The ongoing impact of policy documents on the pandemic based on the framework of the "4Rs" theory and policy tools: in China.

backgroundEnhancing public health emergency (PHE) management capacities has become a critical challenge in global public health governance. During the Coronavirus Disease 2019 (COVID-19) pandemic, Shanghai and Shenzhen implemented region-specific measures tailored to local conditions, reflecting China's overarching control strategy. Systematically analysis of prevention and control policies is essential for optimizing PHE responses. While existing research has primarily focused on policy-outcome relationships through case studies or quantitative models, the application of policy tools across different pandemic stages remains underexplored.

methodsTo analyze the distribution and evolution of policy tools across pandemic stages, this study integrated the policy tool perspective with the "4Rs" crisis management theory to construct a two-dimensional analytical framework. Quantitative text analysis was employed within this framework to code and quantify pandemic prevention and control policies issued between January 2020 and December 2022. Policy texts were collected from the official websites of local governments and the Peking University Law website.

resultsFrom the perspective of policy tools, both Shanghai and Shenzhen predominantly relied on authority tools, followed by incentive tools, with system-changing tools being the least utilized. From the crisis management dimension, the frequency of policy tool usage peaked during the crisis outbreak period, dropped significantly during the crisis receding period, and slightly rebounded during the crisis recovery period. The two-dimensional analysis revealed that, apart from Shanghai's emphasis on incentive tools during the crisis receding period, authority tools dominated across all crisis management stages in both cities. Additionally, as the pandemic progressed, the use of capacity-building tools and incentive tools increased significantly.

conclusionsChinese local governments primarily applied authority tools to drive institutional improvements, complemented by incentive tools and capacity-building tools to enhance policy effectiveness and public engagement. Optimizing PHE management requires dynamic adjustments to policy tools based on crisis stage characteristics, balancing rigidity with flexibility and immediate responses with long-term system development. The findings may provide valuable references for governments worldwide in formulating follow-up PHE policies and offer a replicable framework for future analyses in this field.