Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jan;12(1):e156-e165.
doi: 10.1016/S2214-109X(23)00490-4. Epub 2023 Dec 11.

Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries

Catherine Arsenault  1 , Todd P Lewis  2 , Neena R Kapoor  2 , Emelda A Okiro  3 , Hannah H Leslie  4 , Patrizio Armeni  5 , Prashant Jarhyan  6 , Svetlana V Doubova  7 , Katherine D Wright  2 , Amit Aryal  8 , Sengchanh Kounnavong  9 , Sailesh Mohan  6 , Emily Odipo  3 , Hwa-Young Lee  10 , Jeonghyun Shin  11 , Wondimu Ayele  12 , Jesús Medina-Ranilla  13 , Laura Espinoza-Pajuelo  13 , Anagaw Derseh Mebratie  12 , Ezequiel García Elorrio  14 , Agustina Mazzoni  14 , Juhwan Oh  11 , Gillian K SteelFisher  15 , Rosanna Tarricone  5 , Margaret E Kruk  2
Affiliations
Review

Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries

Catherine Arsenault et al. Lancet Glob Health. 2024 Jan.

Abstract

The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests Research for this Series paper was supported by grants to MEK and the QuEST Network from the Bill & Melinda Gates Foundation and the Swiss Federal Department of Foreign Affairs. This research was also supported by grants to CA and MEK from Merck Sharp & Dohme; to EGE and HHL from the Inter-American Development Bank; and to JO from the Taejae Foundation. The funders of the study had no role in study design or conduct, data collection, data management, data analysis, data interpretation, the writing of the Series paper, or the decision to submit the Series paper for publication.

Figures

Figure 1
Figure 1
Reported number of COVID-19 vaccine doses received by country Countries are ordered by the proportion of respondents who received three or more doses of a COVID-19 vaccine. Samples are representative of the adult population in each country except Argentina, where respondents represent the province of Mendoza only. All estimates include sampling weights.
Figure 2
Figure 2
Associations between health-care use and health-system competence and COVID-19 vaccination Associations for respondents who had one or two, three or four, or five or more health-care visits in the past year; had a usual source of care; received at least three other preventive health-care services in the past year; or had unmet health-care needs in the past year. Countries are ordered according to their gross national income per capita (appendix 1 p 12). Full regression results are in appendix 2 (pp 8–15). aOR=adjusted odds ratio.
Figure 3
Figure 3
Associations between perceived quality and user experience and COVID-19 vaccination Associations for respondents who rated the quality of their usual provider as very good or excellent, experienced discrimination in the health system in the past year, or believed medical mistakes were made. Countries are ordered according to their gross national income per capita (appendix 1 p 12). aOR=adjusted odds ratio.
Figure 4
Figure 4
Health system confidence and COVID-19 vaccination Associations for respondents who were somewhat or very confident of getting and affording quality care if sick, somewhat or very confident that government considers public opinion, and who rated the government's management of the COVID-19 pandemic as very good or excellent. Countries are ordered according to their gross national income per capita (appendix 1 p 12). aOR=adjusted odds ratio.
See this image and copyright information in PMC

Comment in

References

    1. Lazarus JV, Wyka K, White TM, et al. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nat Med. 2023;29:366–375. - PubMed
    1. Larson HJ, Gakidou E, Murray CJL. The vaccine-hesitant moment. N Engl J Med. 2022;387:58–65. - PMC - PubMed
    1. Burki T. Global COVID-19 vaccine inequity. Lancet Infect Dis. 2021;21:922–923. - PMC - PubMed
    1. Our World in Data COVID-19 data explorer. 2023. https://ourworldindata.org/explorers/coronavirus-data-explorer
    1. Kafadar AH, Tekeli GG, Jones KA, Stephan B, Dening T. Determinants for COVID-19 vaccine hesitancy in the general population: a systematic review of reviews. J Public Health. 2022;19:1–17. - PMC - PubMed