Madrid was hailed as a public health beacon last November when it rolled out ambitious restrictions on the most polluting cars. Seven months and one election day later, a new conservative city council suspended enforcement of the clean air zone, a first step toward its possible demise.

Mayor José Luis Martínez-Almeida made opposition to the zone a centrepiece of his election campaign, despite its success in improving air quality. A judge has now overruled the city’s decision to stop levying fines, ordering them reinstated. But with legal battles ahead, the zone’s future looks uncertain at best.

Madrid’s back and forth on clean air is a pointed reminder of the limits to the patchwork, city-by-city approach that characterises efforts on air pollution across Europe, Britain very much included.

Among other weaknesses, the measures cities must employ when left to tackle dirty air on their own are politically contentious, and therefore vulnerable. That’s because they inevitably put the costs of cleaning the air on to individual drivers – who must pay fees or buy better vehicles – rather than on to the car manufacturers whose cheating is the real cause of our toxic pollution.

It’s not hard to imagine a similar reversal happening in London. The new ultra-low emission zone (Ulez) is likely to be a big issue in next year’s mayoral election. And if Sadiq Khan wins and extends it to the North and South Circular roads in 2021 as he intends, it is sure to spark intense opposition from the far larger number of motorists who will then be affected.

It’s not that measures such as London’s Ulez are useless. Far from it. Local officials are using the levers that are available to them to safeguard residents’ health in the face of a serious threat. The zones do deliver some improvements to air quality, and the science tells us that means real health benefits – fewer heart attacks, strokes and premature births, less cancer, dementia and asthma. Fewer untimely deaths.

But mayors and councillors can only do so much about a problem that is far bigger than any one city or town. They are acting because national governments – Britain’s and others across Europe – have failed to do so.

Restrictions that keep highly polluting cars out of certain areas – city centres, “school streets”, even individual roads – are a response to the absence of a larger effort to properly enforce existing regulations and require auto companies to bring their vehicles into compliance. Wales has introduced special low speed limits to minimise pollution. We’re doing everything but insist that manufacturers clean up their cars.

Nearly four years after the Volkswagen scandal exposed rampant rule-breaking and bending across the industry, car makers are still selling diesels whose nitrogen dioxide emissions are many times over the legal limit. And of course all their old cars, which violate the rules even more egregiously, are still on our roads too.

In addition to stunning corporate malfeasance, the diesel cheating revelations also laid bare the profound shortcomings of regulators who failed for years to stop it.

In the US, authorities required Volkswagen to spend billions of dollars to compensate customers and buy back cheating cars, or fix them so they would run cleaner. There are many more diesels in Europe, so the harm to health has been far greater – more than 11,000 deaths annually from nitrogen dioxide emitted beyond legal limits, according to one study. But VW and its peers have mostly been able to get away with cheaper software tweaks that haven’t solved the problem.

Of course, we’ll never have truly healthy air – or hope of stabilising the climate – while cars run on fossil fuels. We must move to electric vehicles, and away from car-centric cities, toward better public transport and infrastructure that makes cycling and walking easier.

But even so, our air would be so much cleaner if the cars on our roads right now met the pollution limits that already exist on paper. Insisting manufacturers make those cars cleaner would be far more effective than policing exactly where they can go.

‘German prosecutors charged former Volkswagen CEO Martin Winterkorn with fraud.’ Photograph: Julian Stratenschulte/AP

Last month, equipment problems forced Birmingham and Leeds to delay implementation of their planned clean air zones. That was about logistics, not public opposition – although there is that too – but it highlights the inevitable difficulties when each city and town must fend for itself.

Diesel owners, like all of us who breathe the foul fumes their cars pump out, are not perpetrators, but victims of one the biggest corporate scandals ever. We are all paying a steep price, a cost exacted in health harmed and lives lost, as well as pounds and pence.

The question is who will pay to clean up. No local official has the power to require a vast corporation to rectify its misdeeds. Only national governments, and European authorities, can do that.

In April, German prosecutors charged former Volkswagen CEO Martin Winterkorn with fraud, adding to the US indictment he already faced. European regulators have moved towards on-road testing to remedy the weaknesses VW exploited with “defeat device” software designed to cheat in-the-lab checks.

But other loopholes remain. And instead of pushing to upgrade or retire the millions of cars still shattering pollution limits, governments seem to be waiting for changes in consumer tastes – spurred by local clampdowns – to get the dirtiest diesels parked for good.

Even short of making the companies pay, a national scrappage scheme that helps owners junk the dirtiest diesels would shift the financial burden of a cleanup from individuals to the public purse.

For now, mayors and councils are doing their best with the tools they have. While Madrid backs away from action, Paris is pushing ahead, tightening its clean air zone this week and planning to ban diesels altogether by 2024.

Unless, of course, a future mayor decides not to.

• Beth Gardiner is an environmental journalist and author of Choked: The Age of Air Pollution and the Fight for a Cleaner Future