This chapter identifies trends in how countries differed in their response to the challenges posed by the COVID-19 pandemic. In most federal countries, health care is one of the policy areas usually assigned to sub-national governments. The exact nature of this assignment is shaped by the differing needs and expectations of citizens as to how a health system should be managed. More recently, federal governments have taken the lead in certifying and securing vaccine supplies from national and global suppliers. In the majority of cases, governments attempted to control the spread of the virus by imposing lockdowns. Following the first COVID-19 cases in Ethiopia, both the federal and state governments took measures to prevent a wider outbreak of infections. In a number of countries both federal as well as constituent unit governments recognized the urgency and necessity of working together to deal with the crisis.