Resumen
It is a complex task for provincial governments to sustain the effectiveness of the governance system in containing the spread of COVID-19 in the early stages. This study aims to examine the complex causal combinations of certainty, uncertainty and governance capabilities leading to high and low effectiveness of governance across 30 Chinese provincial administrative regions. The fuzzy-set qualitative comparative analysis (fsQCA) shows that: (1) Two paths lead to a high level of governance effectiveness. One is condition-based, while the other is mainly based on the expertise of health directors and low-spreading control conditions. (2) Two paths lead to a low level of governance effectiveness. Because of a high level of spreading control difficulty, most provinces take the first path. (3) The SARS experience in 2003 may not be a necessary condition to improve the governance effectiveness of the COVID-19 outbreak. Provinces could achieve good governance effectiveness even if they had no prior SARS experience. The findings enhance the understanding of the emergency response to a public health crisis in a country with a strong government by clarifying various effective and ineffective configurations. It also reflects China?s existing public health emergency system to maintain sustainable governance under varying degrees of certainty and uncertainty.