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Immunization in developing countries : its political and organizational determinants

  • Gauri, Varun
  • Khaleghian, Peyvand

The authors use cross-national social, political, economic, and institutional data to explain why some countries have stronger immunization programs than others, as measured by diphtheria-tetanus-pertussis (DTP) and measles vaccine coverage rates and the adoption of the hepatitis B vaccine. After reveiwing the existing literature on demand- and supply-side side factors that affect immunization programs, the authors find that the elements that most affect immunization programs in low- and middle-income countries involve broad changes in the global policy environment and contact with international agencies. Democracies tend to have lower coverage rates than autocracies, perhaps because bureaucratic elites have an affinity for immunization programs and are granted more autonomy in autocracies, althought this effect is not visible in low-income countries. The authors also find that the quality of a nation's institutions and its level of development are strongly related to immunization rate coverage and vaccine adoption, and that coverage rates are in general more a function of supply-side than demand effects. there is no evidence that epidemics or polio eradication campaigns affect immunization rates one way or another, or that average immunization rates increase following outbreaks of diphtheria, pertussis, or measles.

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Paper provided by The World Bank in its series Policy Research Working Paper Series with number 2769.

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Date of creation: 31 Jan 2002
Date of revision:
Handle: RePEc:wbk:wbrwps:2769
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  1. Nichter, Mark, 1995. "Vaccinations in the third world: A consideration of community demand," Social Science & Medicine, Elsevier, vol. 41(5), pages 617-632, September.
  2. Beck, Thorsten & Clarke, George & Groff, Alberto & Keefer, Philip & Walsh, Patrick, 2000. "New tools and new tests in comparative political economy - the database of political institutions," Policy Research Working Paper Series 2283, The World Bank.
  3. Robert W. Fogel, 1984. "Nutrition and the Decline in Mortality Since 1700: Some Preliminary Findings," NBER Working Papers 1402, National Bureau of Economic Research, Inc.
  4. Anne Pebley & Noreen Goldman & Germán Rodríguez, 1996. "Prenatal and delivery care and childhood immunization in guatemala: Do family and community matter?," Demography, Springer, vol. 33(2), pages 231-247, May.
  5. Sonalde Desai & Soumya Alva, 1998. "Maternal education and child health: Is there a strong causal relationship?," Demography, Springer, vol. 35(1), pages 71-81, February.
  6. repec:oup:restud:v:49:y:1982:i:4:p:533-49 is not listed on IDEAS
  7. Kim Streatfield & Masri Singarimbun & Ian Diamond, 1990. "Maternal Education and Child Immunization," Demography, Springer, vol. 27(3), pages 447-455, August.
  8. Muraskin, William, 1995. "Bucking the health establishment: Alexander Milne and the fight for a New Zealand hepatitis B immunization program," Social Science & Medicine, Elsevier, vol. 41(2), pages 211-225, July.
  9. Streefland, Pieter H., 1995. "Enhancing coverage and sustainability of vaccination programs: An explanatory framework with special reference to India," Social Science & Medicine, Elsevier, vol. 41(5), pages 647-656, September.
  10. Anastasia Gage & A. Sommerfelt & Andrea Piani, 1997. "Household structure and childhood immunization in Niger and Nigeria," Demography, Springer, vol. 34(2), pages 295-309, May.
  11. Langsten, Ray & Hill, Kenneth, 1998. "The accuracy of mothers' reports of child vaccination: evidence from rural Egypt," Social Science & Medicine, Elsevier, vol. 46(9), pages 1205-1212, May.
  12. repec:oup:qjecon:v:112:y:1997:i:4:p:1251-88 is not listed on IDEAS
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