Democracies are generally thought to be better able to handle the provision of public goods than non-democracies. However, vaccines are a type of public good where we might expect this dynamic not to apply. Generally, a high vaccination uptake is net-profitable for the state above a certain level of national wealth, given losses of tax income to disease and health care expenditures. At the same time, democracies may be suspected to be less likely to use coercive means to achieve the goal of high uptake. This leads to the hypothesis that at least among rich countries, democracies may fare worse in terms of vaccination uptake.
In this paper, I test this proposal using a cross-country panel of WHO uptake data. I test both traditional panel models, as well as an IV-approach using regional democratization waves as an instrument for own-country democracy. With both approaches, the theoretical prediction appears to hold up: rich non-democracies do indeed achieve higher uptake than rich democracies.