Scholars who study governance in authoritarian countries have long highlighted the importance of fiscal capacity and pressure from the central government in determining the responsiveness and policy changes of subnational governments. However, policy orientation is also important in shaping how subnational governments react to a crisis. Using provincial governments’ responses during the 2018 Chinese vaccine scandal, I find strong evidence that an emphasis on public health, as well as early responses by neighboring provinces, increased the likelihood of a quick response. Moreover, issue salience minimized the direct effect of pressure from the national government. An additional paired case study of the provinces of Hubei and Hunan shows that the importance accorded by the provincial government to public health policy was implemented at the sub-provincial level through China’s one-level-down cadre management system; it also may explain Hubei’s delay in responding to COVID-19 at an early stage.

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