Diego A. Diaz, Cristian Larroulet and Andres Marticorena
Globalization and Health, Volume 22, Article 71 (2026)
Background: The COVID-19 pandemic revealed substantial differences across countries in mortality, vaccination rates, and economic recovery. This study investigates how institutional quality before the pandemic was associated with health and economic outcomes, including the potential role of vaccination.
Methods: The authors combine the World Bank’s 2019 Worldwide Governance Indicators with international data on COVID-19 mortality, vaccination, economic performance, and government responses. Cross-country regression models and an exploratory mediation analysis are used to evaluate these relationships.
Results: Higher institutional quality is associated with lower reported and excess COVID-19 mortality and higher vaccination coverage. In the fully adjusted models, a one-unit increase in institutional quality is associated with 384 fewer reported deaths per million, 1,860 fewer excess deaths per million, and a 15.5 percentage-point increase in full vaccination coverage. The relationship with economic growth is less consistent, particularly during 2020.
Conclusions: Institutional quality before the pandemic was strongly associated with health outcomes and vaccine deployment. Economic relationships varied across phases of the pandemic. Although the findings do not establish causality, they highlight the importance of effective institutions for future pandemic preparedness.
