The Regulatory State and Politicisation: Drug Rationing in the Post Covid-19 Era

Over the last two decades, the authority of independent regulatory agencies has been publicly contested. To what extent and how has such politicization altered policymaking by regulatory agencies and the broader regulatory state? This paper presents an analytical framework for better understanding the relations between delegation, (de)politicization, and policy development after the creation of independent regulatory agencies. It draws on the author’s research that illustrates the framework through a comparative-historical analysis of drug rationing policies in advanced industrialised countries. In doing so, the paper discusses the broader implications of the framework for the relations between the regulatory state and democratic politics. Rationing – restricting the public provision of goods and services – serves as a window onto political struggles after the creation of independent regulators, due to both its functional justification for efficient resource allocation and its deep political consequences. The paper begins by summarising the empirical findings of the comparative analysis of drug rationing policies, highlighting the role of the structures of delegation in shaping varying degrees and forms of politicisation and their impact on the subsequent policy development. The paper then discusses the theory’s implications for broader public service sectors, where rationing has taken place in different forms. It further extends the framework to the politics and policy during the Covid-19 pandemic, where rationing of resources was especially acute. The paper ends by reflecting on the regulatory state and drug rationing in the post Covid-19 era.