The pandemic, and the policies devised in response, have had a profound but highly unequal impact on countries across the world, and it will take time to fully grasp the nature and extent of the implications. Battling COVID-19 and facing historic economic downturns in 2020, the most well-off nations resorted to public debt at a wartime scale. However, compensation schemes for job and activity losses and investment to boost the economy were uneven. Politicization of crisis management was stronger in some countries – such as the US, where the ascent to the presidency of Democrat Joe Biden changed federal government policies radically. Restrictions and mask or vaccine mandates tied to public health were tightened; structural investment and budgets of a magnitude unseen since World War II have been put forward by the Democratic administration. The government is advancing proposals to raise taxes on top incomes and make tax collection more effective. This is a major programmatic shift that is likely to have an impact beyond the US, although part of this ambition faces opposition.

Many other countries have witnessed considerable increase of public debt and a renewed role for the state and for health care or elderly care institutions, but it is not clear whether these will substantially change the politics of welfare and health care reforms that prevailed before the pandemic struck. In the UK and France, where hospitals and long-term care have been under pressure for a long time, plans have been announced or passed to raise taxes and sometimes wages. Recently, in September 2021, Boris Johnson broke Conservative vows with a proposal to impose a new flat tax of 1.25% to fund better care and make it more affordable, but also to ‘rescue the NHS’. He also aimed to put a cap on lifetime individual expenses for elderly care. The proposal was immediately criticized as unfair and too narrow even to catch up with the huge backlog of untreated non-COVID-19 cases. Behind the scenes, it was not clear whether the bill sent to parliament in September 2021 would challenge competitive tendering and fragmentation within the NHS and re-establish more political control, or if it would lead to more deregulation.