Higher agency may explain why Latin America outperformed Eastern Europe in COVID-19 vaccination and life expectancy

When a new health threat emerges, the success of a global response often depends on more than just the availability of medicine. It relies on whether people trust the science, believe in the institutions offering help, and feel capable of making the right choice for themselves and their families. This capacity to act on one's own behalf, to gather information and make a decision that protects one's well-being, is what sociologists call "agency." It is not simply about having money or access to a hospital; it is the internal ability to navigate a complex world and take charge of one's own health. Understanding why some populations embrace life-saving measures while others hesitate has become a critical question for public health, especially after the global experience with the COVID-19 pandemic revealed that wealth and medical infrastructure do not always guarantee a successful outcome.

A recent study by researchers in Poland and the United States investigates a puzzling contradiction that emerged during the pandemic: why did countries in Latin America achieve significantly higher vaccination rates and better long-term health outcomes than countries in Eastern Europe, despite having less money, lower education scores, and weaker healthcare systems? Conventional wisdom suggests that wealthier nations with better hospitals should naturally have healthier populations and higher vaccination uptake. The data, however, told a different story. The researchers set out to find the hidden factor that allowed Latin American nations to outperform their Eastern European counterparts, looking beyond the usual economic indicators to uncover a deeper social dynamic.

To solve this mystery, the team analyzed data from dozens of countries, focusing on two specific regions: Latin America and Eastern Europe. They compared these regions using standard measures of national success, such as gross domestic product per person, education levels, and the quality of healthcare access. As expected, the Eastern European nations scored higher on these traditional metrics. They were wealthier, their citizens had higher test scores, and their healthcare systems were rated as more accessible and of higher quality. Yet, when the researchers looked at the actual number of people who received at least one dose of a COVID-19 vaccine by the end of 2021, the pattern flipped completely. Latin American countries vaccinated a much larger share of their population. The gap was so wide that even after adjusting for the fact that Latin America had fewer resources, the region still vaccinated about 35 percentage points more of its people than the global trend would have predicted, while Eastern Europe fell short by a similar margin.

The researchers proposed that the answer lay in a concept called "agency," which they defined as the ability of individuals to make autonomous, well-informed decisions and to use available resources effectively. They argued that this capacity is not built overnight but is shaped by decades, or even centuries, of history. In Eastern Europe, decades of communist rule following the Russian Revolution had suppressed independent civic activity. During that time, the state controlled most aspects of life, including health decisions, leaving citizens with little practice in organizing themselves or making independent choices. In contrast, Latin America experienced a long history of revolutionary struggles and grassroots mobilization. Even though these movements often faced opposition from powerful foreign nations, the repeated need for ordinary people to organize, form unions, and build non-governmental groups fostered a culture of self-reliance and collective action.

To test this idea, the team created a new measurement tool, which they called an Agency Index. Instead of asking people how they felt, they looked at observable behaviors that indicate a society's ability to act independently. They combined three specific indicators: the level of participation in democratic processes, the rate at which people work for themselves rather than for an employer, and the proportion of adults who start their own businesses. By averaging these numbers over a twenty-year period, they smoothed out temporary political shifts to see the long-term trend. The results were clear: Latin American countries scored significantly higher on this index than Eastern European nations.

The study then connected this index to health outcomes. Among the countries analyzed, those with a higher Agency Index showed a much stronger tendency to vaccinate, even when their economic and healthcare resources were lower. The correlation was strong enough that the researchers found the Agency Index to be a better predictor of vaccination success in these regions than money or education alone. The same pattern appeared when looking at life expectancy. Latin American countries lived longer than their economic status would suggest, while Eastern European countries lived shorter lives than expected given their wealth and healthcare quality. The difference in life expectancy between the two regions, after accounting for healthcare quality, was about four years.

The researchers also examined other possible explanations to ensure they were not missing the real cause. They looked at whether trust in the government or trust in science could explain the difference. The data showed that trust levels did not match the vaccination results. For instance, in 2018, trust in science was actually higher in Eastern Europe than in Latin America, yet the former region vaccinated far less. Similarly, trust in government fluctuated wildly in both regions without a clear link to who got vaccinated. In one notable case, trust in the government in Brazil rose sharply even while the president was spreading false information about the virus, yet the country still achieved a high vaccination rate. This suggested that the decision to get vaccinated was not simply a matter of trusting the authorities, but rather a reflection of a deeper, more personal capacity to make health decisions.

The study concludes that as material constraints like poverty and lack of medicine become less of a barrier, the ability of a population to make informed, autonomous choices becomes the most important factor in public health. The researchers suggest that the historical development of civic life in Latin America created a society where people were more practiced at taking initiative, organizing, and making decisions for themselves. This "agency" allowed them to translate available resources into better health outcomes, even when those resources were scarcer than in Eastern Europe. Conversely, the long history of state control in Eastern Europe may have left a legacy where citizens were less accustomed to making independent health choices, leading to lower vaccination rates and shorter lives despite having more money and better hospitals. The findings suggest that building a healthy society requires more than just funding hospitals; it also requires fostering the social conditions that allow people to feel capable of acting for their own well-being.