Institutional Quality and Pandemic Resilience: Cross-Country Evidence on Health and Economic Outcomes during COVID-19

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Diaz, Cristian Larroulet, Andres Marticorena This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9142776/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract The COVID-19 pandemic exposed large cross-country differences in mortality, vaccination rollout, and economic recovery, raising a central global health question: whether stronger pre-pandemic institutions helped countries respond more effectively. This paper examines the association between institutional quality, measured using the World Bank’s Worldwide Governance Indicators, and pandemic outcomes across up to 204 countries during 2020–2021. Across a range of multivariable cross-country models, stronger institutional quality is associated with lower reported COVID-19 mortality, lower excess mortality, and higher end-2021 full vaccination coverage. A one-unit increase in the WGI composite is associated with roughly 375 fewer reported COVID-19 deaths per million, 1,728 fewer excess deaths per million, and 16 percentage points higher full vaccination coverage. Institutional quality is not robustly associated with the depth of GDP contraction in 2020, but it is positively associated with GDP growth in 2021. Exploratory mediation analysis suggests that faster vaccination rollout may have been one pathway linking stronger institutions to lower late-2021 mortality. A descriptive case study of Chile illustrates these patterns, while also highlighting the role of macroeconomic support alongside institutional capacity. The findings identify institutional quality as an important correlate of pandemic resilience and underscore the relevance of governance and state capacity for global health preparedness, while also pointing to the limits of causal inference in cross-country observational research. JEL Classification: I18, H12, O43, O17 institutional quality COVID-19 governance pandemic resilience vaccination Chile excess mortality Full Text Additional Declarations No competing interests reported. Supplementary Files replicationscripts.zip supplement.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 May, 2026 Reviews received at journal 11 May, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers agreed at journal 24 Apr, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor assigned by journal 07 Apr, 2026 Submission checks completed at journal 07 Apr, 2026 First submitted to journal 16 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9142776","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":620991564,"identity":"cb74ca31-c900-4dcc-973a-6f35b0482722","order_by":0,"name":"Diego A. 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