Political, Economic, and Social Determinants of the COVID-19 Vaccination Rate with Focus on Institutional Quality and Human Development: A Finite Mixture Approach

Document Type : Original Article

Author

Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/jhmi.2025.109309.1327

Abstract

Introduction: Although immunization against COVID-19 is one of the most effective
strategies to control the pandemic, political, economic, and social determinants play a vital role
in improving vaccine access and vaccination rates across countries. The present study aimed
to investigate the roles of political, economic, and social determinants in the performance of
countries facing the COVID-19COVID-19 pandemic, focusing on institutional quality and
human development.
Methods: The required data were gathered from international organizations’ databases. After
descriptive and correlation analysis, finite mixture model (FMM) was used for estimation
of the effect of institutional quality (IQ), human development index (HDI), and other
control variables (government health expenditure percentage of total health expenditure
(GHE%THE), logarithmic gross domestic production (LGDP) and unemployment rate
(UR)) on the covid-19 complete vaccination (CFV). The researchers’ assumption in using
FMM was that CFV had different dimensions and heterogeneity, and HDI had one observed
dimension and several unobserved ones, which could better explain CFV heterogeneity than
other explanatory variables. Stata 17 was used for model estimation.
Results: In the first class estimation of the FMM model, coefficients of IQ (γ1=0.1458, P=0.000),
GHE%THE (μ1,1=0.2761, P=0.009), and LGDP (μ1,2=0.0586, P=0.014) were significantly
positive, and UR (μ1,3=-.0124, P=0.000) was significantly negative. Moreover, class-two
estimation showed a significant effect of HDI on CFV (δ2=63.0537, P=0.009). There is also
a significant and positive relationship between CFV and IQ (γ2=0.1199, P=0.000), GHE%HE
(μ2,1=0.27085, P=0.002), and LGDP (μ2,2=0.0559, P=0.000) and UR (μ2,3=0.0169, P=0.000).
Conclusion: Countries with high human development and better institutional quality (voice
and accountability, control of corruption, political stability and absence of violence/terrorism,
rule of law, regulatory quality, and government effectiveness) reported higher vaccination
rates. In other words, political, economic, and social determinants played a significant role in
the performance of health systems amid critical conditions, such as the pandemic, particularly
in access to vaccines and vaccination rates against COVID-19.

Highlights

Alireza Hadipour: Google Scholar

Mohsen Bayati: Google Scholar

Keywords

Main Subjects

References

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Health Management & Information Science
Volume 13, Issue 1
January 2026
Pages 53-59

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