The coronavirus disease (COVID-19) outbreak has resulted in the death of over four million people since late 2019. To reduce the human and economic costs of COVID-19, different vaccines have been developed and distributed across countries. There has been significant cross-country variation in the vaccination of people against COVID-19. In this study, we focus on public corruption to explain the significant cause of cross-country variation in immunization progress. We suggest that countries with a higher degree of public corruption have been less successful in the vaccination of their population, controlling for other important determinants of immunization progress.

      But how can corruption affect the speed and scale of worldwide vaccination projects? In light of the extraordinary speed and global scale of COVID-19 vaccine distribution,The end of 2019 saw the emergence of a novel and particularly infectious disease which had a sudden and profound global impact. The new coronavirus spread rapidly and soon took over the planet. There have been more than 213 million confirmed cases and close to 4.5 million deaths as of August 2021. To limit the spread of the virus, COVID-19 containment measures were implemented by countries. These measures, such as social distancing, entail economic and psychological costs. The only long-term response to the crisis is the immunization against the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2).

      Several vaccines have been developed and offer high protection against disease and infection from the virus. For example, the Pfizer/BioNTech vaccine has 92% efficacy at preventing the COVID-19 disease for the ancestral type and Alpha variant and 90% for the Beta, Gamma, and Delta variants. The vaccine has 86% efficacy at preventing the infection for the ancestral and Alpha and has 78% efficacy for the Beta, Gamma, and Delta variants4. Countries such as Bhutan, Israel and the Seychelles have already vaccinated large contingents of their adult population5. However, there have been challenges in vaccinating the global population. The problem of corruption in the vaccine process has gained the attention of media and international organizations.

      In the report “COVID-19 Vaccines and Corruption Risks: Preventing Corruption in the Manufacture, Allocation and Distribution of Vaccines,” the United Nations Office on Drugs and Crime6 discusses the potential risks of corruption in the distribution process, where vaccine doses could be stolen, the theft of emergency funding and opportunities for nepotism, favoritism, and corrupted procurement systems. Transparency International7 and the European Anti-Fraud Office8 raised similar concerns regarding the distribution of vaccines. 

    The supply shortage of COVID-19 vaccines creates opportunities for corruption throughout the world. In South America, Peruvian and Argentinian politicians and their families received vaccinations prior to being officially eligible for them9. There have also been reports of wide-ranging corruption scandals related to the COVID-19 vaccine in Brazil and Venezuela9. In Spain, local mayors received preferential access to vaccine doses before they were widely available to the general public10,11. In Italy, there have been reports of vaccine sales on the grey market12,13. Corruption scandals around the vaccine were also reported in Lebanon, South Africa and China14,15. Another example is Iran, which is struggling with significant mortality rates due to COVID-19 and slow vaccination progress. In May 2021, Kianoush Jahanpur, the spokesman for Iran's Food and Drug Administration, noted significant over-invoicing of imported vaccines by private firms (up to 12 times higher than the real price of the vaccines). Such firms with access to subsidized rates on vaccines are incentivized to over-invoice their imports and sell the additional amounts in the black market for foreign exchange at a high premium16. In addition to the recent COVID-19 vaccine scandals, it is worth mentioning that some of the pharmaceutical companies manufacturing the COVID-19 vaccine (AstraZeneca, Johnson & Johnson, Pfizer) were sued over bribery prior to the pandemic15. These examples argue for the possible destructive effects of public corruption on the successful vaccination against COVID-19. However, a data-driven cross-country investigation on the role of corruption in vaccinations is lacking. In this study, using data on the share of the population who have been vaccinated against COVID-19, public corruption, healthcare capabilities and economic indicators from over 90 countries, we examine the association between corruption and COVID-19 vaccination coverage. We find strong evidence of the damaging effects of pre-pandemic corruption on immunization progress across countries.

     The quality of the health sector essentially defines the speed and effectiveness of the COVID-19 vaccination process. However, the health sector is also prone to corruption. Savedoff and Hussmann19 state: “No other sector has the specific mix of uncertainty, asymmetric information and large numbers of dispersed actors that characterize the health sector. As a result, susceptibility to corruption is a systemic feature of health systems.” The authors underscore the enormous amount of global government spending on health, which would make the health sector highly profitable and therefore especially vulnerable to corruption. Transparency International estimates that 7.5 trillion dollars every year are spent on public health globally, 500 billion dollars of which is misappropriated due to corruption20.

    Moreover, there is empirical evidence for the substantial negative effects of corruption on the health sector. find a positive relationship between corruption and child mortality. The authors estimate that more than 140,000 deaths of children every year could be indirectly attributed to corruption. Sommer21 also focuses on child and infant mortality as the dependent variable and concludes that the interaction between corruption and health expenditures negatively affects child and infant mortality verify the negative effects of corruption on five different measures of health outcomes and conclude that corruption causes deaths. Habibov26 finds a negative relationship between corruption experienced in the healthcare sector and satisfaction with healthcare as subjective indicators. Achim et al.27 find that higher levels of corruption negatively affect physical (expressed as life expectancy and mortality) and mental health (expressed by happiness). Azfar and Gurgur28 find that in areas in the Philippines with widespread corruption, respondents reported longer wait times in public clinics and a higher frequency of being denied vaccines even prior to the COVID-19 crisis. Among other health outcomes, which were negatively associated with corruption, the authors find that corruption reduces immunization rates and delays the vaccination of newborns. 

    Another channel through which corruption may affect COVID-19 vaccination progress is social and political trust. Studies find that corruption negatively affects trust. Low levels of political trust may decrease the acceptance of vaccines against the COVID-19 virus. Empirical research finds a positive effect of trust on vaccine acceptance during previous immunization campaigns. During COVID-19, trust in institutions and the health sector is especially crucial due to the shortened clinical trials and emergency approvals of the vaccines in many countries. report that higher levels of trust in information provided by the government are associated with higher COVID-19 vaccine acceptance.

    In addition to the direct causes of corruption on the vaccination progress, the development stage of the COVID-19 vaccines needs to be considered. The first vaccine approved by the US Food and Drug Administration was from Pfizer/BioNTech36. BioNTech is a German startup that collaborated with Pfizer to develop a COVID-19 vaccine. One of the co-founders of the BioNTech Company, Dr. Ugur Sahin, commented in an interview with the New York Times regarding the development of the vaccine: “There are not too many companies on the planet which have the capacity and the competence to do it so fast as we can do it. The fast development of effective vaccines against the COVID-19 virus presupposed a constructive climate for entrepreneurship and highly educated scientists. Higher levels of corruption have been shown to have negative effects on productive entrepreneurship38 and quality of education39. Therefore, corruption may additionally have an indirect impact on vaccination projects by reducing entrepreneurship and the quality of education in the long term.