This article examines the evolution of COVID-19 vaccination efforts during 2021 and 2022 in six Central American countries, each with distinct social policy legacies and political regimes. Drawing on official data sources, the article differentiates two phases: the initial rollout of vaccines and the subsequent expansion of second-dose coverage to secure immunity. We advance three main arguments. First, differences in performance can be partly explained by the state capacities needed to implement vaccination campaigns. Second, regime type does not explain success; Nicaragua matched the performance of the most effective democratic countries. Third, presidential will accounts for the divergent trajectories of autocratic regimes. These findings underscore that in times of crisis, effective social intervention is possible without democratic pressures and accountability and highlight the need to further examine variation within nondemocratic regimes.