The debate on appropriate COVID-19 response between the provincial and Federal governments in Pakistan quickly morphed into one questioning the wisdom of the 18th Amendment – the constitutional provision that provides provinces semi-autonomous powers under the Federation. Does a global pandemic of the scale of COVID-19 necessitate more centralized authority? In the latest Tabadlab Policy Roundtable, our discussion looks back at the spirit and need of the 18th Amendment, and measures its efficacy from different angles.