ArticleGlobalization and health2026
Institutional quality and pandemic resilience: cross-country evidence on health and economic outcomes during COVID-19.
Article in Globalization and health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe COVID-19 pandemic exposed large cross-country differences in mortality, vaccination rollout, and economic recovery. We examine whether stronger pre-pandemic institutions were associated with better pandemic performance and whether vaccination rollout helps explain part of that relationship. We combine 2019 World Bank Worldwide Governance Indicators with COVID-19 outcomes, policy measures, World Development Indicators, and V-Dem electoral democracy data, estimating cross-country regressions and a temporally ordered exploratory mediation model using vaccination by September 2021 and deaths accrued in the fourth quarter of 2021.
resultsIn full multivariable specifications, a one-unit increase in the WGI composite is associated with 384 fewer reported COVID-19 deaths per million, 1,860 fewer excess deaths per million, and 15.5% points higher full vaccination coverage by end-2021. These associations remain in robustness checks using V-Dem electoral democracy controls, WGI principal-component measures, timing-specific outcomes, and influence diagnostics. Institutional quality is not robustly associated with GDP growth in 2020; its positive association with GDP growth in 2021 persists but is weaker after controlling for OxCGRT economic-support policies. The exploratory mediation decomposition is consistent with an indirect path through vaccination representing about 35% of the total association between institutional quality and late-2021 mortality.
conclusionsPre-pandemic institutional quality was consistently associated with pandemic health outcomes and vaccine deployment, while economic associations were more phase-specific. The findings are observational and should not be read as definitive causal estimates, but they underscore the relevance of governance capacity for future pandemic preparedness.
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