Table 1

Legitimacy and interdependence: governance set-up, and inclusion of other bodies

Health governance structure
  • The federal structure with democratically legitimate ‘Bunderländer’ take key responsibility in line with constitution.90

  • A crisis task force, the ‘Corona Kabinett’ jointly led by the German Federal Ministry of the Interior (BMI) and German Federal Ministry of Health (BMG) gathers all ministry-specific competences.91

  • Provision of healthcare is under the auspices of the ‘Bundesländer’ and governed by the devolved healthcare system.

  • Two constitutionally legitimate crisis management structures—one under the Ministry of Interior and a group for strategic coordination (strategisk samordning) are foreseen but were not activated.92

  • Government delegated the handling of the pandemic largely to its state Public Health Agency (PHA).

  • It remains unclear if constitutional restriction, such as the ministerial rule or other bills restricted government involvement.93 94

  • The provision of healthcare and the operationalisation of the response is devolved to 21 county councils and regions.83

  • The government is ultimately responsible together with the 4 UK governments’ chief medical officers (CMOs).

  • Implementation and the institution of public health policies was devolved to Public Health England (PHE) as well as the Public Health bodies in Scotland and Wales and the Public Health Agency of Northern Ireland.

  • Cabinet Office Briefing Room A (COBRA), the crisis cabinet met unfrequently during the crisis, thus leaving weak coordination between nations.

  • The provision of healthcare is organised by the National Health Services (NHS) with their public health departments.

Laws passed
  • In Germany, a revision of the 2001 Infection Protection Act (Infektionsschutzgesetz, IfSG) was passed by the parliament on 27 March and again on 18 November.95

  • In Sweden, the Infectious Diseases Act 2004: 168 gives key responsibility to the individual and may limit government response.96 A COVID-19 emergency law passed in January 2021 provides the government with stronger emergency power93 contradicting earlier explanations that the government was not able to pass a law providing emergency power.

  • In the UK, the Coronavirus Act 2020 gave the government emergency power over parts of the NHS, social care, schools, police, the border force, local councils, funerals and courts.97 The act received royal assent on 25 March 2020.

Statal and parastatal advice structures
  • Robert Koch Institute (RKI), a federal institution, is charged with the nationwide health monitoring. It collects and interpret epidemiological data laid down in the Infektionsschutzgesetz (IfSG).

  • The RKI provides advise to the government. The Robert Koch Institute has no mandate to decide on strategies.38

  • The PHA advised and released recommendation in relation to direct health matters.

  • The legitimacy of its recommendations, for example, against the closing of public life and against closing schools is unclear.98

  • Scientific advisory Group for Emergencies (SAGE) committees provide independent scientific advice, but this is non-binding. Membership of SAGE and meeting minutes was made public since June 2020.99

  • PHE was established in 2013 and is an executive agency of the Department of Health and Social Care, and a distinct organisation with operational autonomy. Its role is to protect and improve the nation’s health and well-being and reduce health inequalities.

Inclusion of academia
  • A multitude of universities and research institutions involved throughout to inform the government and the public.

  • Research institutions conceived advisory boards to inform the government, among them the Helmholz Institute.100

  • Deutsche Akademie der Naturforscher Leopoldina - Nationale Akademie der Wissenschaften.101

  • Ethics advisory board.102

  • The PHA agreed on an advisory board, but no minutes or meeting schedules are published.46 91

  • A multi-professional group formed in April 2020 has been active in publishing in newspapers, in preparing educational talks and summarising evidence.103 The group has no official mandate.

  • SAGE is a standing committee. It held twice-weekly meetings since January 2020.

  • SAGE relies on external science advice and on advice from expert groups. During the COVID-19 pandemic this included the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), the Scientific Pandemic Influenza Group on Modelling (SPI-M) (Department for Health and Social Care), Independent Scientific Pandemic insights Group on Behaviours (SPI-B) and others.

  • The so-called alternative SAGE includes 18 academics which post live broadcasting and alternative reports and guidance.104 They receive a good amount of media coverage but have no official mandate.

Inclusion of other institutions
  • The German Ethics committee was consulted in regular intervals to provided ad-hoc advice, such as on restrictive measures as well as also vaccination, etc.105

  • End of June 2020 a Corona commission was launched, an independent expert committee to assess the national strategy.106 The first report on care for the elderly was release mid-December 2020.107

  • No other institution or link to lay persons.

  • Corona becomes part of the daily key public news.

  • The public television channels have been including debate sessions of each about 5 hours per week. These debate sessions allowed a broad discussion between scientists, politicians, philosophers etc. Different views were included and a high-level understanding of the underlying principles as well as the challenges were thus made open to the public.

  • Daily, later bi-weekly television broadcasting with the state epidemiologist presenting on most occasions. A total of 200 press conferences have been held.108

  • Media largely supported the national strategy, with limited critical questions to the PHA.73 Media have been overwhelmingly providing the PHA with space to outline their views.

  • Daily government briefings, which include a range of ministers, the CMO, and the prime minister. These are broadcast live.

  • Complemented by pre-recorded statements from the prime minister.

Other media channels
  • Since the 26 February a podcast where one of the leading virologists Christian Drosten, explains each weekday for about 40 min what is known in plain language and gives thus a large number of people a good understanding of what is known and what is not known.

  • no any

  • There is a wide engagement of universities. Alternative YouTube broadcastings by scientists are available—although they have not been formalised. LSHTM has been notable in hosting open talks which the public can access.