Supply, then demand? Health expenditure, political leanings, cost obstacles to care, and vaccine hesitancy predict state-level COVID-19 vaccination rates

Abstract

ObjectivesTo examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021. MethodsUsing publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout. ResultsWe identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determinants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increasingly salient over time. We find that our results are generally robust to a range of alternative specifications. ConclusionsBoth supply and demand-side factors relate to vaccination coverage and the determinants of success have changed over time. Policy ImplicationsInvesting in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost obstacles to care may be crucial for later immunisation campaign stages.