Thanks to the federal system, the Swiss cantons enjoy a relatively high degree of autonomy by international standards. The way the pandemic has been managed (after the “extraordinary situation” came to an end) is no exception. Avenir Suisse has taken this as an opportunity to produce a new Canton Monitor. For study author Lukas Schmid, the aim of this comprehensive report, which includes the collection of primary data, was to seek lessons for future crisis situations – and in some cases for the rampant fifth wave of Covid-19.
More tests – better control
To keep a pandemic under control, in practice there is no way around extensive testing in combination with contact tracing (CT). Here a comparison of the cantons shows clearly that efforts in this area pay off: BS, BL, ZG, and GR have been best able to keep the incidence of infection under control, while JU, NE, OW, AG, SG, LU and SZ have been confronted with higher incidences because of their more restrained approached. Another conclusion of the study is that only very few cantons have managed to set up an extensive decentralized testing infrastructure. The track record is poor, particularly when it comes to repeat testing at the workplace, which has only worked in GR. What has made matters worse is that it has not been possible to assure the flow of information between cantons because they have different contact tracing systems. A nationwide CT system is urgently needed.
Risky loss of capacity in intensive care units
So far it has been possible to prevent the Swiss healthcare system from becoming completely overwhelmed. There are, however, considerable differences from canton to canton in the utilization of intensive care units. The effects on other areas of the healthcare system have also varied. The displacement effect resulting from the postponement of elective surgery remained low in TI, and despite high utilization, in LU, GE, and VD as well. However, with the exception of BS, SO, and GR, the available data indicate that at the height of the pandemic, “silent triage” sometimes occurred in hospitals. The fact that many cantons have been unable to maintain capacity in intensive care units during the crisis does not bode favorably for the further course of the pandemic.
Sub-optimal vaccination campaigns
Vaccinating the population is the most important lever in pandemic management. Even in the oldest population groups, where high vaccination readiness can be assumed, the cantons moved at varying pace. The quickest to vaccinate were TI, ZG, and FR; the campaigns in OW and AI yielded only low vaccination rates. On the other hand, the cantons acted in lockstep when it came to efforts to increase vaccination readiness and the information obligations directly related to it: these were neglected for too long all over Switzerland. The impression of hesitancy was reinforced by the lack of speed displayed in the booster campaign.
Major differences in cantons’ handling of hardship assistance
Hardship allowances were a comprehensive program put together by the Federal Council to support affected companies; the cantons have been responsible for structuring compensation for companies of less than CHF 5 million, but the federal government has provided 70% of the funding. In addition to the fact that contributions with no hope of a return have become the dominant form of support, the linking of support to the duration of operating restrictions (rather than to economic losses) should be questioned in many cantons. Only BS, GR, SO, VD, and VS have calculated compensation strictly in accordance with economic criteria. Since hardship assistance is likely to remain a feature in future crises, it is imperative to reconsider the objective of the mechanism and the demarcation of roles.
The best handling of public schools
The decision to open or close schools lies with the cantons. After the first wave, the schools remained open in most cantons – for good reason given that distance learning was such an extraordinarily heavy burden for everyone involved in schooling. The decision to open schools was accompanied by testing regimes, which – depending on the financial and human resources deployed – had very different scopes. In an environment of high case numbers in fall 2021, ZG and GR were the only cantons to test twice a week. As long as the pandemic continues, hybrid or distance education will remain a reality – at least for those students who are in quarantine for a certain period of time.
Conclusion: Strengthen cantonal responsibility:
Federalism has passed the litmus test of the pandemic. This is evidenced by the leading cantons GR, TI, and ZG, which have done well across the board. The comparative analysis also shows, however, that in many areas the challenges have been at the limits of what is manageable. The failures have been both self-inflicted and the result of institutional shortcomings in today’s federal system. The key learnings from the crisis are as follows:
- More thorough crisis preparedness: The way the cantons went about preparedness planning in healthcare and civil protection lacked sufficient detail. Too little weight was given to clarifying responsibilities in emergency planning. Crisis preparedness should also include planning for emergencies of an unknown nature.
- Greater crisis awareness and forward-looking action: Sometimes there has been a lack of awareness of the steps needed in the short term to contain the pandemic, such as contact tracing in summer 2020, the lack of a low-threshold testing offering in autumn 2020, and the uncreative attempts to increase the vaccination rate in summer 2021 and the booster vaccination in winter 2021/22. The tendency to lull oneself into a false sense of security may be justified in light of the experience of life in Switzerland in the past decades, but it proved to be the wrong approach in the pandemic.
- Stronger federalism by disentangling structures and clarifying the demarcation of roles between federal government and cantons: The cantons’ ability to discharge their responsibilities has also been impaired by a lack of clarity in the demarcation of duties between the levels of government and the conferences of cantonal ministers: What is interpreted in public as hesitation and procrastination on the part of the cantons is the result of the intermediate level; this makes adequate decisionmaking in the individual cantons difficult, and must be reviewed from the point of view of national policy. This particularly applies to the Conference of the Cantonal Ministers of Public Health.