Institutional quality and COVID-19 vaccination: does decentralization matter?

Area of Science:

• Public Health
• Health Policy
• Epidemiology

Background:

• Viral pandemics, such as COVID-19, pose significant global health challenges.
• Vaccination campaigns are crucial for mitigating the adverse effects of pandemics.
• Understanding factors influencing vaccination campaign success is vital for public health preparedness.

Purpose of the Study:

• To identify institutional factors associated with higher COVID-19 vaccination success rates globally.
• To explore the relationship between national and subnational governance structures and vaccination campaign outcomes.

Main Methods:

• Cross-country analysis examining vaccination rates (percentage of vaccinated population).
• Assessment of institutional factors at national (healthcare organization, governance, social capital) and subnational (government tiers' authority and autonomy) levels.
• Consideration of supply-side determinants alongside institutional factors.

Main Results:

• Institutional factors are significant correlates of successful COVID-19 vaccination campaigns.
• Effective healthcare sector organization, robust governance, and strong social capital at the national level are linked to higher vaccination rates.
• Decentralized government structures with empowered subnational authorities also correlate with campaign success.

Conclusions:

• Public policy interventions should focus on strengthening institutional frameworks to enhance vaccination campaign effectiveness.
• Improving healthcare organization, governance, and social capital can bolster pandemic response.
• Empowering subnational governments is a potential strategy for optimizing vaccine rollout.