WHO's management of the pandemic crisis, as well as the conflicts of interest of some of its experts and their impact on the WHO's recommendations (Sénat, 2010). In March 2011, the report of the Court of Auditors also criticized the decisions made by the government, in particular the decision to order vaccines early at the start of the epidemic, “the badly negotiated contracts,” and the choice of vaccine coverage to the total of the population (Cour des comptes, 2011).

In this second phase, we thus observe a blame-generation mechanism in which political elites and media turn into controversy governmental actions “that did not work out as planned” (Hinterleitner, 2023: 1237)—in our case an overestimation of the risk of the H1N1 virus. In such a mechanism, the opposition engages in personal attacks and generates blame at its political opponent (Hinterleitner, 2017; Weaver, 1986), while the media plays its role of a watchdog with a view of generating public attention. Two facilitating factors of this blame generation were the concentration of power that characterises the French system and the accusations, transmitted by the media, of conflict of interests between public officials (notably in the World Health Organization) and pharmaceutical companies (Cohen and Carter, 2010).

Phase 3: gradual dismantlement of the preparation efforts (2011–2020)

After the H1N1 episode, in November 2010, Xavier Bertrand, was nominated again as the Minister of Health. Yet times were very different than a decade ago. As Bertrand explained in front of the Parliamentary inquiry, at his second term everyone was afraid to spend money preparing a pandemic: “After the episode of the H1N1 flu, at the end of which Roselyne Bachelot was unfairly vilified (…) people thought that we had done too much and that it had cost a lot of money (…) the climate was the one that the health risk came up against budgetary constraints” (Xavier Bertrand, interview at Assemblée Nationale, 2020).

During his time in office, Bertrand made no new orders for the purchase of expired FFP2 masks despite technical recommendations in favor of it (Haut Conseil de la Santé Publique, 2011; Sénat, 2020). Nor did so her socialist successor, Marisol Touraine. She based her decision on a note from the General Secretariat for Defence and National Security (SGDSN) indicating that it was employers’ responsibility to stockpile masks to protect their staff (Lhomme and Davet, 2020). While the authors of the document later clarified that the note was never intended to apply to public employers like hospital managers (Hearing of SGDSN civil servants, Sénat, 2020), the Health Minister interpreted it this way (Hearing of Marisol Touraine, Sénat, 2020). As a result, there were almost no FFP2 masks in stock by 2016 (Sénat, 2020).

In 2014, it was decided to merge EPRUS, the Institute for Health Surveillance and the National Institute for Prevention and Health Education in a new French Public Health Agency. Thus, EPRUS logistic competences were “diluted within an establishment with much broader missions” (Sénat, 2020: 55). In addition, this merger has led to a reduction in staff numbers of 30% since 2010, and a reduction of the budget (−56% relative to 2011) (Lhomme and Davet, 2020; Sénat, 2020). In 2015, the then-Senator Francis Delattre wrote a parliamentary report alerting about the reduction of the budget of EPRUS and the decision to stop the renewal of masks, but this time policy-makers turned a deaf ear (Sénat, 2015). All this occurred in a context of fiscal consolidation in which Ministers were asked to cut spending (Interviews 1, 4, and 7), but also of one in which the risk of terrorist attacks put the fear of a pandemic in the background (Hearing of Claire Landais, Sénat, 2020).

In September 2018, more than 78% of the chirurgical masks in stock, together with most of the antivirals, antibiotics and antidotes stocked, were evaluated as improper to use and were destroyed but not replaced (Assemblée Nationale, 2020; Sénat, 2020). This decision, which later became very controversial, was taken by the Health Director General, Jérome Salomon, in consultation with the Director General of Santé Publique France François Bourdillon (Assemblée Nationale, 2020). Both decided that it was not necessary to stock masks, as they could instead keep a small “buffer” stock in warehouses with guarantees of additional supply negotiated with foreign manufacturers (Assemblée Nationale, 2020). As one of our informants explained: “We thought that there was no point in keeping large stocks of masks once they could be ordered from China” (Interview 6). The French administration thus failed to anticipate supply disruptions linked to the explosion in global demand (Interviews 2, 5, and 6, Hearing of Agnés Buzyn in Sénat, 2020).

Allegedly, neither the new minister of Health Agnes Buzyn, nor the members of her cabinet, nor the Member of Parliament were informed of Salomon's and Bourdillon's decision (Sénat, 2020, Hearing of Touraine, Assemblée 2020). As noted by the rapporteur of the Assemblée Nationale: “The reduction in the State's strategic stocks seems to have been carried out with indifference or ignorance on the part of the political authorities (…) and has never been brought into the public debate” (Assemblée Nationale, 2020). In 2018, owing to the lack of public procurement, the four French factories producing masks closed their doors.

The lack of preparation for future pandemics was also visible in the exercises preparing for a pandemic. They had been created in 2004, were held yearly in the first years, but became increasingly rare over time, and were no longer held after 2013 (Assemblée Nationale, 2020). One interviewee who had played a role in lobbying for the creation of those exercises told us that he thought that “the job was done” and was unaware of the end of preparatory exercises (Interview 5). Another also said that he felt “traumatized” by the accusations of overspending and overreaction made to Bachelot and preferred not to raise the issue (Interview 2). As a top official from the Ministry of Interior analyses: “Everyone thought at this time that it was riskier for a policy-makers to make too little than to do too much” (Hearing of Francis Delon, Assemblée Nationale, 2020).

A blame-avoidance mechanism—according to which political actors are motivated primarily by the desire to avoid blame for unpopular actions rather than the one to claim credit for popular ones (Hood, 2010; Weaver, 1986)—emerges clearly from this section. French ministers and MPs were clearly avoiding being blamed for spending too much on preparation for pandemics. An important finding also is that this blame-avoidance mechanism is derived from another mechanism of political learning according to which policy-makers “learn from the past to avoid blame in the future” (Howlett, 2012). Those two mechanisms took place in a context of budgetary pressures and of seclusion of the decision-making process, which prevented some political and civil society actors concerned about pandemics from being informed of the gradual dismantlement of the preparedness institutions.

Phase 4: the aftermath (2020)

In December 2019, when the COVID-19 pandemic hit France, the government had not made any pandemic preparedness exercises since 2013 and the strategic stocks of antiviral equipment were only a tiny fraction of what they used to be. In February 2020, Olivier Véran was appointed Minister of Solidarity and Health, and one month later the first lockdown was announced. At this time, Véran declared that masks were available but not useful to reduce infections (Ouest-France, 2020). This was seen by a series of media as a dishonest attempt to hide the fact that the stock of masks had disappeared (Le Parisien, 2020; Libération, 2020). The first new stocks only arrived in May 2020, after the first peak of infections (Hassenteufel, 2020).

By October of the same year, France recorded 35,018 deaths—one of the highest numbers per capita in the EU—although the government had used the same repertoire of mitigation strategies as most other countries (Capano et al., 2020; Hassenteufel, 2020). This announcement led to another wave of virulent criticism from the media for a lack of preparedness to the crisis, in particular the lack of protection of health workers (Interview 6). The controversy was fuelled by the discovery that France had previously disposed of large stocks, which had been progressively destroyed by the current government and its predecessors. Journalists talked of a “state scandal” (e.g. Alternatives Economiques, 2020; Radio France, 2020). Two parliamentary inquiry commissions (in both the National Assembly and the Senate) were set and numerous legal complaints against members of the government were filed—obliging the government to offer indemnities to health workers (Franceinfo, 2023). It was also at this time that the public prosecutor announced the opening of a vast preliminary investigation into the management of the health crisis, including charges such as “manslaughter” and “endangering the lives of others” against the previous two Health Ministers, which did not result in any condemnations.

This final phase thus witnesses a second mechanism of blame generation, this time to current and past governing parties, where media and MPs from non-governing parties accused ministers of the dismantlement of past efforts. This was fuelled by the media divulging that the country used to be prepared and was not anymore.

Discussion: new theoretical insights and practical lessons

By looking at the case of France during two decades, we identified different mechanisms at play. At the beginning of our study, we witness the importance of political entrepreneurs in overcoming the obstacles against future-oriented policies. Those political entrepreneurs were politicians who invested in general-interest policies that would not bring them electoral gains. This suggests that cost–benefit calculations are not always the main driver of political actions, and that predictive models might benefit from relaxing this assumption. However, political entrepreneurship was possible because there was an alignment of the right conditions: political attention, foresight capacity, fiscal leeway, and the inclusion of various stakeholders. Those are factors that help to address grand challenges, as argued in the introduction to this special issue (see also Compton and ’t Hart, 2019).

In the second period we observe a blame-generation mechanism, during which the opposition and the media generated blame towards the government, and in particular its health minister Roselyne Bachelot, for having spent too much preparing for a flu that was milder than initially predicted. This mechanism was reinforced by the centralization of decision-making in France—which involves clear political responsibility, and by the media highlighting the existence of conflicts of interests between the pharmaceutical industry and international actors.

In a third period, political actors engaged in a typical blame-avoidance mechanism, through which they preferred not to raise the issue of pandemic preparedness, in particular after learning the risks of such an endeavour. This occurred in a context of budgetary restraint and of decision-making seclusion which prevented policy entrepreneurs from being fully aware that pandemic preparation policies were being dismantled. Finally, when the COVID pandemic hit, it became visible—again because of media actions—that France had been prepared and was not anymore, leading to yet another blame-generation mechanism.

From the discovery of those mechanisms, we induce a novel argument. As we see it, preparation for pandemics, and more generally adverse events prevention, should be seen as an insurance rather than as an investment. In contrast to investments, which theoretically generate returns in the future, insurance is about reducing future costs. However, the French case shows that preparedness, like an insurance, sometimes only involves costs. That happens when the feared event does not happen or when its impacts have been overestimated and incur costs that remain lower than the price of the insurance premium. In those cases, pandemic preparation policies might be perceived as a “preemptive over-reaction”—a situation in which policy measures imposing costs to avoid a risk are too high given the benefits (Maor, 2012: 232–235). Helped by the media, opposition political actors have an opportunity to frame this as a policy failure, especially in cases like France in which power is concentrated and blame avoidance is difficult (Weaver, 1986).

Seeing preparedness (and prevention) as an insurance also enables us to distinguish between the activation of the insurance and its maintenance. While policy-makers and political entrepreneurs have incentives to put effort into the creation of an insurance, insurance maintenance is harder to sustain. Given that insurance maintenance is one of the most invisible, zero-credit political actions, it is particularly vulnerable to short-term fiscal imperatives, especially when decision-making is in the hands of a few persons. This holds true for all types of insurance, even those for risks that a population fears, because the population does not necessarily know that the insurance has been discontinued.

However, our empirical analysis also shows that there is a fundamental difference between preparedness policies that require continuous efforts and spending to be maintained (in our case individual protective equipment stockpiles) and those for which preventive infrastructure, once established, remains effective over a longer duration without the need for constant replenishment (for example walls against flooding or earthquake-resistant constructions).

Finally, if the feared event happens when the insurance has been deactivated, it is the worst-case scenario for a government, as its failure in not taking action preventively is even more visible than if it had never pursued any action. Conceiving preparedness as insurance rather than an investment thus allows us to see more clearly that not only do governments have few electoral incentives to spend money on preparedness or prevention, but they take significant electoral risks when they do. As such, preparedness and prevention generate more intertemporal trade-offs and political costs than other types of long-term investments.

This article has several limitations that should be addressed in future research. First, the focus on France limits the generalizability of the findings and future research should conduct comparative studies to determine whether similar blame avoidance and political learning mechanisms occur in other countries and for other risks. Second, we could only assume that the media framing influenced politics and public opinion. Future research should explore public opinion dynamics to understand how media framing shapes voter attitudes toward preparedness spending

Policy lessons

The French case offers a series of practical lessons for policy-makers. A first message is that it seems essential that experts, policy-makers and members of parliament alike are taking part in the decision to create and to maintain future-oriented investments. While foresight, expertise, and political commitments are essential to initiate prevention, the long-term success of these efforts depends on building institutional and legal safeguards to protect them from future political or economic fluctuations (see also Rose, 2024). In practice, policy-makers should lock in preventive policies through legal mechanisms such as supermajorities, or through the empowerment of political actors who would be vocal if the prevention efforts were discontinued. This path would also limit blame attribution if mistakes were made. Moreover, governments should promote cross-sectoral decision-making to reduce policy vulnerability to political shifts.

The French case demonstrates once again the vulnerability of invisible policies to short-term fiscal imperatives and hence the necessity of distinguishing investments, prevention and preparedness from current expenditures. Hence, governments should establish independent agencies with protected budgets to oversee long-term prevention policies. Finally, our analysis highlights the importance of transparency and communication to strengthen pandemic preparation. In our view, public reporting systems should be put in place to demonstrate the value of preparedness, even in the absence of crises. Moreover, governments should launch public awareness campaigns to mitigate perceptions of government overreaction and build support for preventive measures.

Supplemental Material

sj-docx-1-ras-10.1177_00208523251342676 - Supplemental material for Damned if you, damned if you don’t: The politics of pandemic preparation as a grand challenge

Supplemental material, sj-docx-1-ras-10.1177_00208523251342676 for Damned if you, damned if you don’t: The politics of pandemic preparation as a grand challenge by Catherine Moury, Olivier Jacques and Emna Ben Jelili in International Review of Administrative Sciences

Footnotes

Acknowledgments

The authors wish to thank participants of the Italian Political Science Conference in Genova in September 2023, the Council of European Studies conference in Lyon in June 2024 and, in particular, the editors of the special issue, Andrea Perlizzi and Giovanni Esposito. We are also very thankful to the two anonymous reviewers for their insightful comments.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Olivier Jacques acknowledges the financial support of the Fonds de Recherche du Québec—Société et Culture. Catherine Moury acknowledges the financial support of the Portuguese Foundation for Science and Technology.

ORCID iD

Olivier Jacques

Supplemental material

Supplemental material for this article is available online.

Catherine Moury is Associate Professor of Political Science, and the Vice-Head of Department of Political Studies (Portugal). Catherine's research focuses on comparative public management and she is currently the Principal Investigator of a project on the price of pharmaceuticals.

Olivier Jacques is an assistant professor at the Department of health policy, management and evaluation, School of Public Health, Université de Montréal. His research concerns the political economy of public finance, health policy, fiscal federalism and public opinion on fiscal policy.

Emna Ben Jelili is a PhD candidate at the Department of health policy, management and evaluation, School of Public Health, Université de Montréal. Her research interests concern the financing and organization of public health.

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