With at least seven variations of the COVID vaccine available worldwide and over two hundred in development, humanity makes remarkable progress in the battle against COVID-19. Still, vaccine equity remains unrealized. High-income countries can afford to order doses far beyond what the sizes of their populations constitute. For instance, Canada already placed enough advanced orders to vaccinate each of its citizens nearly six times over, the United Kingdom four times over, and the European Union almost 2 times over. Meanwhile, some middle-to-low-income countries lack vaccines entirely, including Peru, South Africa, Ukraine, and Panama. Describing this as a “moral outrage” and an invitation for COVID-19 variants, the director-general of the World Health Organization appealed, “If countries won’t share vaccines for the right reasons, we appeal to them to do it out of self-interest.” Indeed, self-interest prevails. India, China, and their partners are employing vaccine donations to gain influence, an emerging practice known as “vaccine diplomacy.”
In recent years, the divide between China and the U.S. has become increasingly pronounced. Yet, disputes regarding Taiwan, Hong Kong, the South China Sea, trade deals, and the India-China border have created problems well beyond U.S.-Sino relations. Nations now find themselves in a re-emerging Cold War setup where they fall into a rising Chinese sphere of influence or they are backed by established Western powers. Existing on the edge of brinkmanship over multiple subjects of global contention, China and the West now see the COVID vaccine as a crucial leverage. After more than 142 million confirmed cases and over 3 million deaths worldwide, the key to ending the pandemic has become a weapon itself.
Armed with robust public-health-monitoring systems and stringent requirements for its citizens, China managed to control the pandemic by the winter of 2020. As a result, the country returned to a high degree of normalcy while other countries, primarily the United States, experienced record surges in cases and hospitalizations. With greater flexibility to export its vaccines and while maintaining control of the virus, China vowed to aid 53 countries in vaccination efforts and export vaccines to 27 others. Even though its Ministry of Foreign Affairs deemed COVID-19 vaccines a “global public good” and rejected vaccine diplomacy, the scale of its ambitions cannot be reduced to philanthropy.
As China’s Sinovac and Sinopharm doses enter world markets, the country carefully selects its vaccine recipients. In fact, every country receiving its vaccines, except one, partakes in the Belt and Road Initiative, a Chinese-state-backed program lending trillions of dollars to over 100 countries. Criticized as a form of debt-trap diplomacy, in which a nation encourages deficit spending to coerce debtor states into favorable policy positions, China’s vaccine distribution conveniently reinforces its influence-building operation. By flaunting its vaccine beneficence, China lures susceptible nations into its sphere as they seek protection from a lethal virus.
Beyond the parameters of its Belt and Road Initiative, new reports suggest Chinese-associated entities are withholding doses to provoke policy shifts. As reported by The Guardian on March 24, brokers urged Paraguay’s foreign ministry to cut diplomatic ties with Taiwan in return for COVID-19 vaccines from China. In response to this report, China’s foreign ministry denounced these claims as a “malicious,” Taiwan-backed disinformation attempt. However, such a maneuver would align with China’s long-term strategy in dealing with Taiwan, which China regards as part of its national territory. Out of Taiwan’s fifteen formal partners, Paraguay is the only one in South America, making the country imperative to Taiwan’s global engagement. By diminishing Taiwan’s ties with its limited global partners, China strategically undermines the power of Western nations in East Asia. In light of this development, Taiwanese Foreign Minister Joseph Wu asserted China’s activity as “having lots of impact on [Taiwan’s] diplomatic allies,” and vowed to aid Paraguay in purchasing vaccines. Working alongside “like-minded countries,” Wu collaborated with India to provide 100,000 doses to Paraguay and to promise 100,000 more in the future, ensuring that Paraguay will not capitulate to protect its citizens. With the emergence of vaccines as a new front in the tension among China, India, Japan, and other Asian powers, Taiwan and China vie for influence with the help of a “public good.” As countries continue to seek relief from the inequities of vaccine distribution, China’s health and manufacturing prowess serve as advantages in gaining influence across the world.
In light of China’s attempts to accumulate power through vaccination distribution, India has responded with its own efforts in Asia. As its domestic manufacturers produce the AstraZeneca vaccine and develop capabilities to mass produce others, India exported 60 million doses, 24 million more than those administered domestically. Nearby countries receiving these shipments include Nepal, Sri Lanka, and Bangladesh, all potential checks against the rise of China on the Asian continent. Yet, India faces challenges of its own, including a massive surge in cases. To the detriment of foreign vaccine recipients, the Indian government now retains all AstraZeneca doses designated for its own population. Although India’s decision lends a temporary advantage to China, the heightened awareness of other powers complicates the political scene.
To counter China’s vaccine diplomacy, the US also engaged with its traditional Asian partners. At a recent summit this March, the United States, India, Australia, and Japan agreed to supply Asia with up to one billion COVID-19 vaccine doses by the conclusion of 2022. Notably, the summit placed these concerns specifically within the context of China’s influence. Underscoring this focus, US National Security Advisor Jake Sullivan affirmed that “none of [the leaders] have any illusions about China,” and that democracy can overcome autocracy. Later that month, US Secretary of State Antony Blinken issued Washington’s position in even starker terms, claiming that China sacrifices global health for politics and that its vaccine donations have “strings attached.” Although this may be true, the US is not in a morally superior position itself. As it refuses to donate any of its authorized doses in the near-term, a senior administration official emphasized the country is “focused on American vaccinations and getting shots into arms.” As self-interest abounds, countries must rely on the charity of wealthy nations. Unfortunately, even philanthropic donations come with significant barriers for those in need.
One avenue for apolitical aid to poor countries, the COVID-19 Vaccines Global Access Initiative (COVAX), faces severe challenges, inhibiting the eradication of COVID-19 in the most acutely affected areas. COVAX, established in April 2020 by the WHO and vaccine charities, seeks to provide doses to low and middle-income countries that lack the funding necessary to purchase vaccines. The program, however, cannot overcome the realities of vaccine diplomacy and hoarding by wealthy countries. Unlike China, which pledged to supply 10 million doses of its vaccines to COVAX, the US announced a donation of $4 billion to the program. Although the US figure appears generous, funding is essentially useless as long as wealthy countries dominate vaccine contracts, diverting doses to low-risk demographics. To add insult to injury, the US, UK, and EU continue to block the efforts of over 100 countries to suspend patent protections for COVID-19 vaccines, which would allow developing countries to produce doses themselves. In doing so, financial donations made to COVAX will simply flow back to Western powers that dominate both the manufacturing and the purchasing of vaccine contracts. Concurrently, patent protections stymie increases in manufacturing capacity, placing the entire world in jeopardy as a small set of countries and corporations control vaccine production. If world powers genuinely wished to demonstrate compassion, they would forgo patent restrictions and donate available vaccine doses. Evidently, domestic vaccinations take precedence in the West, leaving China with an even greater advantage in the realm of vaccine diplomacy.
The effects of vaccine inequity greatly plague the African continent. With India’s rise in cases and its subsequent vaccine export ban, 36 African countries face lulls in COVAX deliveries. For example, Ghana and Rwanda will soon deplete their supplies of vaccines with no certainty as to when second doses will arrive. Along with the prioritization of patent rights in Europe and the US, these delays may force African states to weather the pandemic without vaccines until 2023—an absolute absurdity considering that 44.4% of the American population received the first dose as of May 3. Amidst this inequity, Director John Nkengasong of the Africa Centres for Disease Control and Prevention issued the following warning to India and other countries that withhold doses for their own populations: “[Y]ou have not done yourself any justice because variants will emerge and undermine your own vaccination efforts.” With the possibility of variants threatening the effectiveness of vaccines, the failure of states to take concrete steps toward equitable, global distribution only endangers their own interests.
As vaccines promise an end to the COVID-19 pandemic, the world faces the loss of loved ones, economic uncertainty, and a severe disruption of social ties. Instead of contributing to vaccination as a global public good, existing political struggles within and outside Asia have dominated national approaches to vaccine equity. As long as China, India, the United States, and other powers perpetuate vaccine inequity, the entire world remains pinned beneath the threat of COVID-19 resurgences and protracted suffering. To right these wrongs, all nations must band together to increase global manufacturing, allocate vaccines to the most at-risk states, and acknowledge that vaccine diplomacy imperils all of humanity. Without this realization, self-interest will triumph to the world’s detriment.