David Barbera-Tomás1, James Bates2 , Enrique Meseguer1 and Michael M. Hopkins2
1Ingenio (CSIC-UPV), Universitat Politècnica de València, Spain.
2Science Policy Research Unit (SPRU), University of Sussex Business School, Brighton, UK.

At the start of the Covid-19 pandemic, countries were encouraged by the World Health Organization to “Test. Test. Test.” This paper compares how healthcare systems in Spain and the UK, simultaneously facing a crisis of similar magnitude, developed diagnostic testing systems that greatly differed in their organizational boundaries. The paper shows how boundary work in each country, influenced by established power structures, defined who could provide diagnostic testing during the crisis response - and very importantly - who was excluded. Results show that in a health crisis, professional boundary work could shape the healthcare system if medical professionals have access to decision makers. If that is not the case, other rationales as efficiency boundary work can overcome professional boundary work during the crisis. The findings contribute to understanding the interplay of formal authority and boundary work. In the UK, the high centralization of authority over testing allowed policy makers to implement a radically novel organizational solution to scale up testing, while devolved authority favoured local clinical professionals in their attempts to retain control of testing in Spain. These findings highlight the importance of accounting for power in explaining the shaping of socio-technical systems. Finally, the legacy of the pandemic response already appears to be very different in these two countries. In Spain, the resources allocated to public hospital labs to expand their PCR capacity have extended and improved their diagnostic capabilities. In the UK, losses in testing capacity and expertise after the closure of most of the labs newly built during the pandemic suggests that the dominance of efficiency logic during the crisis may actually be inefficient, from the perspective of future pandemic preparedness, in the sense that the vast funds expended may have little tangible infrastructural legacy.