Policy Design for COVID‐19: Worldwide Evidence on the Efficacies of Early Mask Mandates and Other Policy Interventions

• Published date: 01 November 2021
• Author: Brian Y. An,Simon Porcher,Shui‐Yan Tang,Eunji Emily Kim
• Date: 01 November 2021
• DOI: http://doi.org/10.1111/puar.13426

Research Article

Policy Design for COVID-19: Worldwide Evidence on the Efficacies of Early Mask Mandates and Other Policy Interventions 1157

Eunji Emily Kim MA, is a doctoral

candidate in the School of Public Policy at

the Georgia Institute of Technology. Her

primary research interests lie in international

technology competition and its impact on

technological innovation. She received her

master’s degree in international relations at

Seoul National University in South Korea.

Prior to joining a PhD program at Georgia

Tech, she worked as a researcher at the

Korea Institute of Science and Technology

Evaluation and Planning.

Email: emily.kim@gatech.edu

Abstract: To understand the extent to which a policy instrument’s early adoption is crucial in crisis management, we

leverage unique worldwide data that record the daily evolution of policy mandate adoptions and COVID-19 infection

and mortality rates. The analysis shows that the mask mandate is consistently associated with lower infection rates in

the short term, and its early adoption boosts the long-term efficacy. By contrast, the other five policy instruments—

domestic lockdowns, international travel bans, mass gathering bans, and restaurant and school closures—show weaker

efficacy. Governments prepared for a public health crisis with stronger resilience or capacity and those with stronger

collectivist cultures were quicker to adopt nationwide mask mandates. From a policy design perspective, policymakers

must avoid overreacting with less effective instruments and underreacting with more effective ones during uncertain

times, especially when interventions differ in efficacy and cost.

Evidence for Practice

• Despite its higher efficacy in containing the coronavirus disease 2019 (COVID-19) spread, the mask

mandate was the least frequently utilized among six commonly used mandates during the first global wave of

the pandemic, and most governments adopted it later than others.

• The mask mandate is consistently associated with lower infection and mortality rates in the short term. Early

adoption of mask-wearing mandates is also consistently associated with lower COVID-19 infection rates in

the long term, indicating the link between a government’s intervention speed and policy instrument efficacy.

• By contrast, domestic lockdowns and restaurant closures do not show any consistent relationships in the short

term. Mass gathering bans and school closures need more time to manifest their efficacies as short-run policy

instruments. Early adoption of these mandates, however, does not maintain their efficacy in the long run.

• Governments prepared for a public health crisis with stronger resilience or capacity and those with stronger

collectivist cultures were quicker to adopt nationwide mask mandates.

• Policymakers must be aware of various policy instruments’ differential efficacies and their preferred timing to

achieve public health goals. Each instrument’s benefits and costs must be gauged against the expected effects

and timeframes.

Before the widespread availability of effective

vaccines, the only viable approach to slow the

spread of SARS-CoV-2 (COVID-19) has been

to use government-imposed non-pharmaceutical

mandates such as social distancing, mandatory

mask-wearing, mass gathering bans, stay-at-home

orders, and closures of schools and businesses.

Studies have assessed the efficacies of individual

mandates (e.g., Betsch et al. 2020; Cheng et al. 2020;

Dehning et al. 2020; Ferguson et al. 2020; IHME

COVID-19 Forecasting Team 2021; Schlosser et

al. 2020; Xu et al. 2020). Despite their demonstrated

effectiveness, many government mandates hurt the

economy and other aspects of social and personal

wellbeing (Gourinchas et al. 2020; McKibbin

and Fernando 2020; Spelta et al. 2020; see also

Gaynor and Wilson 2020; Martin-Howard

and Farmbry 2020; Menifield and Clark 2021;

Yancy 2020 about social and racial equity concerns).

A growing body of scholarship has studied how

these mandates compare in relative efficacies (e.g.,

Anderson et al. 2020; Chernozhukov, Kasahara, and

Schrimpf 2021; Haug et al. 2020; Haushofer and

Metcalf 2020). Yet, little is known about whether

early adoption of policy mandates makes a difference

in crisis management. To our knowledge thus far,

only a small body of studies has examined how policy

intervention timing shapes differential effects on

COVID-19 containment. Using simulation models,

Policy Design for COVID-19: Worldwide Evidence on the

Efficacies of Early Mask Mandates and Other Policy

Interventions

Brian Y. An

Simon Porcher

Shui-Yan Tang

Eunji Emily Kim

Georgia Institute of Technology

Georgia Institute of Technology

IAE Paris - Sorbonne Business School

University of Southern California

Shui-Yan Tang is the Frances R. and John

J. Duggan Professor in Public Administration

and Chair of the Department of Governance

and Management in the Sol Price School of

Public Policy at the University of Southern

California. His research focuses on

institutional analysis and design, collaborative

governance, common-pool resources, and

environmental politics and policy.

Email: stang@usc.edu

Simon Porcher is an associate professor of

management and scientific director of the

Chair on Public–Private Partnerships at IAE

Paris—Sorbonne Business School, Université

Paris I Panthéon-Sorbonne, France. He is the

creator of Response2covid19, a worldwide

tracker of governments’ responses to face

COVID 19. His research has been published

in the Journal of Public Administration

Research and Theory and the Public

Administration Review.

Email: porcher.iae@univ-paris1.fr

Brian Y. An is an assistant professor in

the School of Public Policy at the Georgia

Institute of Technology. His research

examines how governance design and

institutional choice affect policy and

management processes and outcomes at all

levels, from local and regional organizations

to national governments across the globe.

At Georgia Tech, he leads the Urban

Research Group. He also co-leads the

Pandemic Governance Research Group—a

multi-institution and international team.

Email: yan74@gatech.edu

Public Administration Review,

Vol. 81, Iss. 6, pp. 1157–1182. © 2021 by

The American Society for Public Administration.

DOI: 10.1111/puar.13426.

[Correction added on 9 November 2021, after first online

publication: Simon Porcher’s affiliation has been corrected in this

version.]

1158 Public Administration Review • November | D ecember 2 021

for instance, Pei, Kandula, and Shaman (2020) show that if the

United States adopted social distancing policies and other restrictive

mobility measures one to two weeks earlier than they did during the

pandemic’s early phase (March 15 to May 3, 2020), they could have

avoided substantial cases and deaths. Other research (e.g., Alagoz

et al. 2020; Amuedo-Dorantes, Kaushal, and Muchow 2020; Lai

et al. 2020; Tian et al. 2021) reports similar findings from different

single countries. While previous studies underscore the importance

of intervention timing they did not question, which policy

instruments should have been adopted earlier than others, how early

the action should have been taken, and whether the evidence can

be generalized globally. An exception is Zheng, Li, and Sun (2021),

who question the importance of early policy action using global

data (152 countries), but the study does not compare the relative

efficacies of different policy instruments, particularly on the benefits

of early intervention.

Suppose the mask-wearing mandate is more effective than other

measures in both the short- and long-run. If it is imposed shortly

after the initial outbreak, it may be unnecessary to mandate more

drastic measures such as domestic lockdowns and business closures

(Haug et al. 2020). However, as we will demonstrate, many

governments chose the reverse strategy during the first global wave

of the pandemic due to a lack of scientific knowledge, guidelines

from international and national health institutions, and different

cultural and behavioral orientations, among other factors.

Medical research has shown that transmission rates among

asymptomatic and pre-symptomatic groups may be as significant

as those among symptomatic patients (Lee et al. 2020; Savvides

and Siegel 2020). Moreover, COVID-19 transmission rates vary

across age groups (Davies et al. 2020). For example, epidemiological

data and simulation models indicate lower transmissibility among

children than adults. If so, early school closures alone may have less

effect in controlling infection spread (Viner et al. 2020) than other

restrictive measures targeting adults (Davies et al. 2020). While these

factors complicate government strategies for virus containment, early

adoption may still be crucial for a mandate to attain most gains.

However, without conducting a randomized controlled trial, it

is highly difficult to compare different government mandates’

efficacies (Haushofer and Metcalf 2020). Given the inherent

challenges in launching randomized experiments (e.g., Abaluck

et al. 2021), is it feasible to design an observational study with

existing data on worldwide mandate adoptions to gauge their

relative efficacies? Our research addresses this critical policy and

management question by asking which government mandate likely

benefits the most from early adoption. Our focus on early adoption

relates to the disaster and crisis management literature’s emphasis

on early preparedness, adaptability, and learning systems (e.g., Boin

et al. 2016; Comfort, Boin, and Demchak 2010; Kapucu 2008;

Perry, Lindell, and Tierney 2001; Van Wart and Kapucu 2011).

It also relates to the public administration literature’s concept of

government agility, which partly highlights how fast actions enable

governments to address problems arising from uncertain and

rapidly changing environments (Ansell, Trondal, and Øgård 2017;

DeSeve 2020; Janssen and Van Der Voort 2016; Mergel, Ganapati,

and Whitford 2020; Moon 2020; Room 2011; Walker, Rahman,

and Cave 2011; also see McCann, Selsky, and Lee 2009 for an

application to private sector organizations). Governments’ initial

mistakes can be corrected by adaptive responses, but they could still

face insurmountable barriers in managing the crisis down the road.

While our research design does not allow us to study the adaptive

process (e.g., Janssen and Van Der Voort 2016; Walker, Rahman,

and Cave 2011), we can still examine if early adoption makes any

difference in government policy outcomes.

To understand the extent to which a policy mandate’s early

adoption is crucial, we leverage unique worldwide data that record

the daily evolution of policy mandate adoptions and COVID-19

infection and mortality rates from January 1 to July 15, 2020, a

timeframe generally considered the first wave of the global pandemic

(Cacciapaglia, Cot, and Sannino 2020). Specifically, we identify

policy mandate adoption timing and compare the relative efficacies

between early, late, and noninterventions by using both cross-

sectional and longitudinal research design. Our analytic focus is the

associations between COVID-19 infection rates (and mortality rates)

and six mandates commonly adopted across the globe and their

short- and long-run efficacies. A post-hoc analysis will also examine

what pre-existing governance, institutional, and cultural factors

explain countries’ early adoption of the most efficacious mandate.

The analysis reveals that domestic lockdowns and restaurant closures

do not display any consistent associations with new infection and

mortality rates in the short term. Mass gathering bans and school

closures need more time to manifest their short-term efficacies. By

contrast, mask mandates exhibit the strongest and most immediate

associations with lower new infection and mortality rates in the

short run. More importantly, both cross-sectional and longitudinal

analyses provide consistent evidence that only mask mandates

demonstrate persistent long-run efficacy from early adoption.

Our post-hoc analysis of the antecedents of early mask mandate

adoption further indicates that the temporal adoption of the mask

mandate was not randomly taken across countries. Governments

prepared for a public health crisis with stronger resilience or

capacity—as measured by hospital beds per population—

were quicker to adopt nationwide mask mandates. Moreover,

governments with stronger collectivist cultures were quicker to

adopt mask mandates.

In the remainder of the paper, we first present how the policy

design literature helps explain the global patterns of initial mandate

adoptions, followed by some vignette cases illustrating the success

of speedy government responses to COVID-19. We then present

our empirical strategy and data. Results with various modeling

approaches and alternative measurement for both focal independent

and dependent variables are presented. We conclude with the

implications for both practice and scholarship.

Pandemic Responses from a Policy Design Perspective

The unprecedented pandemic provides a unique setting to examine

how uncertainty shapes government behavior on policy instrument

choices. The policy design literature argues that policymakers

consider various tradeoffs between resource-intensiveness (e.g.,

administrative costs and operational simplicity), targeting (e.g.,

precision and selectivity), political risks (e.g., public support or

opposition), coerciveness/intrusiveness (e.g., restrictions placed on