Vaccine Diplomacy

Strategic Vision vol. 10, no. 50 (September, 2021)

Great-power rivalries open door for other states to employ health diplomacy

A.D. Gnanagurunathan

A shipment of vaccines prepares to depart for the Seychelles as part of India’s Covishield effort.

photo: Salifa Magnan

It has been almost two years since the outbreak of the COVID-19 virus was first reported on December 31, 2019. As the virus outbreak metamorphosed into a global pandemic within just a couple of months, the world suffered a significant disruption of socioeconomic and political life. Governments were forced to meet enormous challenges in controlling and containing COVID-19. It has intensified great-power discord, ignited domestic political turmoil, reduced international cooperation, and increased tensions with global health institutions, even as each state had to deal with the mounting death toll of its citizenry. In this context, it is useful to understand the extent to which the COVID-19 pandemic has influenced global politics, global health governance, and health diplomacy.

Historically, disease outbreaks and pandemics have played a crucial role in shaping world politics, be it changing the outcome of wars or in colonizing new territories. The spread of plague in Athens, for example, at the crucial juncture of the Peloponnesian War in 430 BC ruptured the social fabric of the citystate, contributing to its defeat at Syracuse. Likewise, Justinian’s Plague in the sixth century thwarted the rise of the Byzantine Empire, and the smallpox and measles that ravaged the Incan and Aztec civilizations facilitated Spanish conquest of the Americas.

Politics and technology have also increased the rate at which diseases spread, with railroads and steam ships carrying the Spanish flu to the remote corners of the world a century ago. Yet, thanks to improved sanitization and higher standards of living, advancements in medical science (such as the development of vaccines against viruses and bacterial infections) over the past 150 years have, until now, mitigated the impact of pandemics on global politics.

The outbreak of COVID-19 in December 2019 in the Chinese city of Wuhan occurred at a moment in global politics when tensions were rising between the two great powers, the United States and the People’s Republic of China (PRC), though this conflict was taking place mostly within the realm of trade and technology competition. The battle against the virulent outbreak should ideally have elicited robust responses from these great powers, but their reactions were quite different.

Domestically, politicians in the United States initially refused to acknowledge the severity of the crisis and acted slowly. The administration of then President Donald Trump put the blame for the virus on the Chinese government, accusing Beijing of covering up the initial outbreak. In an attempt to shore up its suffering reputation, the PRC responded with a public relations campaign of its own, calling theories that COVID-19 originated in Wuhan “unsubstantiated,” and accusing the Americans of engineering the virus and having US military personnel release it in China. What ensued was a diplomatic war of words between the two great powers.

Escalating Confrontation

Some US allies like Australia jumped on the bandwagon and demanded an international investigation be conducted into the origin of the virus in China, while others remained either muted or calibrated in their response to these demands. The confrontation escalated when the US government imposed fresh sanctions on Chinese semiconductor and communication technology firms, and banned popular Chinese apps like WeChat over national security and data privacy concerns. Washington also provided incentives for American companies to decouple their supply chains and move their operations out of China.

Taiwan has played an active role in providing international aid to countries battling COVID-19, yet it remains excluded from the WHO at China’s behest.

photo: zupaBA VUCBA

US Army personnel help administer COVID-19 vaccinations at the University of Guam.

photo: MacAdam Kane Weissman

The Chinese response to these US actions was quite measured, as the PRC had less leverage and more to lose, especially as US presidential elections were right around the corner. The PRC government withdrew the press credentials of journalists writing for US newspapers in retaliation, allegedly for biased reporting. China was keen to win the battle of narratives, however, especially as the virus outbreak had dented its international image as a rising superpower; one that could possibly replace the United States.

China grabbed this opportunity to coalesce its position in the global governance structure. While the United States continues to grapple with COVID-19, even though absolute infection and death rates have dropped significantly, official statistics released by the PRC indicate that the virus was largely contained in China by March 2020. Moreover, China exported personal protective equipment (PPE) consisting of masks, gloves, and other medical supplies globally and sent teams of medical experts to over 16 countries for consultation. Even though China’s actions have drawn criticism from certain quarters for exploiting the global crisis to achieve political gain—as well as for donating and selling PPE that later proved to be faulty to several countries in need—many developing countries in Asia and Africa have acknowledged China’s efforts.

Likewise, the United States was excoriated for failing to provide assistance to needy countries after it banned the export of medical supplies, instruments, and pharmaceutical ingredients. A wide gap has emerged in US global commitments and doubts have been raised about its policy competence, although this has largely been attributed to the America First stance of the previous Trump administration. Some scholars argue that COVID-19 hasn’t influenced global health norms the way HIV-AIDS did in the homosexual community in the 1980s. China’s apparent success in containing COVID-19 has prompted Beijing to claim a certain authority, and possibly assume a greater role in future global health normbuilding.

In addition to the great-power rivalry hampering the global effort against COVID-19, the North-South divide has further affected global health governance. Prior to the introduction of the COVID-19 vaccines, the governments of India and South Africa made a radical proposal to the World Trade Organization in October 2020: they suggested that countries should be allowed to manufacture COVID-19 vaccines even without patents, just for the duration of the pandemic. Existing trade rules disallow the cheap, quick manufacture of vaccines, while developed countries not only have the wherewithal to avail themselves of the medicines, but they are also insistent on rejecting such patent waiver proposals. Even influential non-state actors like the Bill & Melinda Gates Foundation, despite its stated commitment to improving healthcare in developing countries and the equitable distribution of COVID vaccines, failed to support the proposal.

US President Donald Trump has long held an America First position, and he openly placed the blame for COVID-19 at China’s door.

photo: Michael Vadon

As the global endeavor to distribute and vaccinate the world’s population is faltering, the situation is moving toward one in which each nation is concerned only with its own citizens, especially as the emergence of new strains has prompted governments to re-impose lockdowns, undoing the past year’s gains derived from the vaccines.

Health diplomacy is fundamentally about using international aid and cooperation to promote health in order to achieve broader strategic and foreign-policy objectives. While the rich countries rushed to inoculate their populations first with the Pfizer-BioNTech and Moderna vaccines developed using a new mRNA approach, and the Oxford-AstraZeneca vaccine using an adenovirus vaccine vector, developing countries in Asia, Africa, and Latin America had to look elsewhere to survive.

Filling the void

Three states in particular attempted to fill the void created by the West: the PRC, Russia, and India. The governments of these three countries are the contenders challenging the global dominance of the West, though they may have a certain strategic, sometimes tactical, understanding with each other, they compete among themselves as well. China and India have the requisite manufacturing capacity and can scale up production to meet the burgeoning global demand.

CoronaVac by the Chinese company Sinovac Biotech Ltd.; Sputnik V by the Gamaleya Research Institute, part of Russia’s Ministry of Health; and Covishield manufactured by the Serum Institute of India under license from AstraZeneca and Covaxin, and developed by Bharat Biotech International Ltd., are all being used in their respective countries, as well as for health diplomacy. Meanwhile, concerns have been raised regarding the efficacy of Sputnik V, as well as the safety of the Chinese vaccine. There is generally greater acceptance of products manufactured by American and European pharmaceutical brands among the populace of Western nations, largely because of their familiarity with those brand names.

According to a March 22, 2021, report by Chinese state media, the PRC has donated or is donating vaccines to 69 developing countries, and is exporting vaccines to another 43 countries. About 20 countries have agreed to import Sputnik V from Russia, meanwhile. India has so far exported both the Covishield and Covax vaccines to 14 countries, including its neighbors in South Asia. These three countries intend to meet 60-70 percent of the global demand for COVID-19 vaccines. Recently, the European Union has approved vaccine exports. Despite the competition (at least among these three states) to supply vaccines and augment their health diplomacy, the challenge of inoculating the global population remains a Himalayan task.

Seeing the value in vaccine diplomacy, now that a substantial portion of the US population has been vaccinated, the administration of US President Joe Biden announced a slew of deliveries to Central and Latin America in recent weeks, as well as to some Asian countries, to counter the Chinese and Russian efforts to increase their influence and good will through the supply of vaccines to developing countries.

The COVID-19 pandemic has unraveled the international political environment to a certain extent. It has widened many of the existing fault lines among states and communities as they were utterly unprepared to face such a gargantuan health crisis. Yet, the silver lining has been that non-Western powers have stepped up to share in the global responsibility. Moreover, the resultant vaccine diplomacy has opened up new avenues for power plays in the international system.

Workers offload PRC-donated COVID-19 vaccines at Robert Gabriel Mugabe International Airport in Harare, Zimbabwe.

photo: Xinhua/Shaun Jusa

Dr. A.D. Gnanagurunathan is a non-resident fellow at the Taiwan Center for Security Studies in Taipei, Taiwan. He can be reached at gnanagurunathan@gmail.com