Federal and decentralised countries are often expected to perform worse in crises for two reasons. First, they require more coordination resources, which are particularly costly when decisions must be made quickly. Second, in federal countries, subnational territories are countervailing powers. Counterpowers favour consensual policies but prevent policy changes and make countries less responsive to crises. While in economic crises this expectation is not clearly congruent with the data, during the COVID-19 pandemic much attention has been paid to its management in federal countries. The comparisons within federal states and between federal and centralised states were intended to illustrate different ways of dealing with the pandemic. Other studies assume that federal states are less efficient and try to find solutions. More surprisingly, no systematic study has attempted to assess whether decentralised management is less effective. This chapter takes advantage of EXCEPTIUS data, which covers the management of the pandemic at the subnational level to address this gap. Interestingly, France, like several other unitary states, has progressively decentralised its pandemic management. Federal states, such as Germany or Switzerland, were decentralised at the beginning of the pandemic, but centralised their management in subsequent waves. In regionalised states, such as Italy and Spain, the evolution of the regions’ competences follows contrasting patterns. The analysis of the role of territorial units and counter-powers in the management of the first three waves of the pandemic (January 2020–April 2021) makes it possible to identify in detail the type of approach chosen by each country and why. This systematic review allows a first preliminary assessment of the relative effectiveness of decentralised versus centralised management by comparing the lethality of the pandemic according to the territorial style of management, with inconclusive results.