How contagious are health shocks on political outcomes? Evidence from the 1918 Spanish flu in Germany

Do large health shocks spill over into politics, and can public infrastructure mitigate such contagion? We examine the long-term political effects of serious health emergencies and the moderating role of hospital infrastructure. During the 1918 Spanish flu pandemic, four out of every 1000 Germans died. We find that influenza mortality rates were lower and did not have political consequences in cities and in rural areas with adequate hospital infrastructure. In contrast, rural areas with low levels of hospital infrastructure had higher influenza mortality rates, and voters punished the governing parties in the next elections. We conclude that adequate public infrastructure can help build resilience against large external shocks.