# Universal Health Coverage and Preparedness Payoffs: Global COVID-19 Vaccination Rates

## TL;DR

Countries with stronger health systems and preparedness had higher vaccination rates during the pandemic.

## Contribution

This study shows that pre-pandemic health system preparedness and universal coverage predict higher vaccination rates.

## Key findings

- Vaccination rates increased from 32.2% in October 2021 to 51.2% by August 2022.
- UHC and SPAR indexes strongly correlated with vaccination rates (r = 0.76 and r = 0.66).
- UHC and SPAR remained significant predictors even after adjusting for income level.

## Abstract

Objective: The pandemic exposed global inequities in terms of health system capacities and vaccination coverage. This study evaluated the relationship between countries’ preparedness and COVID-19 vaccination rates. Methods: In this ecological study, we gathered global pre-pandemic data on country-level States Parties Self-Assessment Annual Reporting (SPAR) and universal health coverage (UHC) indexes. We then analyzed their relationship with COVID-19 vaccination rates in 2021–2022, using bivariate and multivariate analyses, including confounders, such as the country’s income classification and population demographics. Findings: The mean vaccination rates increased from 32.2% in October 2021 to 51.2% by August 2022. The UHC and SPAR indexes showed strong positive correlations with vaccination rates (r = 0.76 and r = 0.66, respectively, p < 0.001). In regard to the multivariate analyses, both the UHC (B = 0.81, 95% CI: 0.56–1.06) and SPAR (B = 0.34, 95% CI: 0.19–0.49) indexes remained significant predictors of vaccination rates, even after adjusting for country income level, with their influence strengthening over time, while income level effects diminished. Conclusions: This study underscores the critical importance of preparedness efforts, as gauged by the SPAR and UHC indexes, in shaping the effectiveness of COVID-19 vaccination responses globally. Strengthening preparedness measures is important for optimizing vaccination strategies and achieving broader immunization coverage targets.