By Serena Ninomiya
Amidst the acceleration of vaccine nationalism and the race to obtain vaccines, China stands out with its rapid production of Chinese vaccines and enthusiasm to share their vaccines, especially with developing countries.
At the same time, however, this has raised concerns from countries such as the U.S., Japan, and Europe, suspecting that China is conducting “vaccine diplomacy,” the usage of vaccines as a diplomatic tool. Indeed, outreach through vaccines and leadership in global health could give China huge soft power and replace the former American leadership, potentially changing the world order.
Should China’s philanthropy be acclaimed or questioned? What should countries do to prevent the politicization of vaccines?
The State of Chinese Vaccines and Foreign Policy
China has exhibited a strong record in the race of vaccine production. China’s CanSino, Sinopharm, and Sinovac produced 4 of the 12 vaccines approved by at least one country. 6 out of the 22 vaccines in Phase 3 Clinical Trials are produced by Chinese pharmaceutical companies. Phase 3 clinical trials for the Chinese vaccines have been held in over 16 countries, including Brazil, Russia, and Indonesia.[1] Sheikh Mohammed bin Rashid Al Maktoum, the Vice President of the UAE, also volunteered to participate in the clinical trials for Sinopharm’s vaccines, indicating strong trust and support from the UAE towards China.[2]
Moreover, because some of the Chinese vaccines can be preserved using regular cold supply chains (2-8 degrees Celsius), they are especially accessible for developing countries that cannot maintain strict cold temperatures.[3]
However, there are some sizable concerns regarding the safety of Chinese vaccines.
Historically, China has had several major scandals with its vaccines.[4] For example, Changchun Changsheng, a major pharmaceutical manufacturer in northeast China, produced over 250,000 substandard vaccines of tetanus, diphtheria, and whooping cough and fabricated data related to its rabies vaccine production.[5]
Compared to major US and UK pharmaceutical firms, there is also a concerning lack of publicly available information surrounding China’s vaccine trials. For instance, scientists exhibited doubts toward the fantastic report on China National Biotec Group Co.’s emergency usage program arguing that the discovery of major health problems should have been reported given that the vaccines were administered on tens of thousands of people of varying ages and from testing conditions.[6]
Despite its risks, vaccines have become a key part of China’s foreign policy through its early and active promotion by Xi Jinping and the Chinese Foreign Ministry. In May 2020, Xi proclaimed that China would make its vaccines a “global public good.”[7] In October 2020, Foreign Ministry spokesman Zhao Lijian elaborated China’s intention to promote the availability and affordability of the vaccine in developing countries through a variety of programs, including donations and non-reimbursable assistance.[8]
Such global outreach has been successful so far as China has pledged its assistance to countries in Africa, South Asia, Southeast Asia, and Latin America.[9]
In terms of financial assistance, Xi pledged to donate $2 million over two years to help countries endangered by COVID-19 and extended $1 billion loans to Latin American and Caribbean countries for access to Chinese vaccines.[10]
Countries that participated in the clinical trials have been granted priority access and vaccines. Sinovac Biotech agreed to provide 50 million doses of vaccine to Turkey and 46 million to Brazil. CanSino Biologics also signed a deal with Mexico to deliver 35 million doses.[11]
Chinese Premier Li Keqiang and other Chinese officials have affirmed priority access of Chinese vaccines to those countries who did not participate in the trials as well.[12] Xi and Liu Jingzhen, chairman of SinoPharm, informed African government officials that their countries would be first to benefit from the COVID-19 vaccines once developed and put into use.[13]
Finally, China joined the World Health Organization (WHO)’s promotion of equitable distribution of COVID-19 vaccines in October 2020, increasing its presence in global efforts for vaccine access.[14]
Concerns towards the Promotion of Chinese Vaccine as “Vaccine Diplomacy”
The active proliferation of Chinese vaccines by the Chinese government has incited concerns. Some countries have labeled China’s recent foreign policy as “vaccine diplomacy” because such promotion of national vaccines increases soft power and Chinese leverage in diplomatic negotiations.
The selection of countries for clinical testing by Chinese pharmaceutical companies indicates China’s early intention for the global distribution of its vaccines. For example, Sinopharm chose UAE not only for its high number of cases but also for its foreign labor force with workers from 125 countries.[15] By testing on a diverse population, China could claim that its vaccines are effective to use globally, ensuring their tool for soft power. China’s decision to join COVID-19 Vaccines Global Access (COVAX)[16] further legitimizes the use of China’s vaccine in OECD countries[17]and developing countries which rely on WHO approval.[18]
The global usage of Chinese vaccines rectifies the imagery of China from being “the cause of the pandemic” to “the solution to the pandemic.”[19] Subsequently, it can be expected that leadership and contributions to global health will foster positive imagery of China, generating China’s soft power as a trustable global leader.
The strategic offers of vaccine priority and/or financial assistance also hints at Chinese intentions for diplomatic benefits.
As the Belt and Road Initiative (BRI) was eclipsed by pandemic, providing priority access to vaccines and donations to Latin American and Caribbean countries replaced conventional BRI outreach, expanding “vaccine diplomacy” into the construction of the new “Health Silk Road.”[20] Such post-pandemic new world order through the delivery of vaccines to poor countries would facilitate Chinese leadership in a new global order,[21] as dependent countries are incorporated into the “Health Silk Road.”
Countries that have diplomatic issues with China are also offered vaccines as well. For example, China promised favorable donations and vaccine priority to countries of the Arab League and with Muslim majorities such as Pakistan and the UAE to alleviate discontent over Xinjiang Uighur re-education camp policies and to expand the range of China’s “Health Silk Road.”[22]
To raise another example, China also agreed to provide their vaccines to the Philippines and Malaysia, two countries that have been critical of Chinese aggression in the South China Sea.[23] The current president of the Philippines, Rodrigo Duterte thanked “China, President Xi Jinping, for offering to provide [Philippines] the vaccine as soon as it is possible for distribution to the public” and considered requesting a “credit” if the vaccines are expensive.[24]This credit could become leverage for China to use in future negotiations with the Philippines over the ownership of the South China Sea.
As much as Chinese officials may claim that the donations and vaccine priority comes with no strings attached,[25] increased soft power through improved global imagery of China and the “debt” of partner and rival countries to China from vaccine purchases inevitably gives China diplomatic benefits, including strong negotiation power and positive atmosphere to promote policies such as the Belt and Road Initiative.
The Greatest Supporter of “Vaccine Diplomacy”
In reaction to criticisms towards China for “vaccine diplomacy”, Xinhua News Agency, China’s state-run press agency, published an article titled Accusing China of "Vaccine Diplomacy" is a Sinister Move. It argued that Western politicians have falsely accused China’s international cooperation on vaccines as “vaccine diplomacy” to undermine China’s power and increased their chances for victory in the vaccine race. Contrary to such “short-sightedness, narrow-mindedness and ill intentions” to politicize vaccines, the article asserts that China is the true protector of human rights for insisting on "people first, life first" and promoting an international health community.[26]
China’s criticism is convincing because there has been a significant lack of participation of developed countries in the global fight against COVID-19.
Instead, with the rise of vaccine nationalism, developed countries have made agreements with the pharmaceutical companies to procure their COVID-19 vaccines before those vaccines are available to other countries. As a result, wealthier nations have bought enough doses to vaccinate their people “nearly three times over by the end of 2021.”[27]Canada, especially, secured 358 million doses, which is enough to roughly vaccinate its people 10 times.[28]
Due to such hoarding of vaccines, there is a limited stock for other poor and developing countries. Only one in ten people in nearly 70 countries are expected to be vaccinated in 2021.[29] Even worse, the WHO’s COVAX program is not a complete solution to such deficiency as it will only cover the most vulnerable 20 percent of each country’s population.[30]
As a result, many countries have been forced to find alternative vaccine supplies, leading to their consideration of vaccines from China and Russia, which are not necessarily transparent on their trials or guaranteed safety.[31]
Furthermore, the suspension of WHO funding by the U.S. in April weakened the WHO, making “individual” presence and power stronger.[32] As China subsequently pledged to donate $30 million to support the WHO’s coronavirus effort,[33] the WHO became more reliant on funding from China, giving China further leverage in the WHO.
Ultimately, the vaccine nationalism and absence from international efforts of equitable access to vaccines has facilitated “vaccine diplomacy.”
To Combat “Vaccine Diplomacy”
As the absence of international support led to the success of “vaccine diplomacy,” the best solution is to strengthen global cooperation for equitable distribution of vaccines. By doing so, countries are not forced to use politicized vaccines promoted by “vaccine diplomacy.”
To do so, first, countries must gain control over their domestic cases of COVID-19 to have the flexibility required to focus on global efforts on the pandemic and engage in international leadership. China, through its strict containment measures, was able to contain the number of COVID cases, giving it room to share its vaccines globally and donate money to WHO efforts.
After the distribution of purchased vaccines, wealthy countries would be more likely to control domestic cases of COVID-19 and increase domestic herd immunity. This is important because Yanzhong Huang, a senior fellow at the Council on Foreign Relations, wrote that the “immunity gap could undercut China’s aspirations to practice vaccine diplomacy.” In other words, Chinese politicians cannot argue Chinese “success” and model over countries which have a higher herd immunity and lower risk of COVID-19.[34] Hence, having a high herd immunity can provide legitimacy and soft power which can be used to promote free and equitable access of vaccines.
Preferably, able countries should also simultaneously support WHO efforts. Notably, with the change of leadership, the U.S. has shown a renewed commitment to WHO and COVAX. President Biden announced a $4 billion fund to COVAX.[35] However, such financial assistance is inadequate. There is still a global shortage of vaccines as the U.S. continues to keep its vaccines acquired through the direct dealings under vaccine nationalism. Furthermore, there is a continued lack of medical experts and infrastructure needed to safely store and deliver vaccines in the developing countries.
Hence, countries should expand their contributions beyond financial assistance. For example, they could send missions of experts to struggling countries to facilitate the construction of low-temp storage and delivery of vaccines. Looking ahead, countries could also encourage pharmaceutical corporations, which are developing COVID vaccines within their country, to contribute to the patent pool under COVAX. The patent pool would allow global licensing of technology and enable production by local factories. As a result, COVID medication would be more available, the competition of vaccines would be higher, and people would be less reliant on vaccines promulgated under “vaccine diplomacy.”[36]
Actively participating in WHO also allows for countries to push for WHO reforms, member state compliance, reduction of reliance on a country, and to increase the cost of non-cooperation. This would help resolve early concerns about the WHO and facilitate development of the WHO to be more responsive and stronger to combat vaccine nationalism and “vaccine diplomacy.”[37]
Conclusion
Muhammad Zulfikar Rakhmat, a scholar at Universitas Islam Indonesia quoted “Should we be suspicious, or should we be grateful [for China’s vaccines]? [...] I think both.”[38]
Considering the improved accessibility of developing countries to vaccines and Chinese soft power, China’s “vaccine diplomacy” is both applaudable and questionable. More importantly, the discussion of “vaccine diplomacy” exposes the true global threat: the lack of participation in global initiatives against COVID-19 such as COVAX.
Not only does international coordination of the equitable distribution of vaccines prevent the prolonging of the pandemic, but it also weakens efforts to use vaccines as a political tool for diplomacy.
Thus, to best combat “vaccine diplomacy,” countries should pursue participation in global solutions like COVAX over vaccine nationalism and bilateral agreements.
Last updated: March 8, 2021
Serena Ninomiya is a junior studying International Relations at the University of Pennsylvania.
Footnotes
[1] COVID19 Vaccine Tracker Team, “ALL VACCINES,” COVID19 Vaccine Tracker, Department of Epidemiology, Biostatistics, and Occupational Health at McGill University, accessed January 16, 2021, https://covid19.trackvaccines.org/vaccines/
[2] David Culver and Nectar Gan, “China has promised millions of coronavirus vaccines to countries globally. And it is ready to deliver them,” last modified December 2, 2020, accessed January 13, 2021, https://edition.cnn.com/2020/12/01/asia/china-coronavirus-vaccine-diplomacy-intl-hnk/index.html
[3] Kaori Fukushima, “こんなに危うい中国の前のめり「ワクチン外交」,” gooニュース, last modified December 10, 2020, accessed January 13, 2021, https://news.goo.ne.jp/article/jbpress/world/jbpress-63219.html?page=1
[4] Huang Yanzhong, “China’s Covid-19 Vaccine Ambitions,” Institut Montaigne, last modified November 16, 2020, accessed January 13, 2021, https://www.institutmontaigne.org/en/blog/chinas-covid-19-vaccine-ambitions.
[5] Javier C. Hernández, “In China, Vaccine Scandal Infuriates Parents and Tests Government,” The New York Times, last modified July 23, 2018, accessed March 8, 2021, https://www.nytimes.com/2018/07/23/world/asia/china-vaccines-scandal-investigation.html
[6] “China’s Race for Covid-19 Vaccine Raises Safety Questions,” Bloomberg Businessweek, Bloomberg, last modified November 3, 2020, accessed January 13, 2021, https://www.bloomberg.com/news/articles/2020-11-02/china-s-race-for-first-covid-19-vaccine-raises-safety-questions
[7] David Culver and Nectar Gan, “China has promised millions of coronavirus vaccines to countries globally. And it is ready to deliver them”
[8] “外交部：中方将以捐赠和无偿援助等多种形式优先向发展中国家提供疫苗,” 新华网, 新华通讯社, last modified October 21, 2020, accessed January 13, 2021, http://www.xinhuanet.com/2020-10/21/c_1126640357.htm
[9] Yanzhong Huang, “Why Mass Vaccination in the West Could be Bad News for Chinese Leaders,” Think Global Health, Council on Foreign Relations, last modified December 10, 2020, accessed January 13, 2021, https://www.thinkglobalhealth.org/article/why-mass-vaccination-west-could-be-bad-news-chinese-leaders.
[10] Sui-Lee Wee, “From Asia to Africa, China Promotes Its Vaccines to Win Friends,” The New York Times, last modified September 11, 2020, accessed January 13, 2021, https://www.nytimes.com/2020/09/11/business/china-vaccine-diplomacy.html.
[11] David Culver and Nectar Gan, “China has promised millions of coronavirus vaccines to countries globally. And it is ready to deliver them”
[12] David Culver and Nectar Gan, “China has promised millions of coronavirus vaccines to countries globally. And it is ready to deliver them”
[13] Neil Edwards, “Vaccine Diplomacy: China and SinoPharm in Africa,” 100, Council on Foreign Relations, last modified January 6, 2021, accessed January 13, 2021, https://www.cfr.org/blog/vaccine-diplomacy-china-and-sinopharm-africa
[14] David Culver and Nectar Gan, “China has promised millions of coronavirus vaccines to countries globally. And it is ready to deliver them”
[15] Huang Yanzhong, “China’s Covid-19 Vaccine Ambitions”
[16] COVAX is a global initiative led by Global Alliance for Vaccines and Immunization, WHO, the Coalition for Epidemic Preparedness Innovations, and others designed to facilitate global equitable access of COVID-19 diagnostics, treatments, and vaccines.
[17] Huang Yanzhong, “China’s Covid-19 Vaccine Ambitions”
[18] Kazumasa Bando, “WHO、ワクチン承認,” 産経新聞 (London, UK), Jan. 3, 2021.
[19] Neil Edwards, “Vaccine Diplomacy: China and SinoPharm in Africa”
[20] Kaori Fukushima, “こんなに危うい中国の前のめり「ワクチン外交」,” gooニュース, last modified December 10, 2020, accessed January 13, 2021, https://news.goo.ne.jp/article/jbpress/world/jbpress-63219.html?page=4
[21] Sui-Lee Wee, “From Asia to Africa, China Promotes Its Vaccines to Win Friends”
[22] Zhou Huiying, “Global Vaccine Start / Reversing the Image to Fight for Voice See how China's vaccine diplomacy is going out,” 中央通訊社, last modified December 9, 2020, accessed January 13, 2021, https://www.cna.com.tw/news/aopl/202012090035.aspx.
[23] DaYan YehXuan, “中国推进“疫苗外交” 旨在“一举多得”,” Deutsche Welle, last modified November 12, 2020, accessed January 13, 2021, https://www.dw.com/zh/%E4%B8%AD%E5%9B%BD%E6%8E%A8%E8%BF%9B%E7%96%AB%E8%8B%97%E5%A4%96%E4%BA%A4-%E6%97%A8%E5%9C%A8%E4%B8%80%E4%B8%BE%E5%A4%9A%E5%BE%97/a-55903673
[24] INQUIRER.net, “Duterte: COVID-19 vaccine from China, Russia won’t come in PH for free,” Youtube, Aug 18, 2020, video, 00:11, https://www.youtube.com/watch?v=esTOwLkzBOc&ab_channel=INQUIRER.net.
[25] Sui-Lee Wee, “From Asia to Africa, China Promotes Its Vaccines to Win Friends”
[26] Xin Cheng, “新华时评：指责中国“疫苗外交”，居心险恶,” 新华网, 新华通讯社, last modified December 24, 2020, accessed January 13, 2021, http://www.xinhuanet.com/2020-12/24/c_1126903703.htm
[27] “Campaigners warn that 9 out of 10 people in poor countries are set to miss out on COVID-19 vaccine next year,” Amnesty International, last modified December 9, 2020, accessed January 13, 2021, https://www.amnesty.org/en/latest/news/2020/12/campaigners-warn-that-9-out-of-10-people-in-poor-countries-are-set-to-miss-out-on-covid-19-vaccine-next-year/.
[28] “COVID-19 vaccine/multilateral agreements,” COVID-19 Vaccine Market, UNICEF, last modified December 9, 2020, accessed January 13, 2021, https://app.powerbi.com/view?r=eyJrIjoiNmE0YjZiNzUtZjk2OS00ZTg4LThlMzMtNTRhNzE0NzA4YmZlIiwidCI6Ijc3NDEwMTk1LTE0ZTEtNGZiOC05MDRiLWFiMTg5MjAyMzY2NyIsImMiOjh9&pageName=ReportSectiona329b3eafd86059a947b.
[29] “Campaigners warn that 9 out of 10 people in poor countries are set to miss out on COVID-19 vaccine next year”
[30] Neil Edwards, “Vaccine Diplomacy: China and SinoPharm in Africa”
[31] Neil Edwards, “Vaccine Diplomacy: China and SinoPharm in Africa”
[32] “中国、国連データにも触手,” 産経新聞, (Naniwa, Osaka), Jan. 4, 2021.
[33] Yanzhong Hu, “Trump’s decision to pull U.S. out of WHO will boost China’s influence,” The Washington Post, last modified December 9, 2020, accessed January 13, 2021, https://www.washingtonpost.com/politics/2020/06/23/trumps-decision-pull-us-out-who-will-boost-chinas-influence/
[34] Yanzhong Huang, “Why Mass Vaccination in the West Could be Bad News for Chinese Leaders”
[35] Joe Parkinson, Chao Deng, and Liza Lin, “China Deploys Covid‐19 Vaccine to Build Influence‐‐‐With U.S. on sidelines”, The Wall Street Journal, February 22, 2021. https://www.wsj.com/articles/china-covid-vaccine-africa-developing-nations-11613598170
[36] Aayushi Kulshrestha, “India: Patent Pooling And The Role Of MPP During The Covid-19 Era,” Mondaq, last modified November 25, 2020, accessed January 13, 2021, https://www.washingtonpost.com/politics/2020/06/23/trumps-decision-pull-us-out-who-will-boost-chinas-influence/
[37] Yanzhong Hu, “Trump’s decision to pull U.S. out of WHO will boost China’s influence”
[38] Sui-Lee Wee, “From Asia to Africa, China Promotes Its Vaccines to Win Friends”
Maryanne -- please include these dates when publishing
