The impact of state capacity on the cross-country variations in COVID-19 vaccination rates

Int J Health Econ Manag. 2022 Sep;22(3):237-255. doi: 10.1007/s10754-021-09319-0. Epub 2022 Jan 29.

Abstract

The initial period of vaccination shows strong heterogeneity between countries' vaccinations rollout, both in the terms of the start of the vaccination process and in the dynamics of the number of people that are vaccinated. A predominant thesis for this observation is that a key determinant of the swift and extensive vaccine rollout is state capacity. Here, we utilize two measures that quantify different aspects of the state capacity: (i) the external capacity (measured through the soft power of the country) and (ii) the internal capacity (measured via the country's government effectiveness) and provide an empirical test for their relationship with the coronavirus vaccination outcome in the initial period (up to 31st March 2021). By using data on 128 countries and a two-step Heckman approach, we find that the soft power is a robust determinant of whether a country has started with the vaccination process. In addition, the government effectiveness is a key factor that determines vaccine roll-out. Altogether, our findings are in line with the hypothesis that state capacity determines the observed heterogeneity between countries in the initial period of COVID-19 vaccines rollout. As such, they are a stark reminder for the need for transparent and fair global response regarding fair and equitable availability of vaccines to every country.

Keywords: COVID-19; Cross-country vaccination heterogeneity; Heckman selection; State capacity.

MeSH terms

  • COVID-19 Vaccines* / therapeutic use
  • COVID-19* / prevention & control
  • Developing Countries
  • Humans
  • Vaccination

Substances

  • COVID-19 Vaccines