Socioeconomic determinants of COVID-19 vaccination and mortality: a cross-national path analysis.

Publication date: Jul 08, 2026

Numerous clinical and epidemiological studies demonstrated that COVID-19 vaccines and boosters reduce infection and mortality; however, the extent to which these effects vary across socioeconomic and political contexts remains insufficiently explained at the population level. Cross-national evidence remains fragmented, with many studies examining vaccination coverage and macro-structural determinants separately rather than evaluating how structural readiness, vaccination and booster coverage interact simultaneously to influence mortality outcomes, particularly during the post-Omicron phase. Consequently, it remains unclear how structural development and policy capacity are associated with differences in the population-level mortality impact of vaccination strategies. This study tested an integrated cross-national structural model examining the interplay between COVID-19 vaccination strategies and country-level macro-structural indicators -the Human Development Index (HDI) and the Containment and Health Index (CHI)- and assessed whether these factors shape vaccination and booster uptake and subsequent COVID-19 mortality change across countries. Using country-level data from 195 countries between March 11, 2020, and August 1, 2022, structural path modeling evaluated hypothesized directional pathways among HDI, CHI, vaccination and booster coverage, and COVID-19 mortality change. Variables were standardized and annualized, and before/after ratios captured mortality changes associated with vaccination rollout. Vaccination and booster coverage were measured at a harmonized late-2021 reference point to ensure cross-national comparability prior to outcome assessment. The model demonstrated acceptable fit and statistically significant associations within the modeled pathways (p 

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