Developed Markets June 30, 2021 / 02:09 pm UTC

Socioeconomic Status Shaping Pace of Vaccination

By Grant Hixon

Bottom line: A fundamental driver of our health and risk of contracting COVID is socioeconomic status. Poor housing, decreased sanitation or weak health systems all increase risk of transmission of COVID. Our analysis here implies that those most at risk of slow vaccine rollout are already vulnerable by way of the social and economic disadvantages that characterize their lives. We find a clear association between the pace of vaccination rollouts and our Country Insights Pillar IV aggregate of social inclusion.

Figure 1: Country Insights Pillar IV Scores Associated with Vaccination Rollouts

Source: Continuum Economics, Our World in Data. Notes: Vaccination data are doses administered per 100 people, on rolling 7-day average — this is counted as a single dose. Data are represented in logs. Negative log vaccination points are from data where vaccination per 100 population < 1.

Social Inclusion during COVID

There has been significant progress in improving social inclusion and health outcomes across the world in the past 30 years. For many, life expectancy has risen and people are living healthier lives thanks to increased access to medicines, vaccines and health services. A fundamental driver of our health — and our risk of contracting COVID — is our socioeconomic status. COVID has ravaged health systems and exposed deep health inequalities and their underlying social determinants across countries.

Health shocks such as the current pandemic disproportionately affect lower-income countries already beset by poverty, structural vulnerabilities and pre-existing major health problems such as infectious diseases. As of 2018, around one-third of WHO member states had no adult vaccination program for any disease, and only one-tenth of countries in Africa and South Asia reported having any such programme. Barely 1% of people in low-income countries have received at least one dose of COVID vaccine. While logistical infrastructure such as storage, delivery and administrative capacity remains a supply constraint, demand is strong. A recent poll by Ipsos MORI indicated that vaccine hesitancy is low in EM: If a vaccine were available, more than 80% of respondents in India, China and Brazil would take the shot.

Country Insights Pillar IV — an Introduction

EM vaccine supply shortages will ease as manufacturing processes increase and imports become more available. But some countries are better placed than others to facilitate the rollout. Societal inclusion and interventions outside of immediate healthcare provision are as important as having hands on the vaccines. Effective community engagement, building confidence in vaccines and overcoming cultural and socioeconomic barriers are key to ensuring successful vaccine rollouts. 

We have constructed a headline measure of social inclusion, Pillar IV, which takes inspiration from the Multidimensional Poverty Index developed by the Oxford Poverty and Human Development Initiative. The metric evaluates factors across living standards, health, education, material well-being and inequality. Each factor is calculated from several subfactors. The health factor, for example, is made up from data such as life expectancy, mortality rates of different age groups and circumstances and vaccination against measles (a proxy to assess strategies to reduce morbidity and mortality of vaccine-preventable diseases).

High Pillar IV Scores Associated with Rate of COVID Vaccination

We looked at the relationship between Pillar IV and COVID vaccination progress and found that countries with a relatively high Pillar IV score tend to have high rates of administered vaccine, and relatively low Pillar IV scores are associated with low COVID vaccination rates (Figure 1). Israel, the UAE and Bahrain have among the highest doses administered per 100 of population and also are among the highest Pillar IV scores. By contrast, most African countries have administered the fewest doses of vaccine and have the very lowest Pillar IV scores.

Vaccination rates are heavily skewed by level of economic development. Of the countries appearing above the 75th percentile of vaccination rate, more than three-quarters are classified as DM or higher-income EM economies like China. Countries in the 25th percentile are overwhelmingly less mature markets, with 85% classified as Frontier Markets. 

This headline association supports the concept that lower-income countries face social inclusion barriers in delivering capabilities in the form of opportunities, well-being and health systems, which has also weighed on their COVID suppression programs and prevented an earlier and faster rollout, delaying economic recovery.

Improving Health Systems

Prior to COVID, health systems globally were generally improving. Of the 173 countries that we cover, 84% had a better health factor score in 2019 compared to 2006 (the start of our dataset). Perhaps unsurprisingly, given the already-mature DM health systems, the largest improvements were in EM.

Figure 2 shows that the greatest development has been in countries in EM and FM across Asia, Eastern Europe and parts of Africa. The latest readings indicate that countries like Zimbabwe, India and Indonesia have much further to go to reach parity with China and Turkey and most DMs.

Figure 2: Health Factor Scores over Past 15 Years Reveal Progress in EM/FM

Source: Continuum Economics; Notes: Pink bars represent change in health factor score from 2006 to 2019 for countries with a greater than 2 standard deviation change across our 173 countries (LHS). Black dots represent latest ‘health’ factor score for Q1 2021 Country Insights release (RHS), 0 to 10 (10 being the best health score).

Slow Vaccination Puts EM Recovery at Risk

Socioeconomic conditions influence our risk of contracting COVID. Poverty, poor housing, inadequate sanitation or weak health systems all increase risk of COVID transmission and tend to be associated with slow vaccine delivery. Our analysis here implies that those most at risk of slow vaccine rollout are already vulnerable by way of the social and economic disadvantages that characterize their lives. Slow vaccine rollout delays the economic recovery offered with vaccination.

The economic impact of vaccination will vary across EM (for example, services vs. export-oriented economies). But countries that lag behind in vaccination rollout will be slower to fully reopen their economies and therefore underperform for longer compared to pre-COVID expectations. The concern is that the longer it takes to manage future waves of COVID, the greater the risk of periodic lockdowns that disrupt activity and in the long run, encourage scarring.

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Analyst Certification
I, Grant Hixon, the lead analyst certify that the views expressed herein are mine and are clear, fair and not misleading at the time of publication. They have not been influenced by any relationship, either a personal relationship of mine or a relationship of the firm, to any entity described or referred to herein nor to any client of Continuum Economics nor has any inducement been received in relation to those views. I further certify that in the preparation and publication of this report I have at all times followed all relevant Continuum Economics compliance protocols including those reasonably seeking to prevent the receipt or misuse of material non-public information.