Michelle Mello and colleagues argue that state legal reforms have generally exacerbated rather than improved weaknesses in US emergency powers revealed by covid-19, jeopardizing future responses
Covid-19 related mortality in the US was higher than in every western European country.1 Compared with its closest neighbour, Canada, also a federated country with a decentralised health system, the US fared far worse.2 With over 1.1 million dead at the end of 2023,3 leaders and academics have begun a painful postmortem. What went wrong, and what can be done to make authorities in the US better equipped for the next pandemic?
In this article, part of a BMJ series examining US covid-19 lessons (http://bmj.com/collections/us-covid-series), we focus on the role of legal infrastructure, including both the law itself and the capacity to wield it effectively.45 A web of federal, state, and local laws determines what officials can do to respond to emergencies. These laws are helpful only to the exte