How useful is priority setting in an emergency? An analysis of its role in national responses to the COVID-19 pandemic

The COVID-19 pandemic presented unique and heightened resource allocation challenges to public managers at all levels and sectors of government. Whereas criteria for resource allocation are usually hidden or implicit, COVID-19 forced governments to make explicit decisions on access to scarce resources such as: personal protective equipment, COVID-19 tests, vaccines and intensive care services. This chapter examines responses to these challenges across a number of national settings to explore what public management might learn from these. It begins with a description of priority setting and an assessment of its role in health care decision-making prior to the pandemic. We then examine its function in government responses to the initial wave, before considering the role it played in the distribution of vaccines, and in managing the ongoing implications of COVID-19 for other areas of health need. We consider the part played by evidence and ethical frameworks, social values, and levels of trust in decision makers. We argue that, while COVID-19 raises some novel issues given the extent of demand, many of these challenges echo those always faced by public management. We conclude with key lessons for public managers and argue that while priority setting remains important, it needs to be incorporated into routine decision making if it is to be of greater value in emergency conditions such as those brought about by COVID-19.