Health vs. wealth? A managerial effectiveness analysis of the COVID-19

This study evaluates the effectiveness of 104 countries in managing the COVID-19 pandemic during the period 2020–2022. We integrate health and economic outcomes through a bidimensional approach combining excess mortality and GDP variation indicators. The estimation method defines directional distance functions within a robust conditional Benefit-of-the-Doubt framework that incorporates the dynamic perspective of Mastromarco and Simar (2015). Results show that joint managerial effectiveness improved progressively while health and economic orientations behaved orthogonally, challenging structural trade-off assumptions, with nearly 90% of countries adopting balanced strategies by 2022, reflecting institutional adaptation rather than deliberate optimization. Quantile regression analysis reveals dynamic effectiveness determinants varying by phase: hospital capacity and participatory legitimacy proved critical in 2020, vaccine introduction and distributive configurations marked the transition in 2021, while government effectiveness and long-term strategic orientation emerged as central factors in 2022. By 2022, traditional instruments such as stringency and mass vaccination display diminishing or null marginal returns, while state effectiveness and a long-term orientation become the primary correlates of sustained performance.