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

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