Public Health Policy as Public Choice Failure

Abstract

The COVID-19 pandemic has wrought a devastating toll, causing over a million deaths in the United States along with widespread disability and economic disruption. Yet the magnitude of these costs was not inevitable—it was shaped by the policy choices made in response to the crisis. This Article argues that the U.S. pandemic response suffered from public choice dynamics that systematically skewed policymaking away from the public interest. Examining three key policy areas—vaccine rollout, mask mandates, and ventilation standards—the Article demonstrates how misaligned political incentives led officials to prioritize short-term appeasement of a pandemic-weary public over science-based strategies that would maximize long-term welfare. In each domain, political actors faced strong incentives to downplay risks, overpromise solutions, and delay difficult decisions, resulting in a pandemic response that was often too little, too late, and too beholden to partisan interests. The Article concludes that reckoning honestly with these failures is a crucial first step toward reforming our public health institutions and ensure a more effective response to the next crisis. It offers recommendations for rebuilding public trust, depoliticizing public health communication, and institutionalizing science-based policymaking. More broadly, the Article underscores the urgent need to realign political incentives with the public interest in the prevention of and response to public health emergencies.