Immunization in Developing Countries: Its Political and Organizational Determinants

The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and do not necessarily represent the views of the World Bank, its Executive Directors, or the countries they represent. Working papers describe research in progress by the author(s) and are published to elicit comments and to further debate.Abstract This paper uses cross-national social, political, economic, and institutional data to explain why some countries have stronger immunization programs than others, as measured by DTP and measles vaccine coverage rates and the adoption of the hepatitis B vaccine. After reviewing the existing literature on demand-and supply-side factors that affect immunization programs, the paper finds that the elements that most affect immunization programs in low-and middle-income countries involve broad changes in the global policy environment and contact with international agencies. Democracies tend to have lower coverage rates than autocracies, perhaps because bureaucratic elites have an affinity for immunization programs and are granted more autonomy in autocracies, although this effect is not visible in low-income countries. The paper also finds that the quality of a nation's institutions and its level of development are strongly related to immunization rate coverage and vaccine adoption, and that coverage rates are in general more a function of supply-side than demand effects. There is no evidence that epidemics or polio eradication campaigns affect immunization rates one way or another, or that average immunization rates increase following outbreaks of diphtheria, pertussis, or measles.