Vaccine Diplomacy: Competition and Potentials for Cooperation
By: Tsung-Han Tsai
The surge of the latest Omicron variant has re-invigorated the contentious debate of fair vaccine distribution. While there have certainly been efforts to improve lower-income countries’ access to vaccines, most notably the WHO’s COVAX program, certain parts of the world remain largely unvaccinated and vulnerable to the pandemic. One major example is Africa, where only 11 percent of the continent’s population is fully vaccinated as of February 2022 (“Africa needs to ramp up”). With over 1.3 billion people, Africa will need at least 1.6 billion doses to meet its 60 percent vaccination target (Campbell). However, the acquisition of these vaccines has been an extremely challenging process as American and European governments have the capability to pre-purchase vaccines at higher prices from manufacturers like Pfizer, Moderna, and J&J (Campbell). Such difficulty has inevitably made African governments consider other alternatives, most notably China’s Sinovac and Sinopharm (Campbell). Under pressure to share their vaccine supplies, the US and its European allies also pledged to step up their donations, whether it is through direct donations or COVAX (Holland). Regardless of the diplomatic, economic, or political agenda behind these donations, it is clear that a rivalry between the US and China, which previously took the forms of military and economic dispute, has now entered the realm of global health.
China’s Early Success
China’s ability to scale up the production of Sinovac and Sinopharm vaccines has enabled it to gain the upper hand in the earlier stages of Africa’s immunization campaign. When the US-produced Pfizer and UK-produced AstraZeneca vaccines were limited mainly to the higher-income countries of the West, President Xi Jinping was already making pledges to African leaders about the accessibility and affordability of Chinese vaccines (Bone and Cinotto). Such effort is exemplified not only by Xi’s opening remark at the 73rd session of the World Health Assembly, but also on one occasion in which ambassadors and diplomats from 50 African states visited Sinopharm’s manufacturing facility in China (Bone and Cinotto). During the visit, Liu Jingzhen, the chairman of Sinopharm, declared that Sinopharm “stands ready to work with the African people” and “to deepen cooperation in the fight against and pandemic, consolidate China-Africa friendship and make important contributions to the joint development of the China-Africa health community” (Yang and Jing). In the face of the more recent Omicron variant, Xi even promised to donate 600 million additional doses to African nations, which would add up to 1 billion promised doses in total, with the other 400 million doses being offered through local production by Chinese companies in Africa (Siladitya). Regardless of the skepticism surrounding the efficacy of Chinese-manufactured vaccines, one must recognize that China has, to a large extent, used its vaccine to bolster its economic and political presence in Africa and other low-income regions struggling to obtain Western vaccines (Siladitya; Campbell).
The US Challenges China in Africa
Despite the early allegations towards the West of vaccine nationalism from numerous African states and China, the supply of vaccines to Africa from the West has still risen significantly (Ghebreyesus; Wang; “Africa needs to ramp up”). In December 2021, the Biden Administration not only pledged to send more than 200 million doses of US-manufactured mRNA vaccines to Africa, but during Secretary of State Anthony Blinken’s visit to Kenya, Nigeria, and Senegal, he also discussed boosting Africa’s local vaccine production (Elba and Egan; Siladitya). Besides the donation of vaccines on a bilateral basis, the US has also provided doses through the COVAX mechanism and the Africa Vaccines Acquisition Trust (AVAT) of the African Union (“Africa needs to ramp up”). One of the more recent examples of such assistance on a multilateral basis was Biden’s pledge to donate 17 million single doses of J&J vaccines to the AU (Siladitya). When combined with concerns associated with the safety and efficacy of Chinese vaccines against different variants, many scholars and policy analysts have suggested that the effectiveness of China’s vaccine diplomacy has been watered down, with many local health authorities recommending pairing non-Chinese booster with Sinovac or Sinopharm (Lin et al.). Furthermore, since the discovery of the Omicron variant, Biden has also endorsed the call for intellectual property (IP) protection waiver for COVID vaccines in order to boost its worldwide production and make access to vaccines more equitable for lower-income states (Bose et al.). However, major obstacles remain for the Biden administration due to the contentious nature of IP protection waiver and the vocal opposition from major pharmaceutical giants, most notably Pfizer and J&J (Schwartz).
Though perspectives on the US and China vary across the continent, African states generally appreciate all forms of assistance pledged by the higher-income countries who have doses to offer (Bengali). Most African leaders are concerned about the implications of class divide in vaccine access, an issue that President Hage G. Geingob of Namibia branded “vaccine apartheid” (Bengali).
Furthermore, as more vaccines are shipped to Africa, the rollout of these vaccines also becomes a concern due to the logistical challenges associated with Africa’s poor transportation infrastructure and insufficient public health facilities and personnel (Bengali; Campbell). According to Dr. Benido Impouma, the program director of the WHO’s Africa program, vaccine deliveries to Africa have been not only slow and scant, but also unpredictable (Bengali). In some cases, vaccine deliveries arrived with little notice as well as short shelf lives ranging from two to three months, a timeframe that was not long enough for local health systems to get the doses to those unvaccinated, many of whom lived in rural areas far from health facilities (Bengali). If Africa is to meet its 70 percent vaccination target by the end of 2022, the continent would have to increase its current rate of administering vaccines by six-folds, something that would require an additional $1.29 billion in funds (“Africa needs to ramp up”). This estimate, according to the WHO and UNICEF, largely consists of the costs for deploying medical and technical personnel to rural areas, the surveillance of adverse events following immunization, the management of data on vaccination uptake and vaccine stock, and other miscellaneous operational costs (“Africa needs to ramp up”). It would be a near-impossible task if individual African states were to shoulder these burdens without the help from the international community.
The Pandemic and Potentials for US-China Cooperation
Many in the field of international relations believe that ensuring equitable access to vaccines, which is critical in advancing the world’s “health security” amidst the pandemic, is an essential goal that must transcend national boundaries and political differences if the international community wishes to bring the pandemic under control (Ghebreyesus; Adeshokan et al.; Huang and Kennedy 6). It is then worth asking, if possible, what it would look like if the US and China were to cooperate to address Africa’s COVID vaccine crisis?
According to a report published by the Center for Strategic and International Studies (CSIS), a DC-based Think Tank, vaccine production and development happens to be a realm for collaboration between the US and China if the international community wishes to address its shortages (Huang and Kennedy 6). This rationale follows the idea that China has the ability to mass-produce vaccines at a more rapid pace, while the US and its allies have the technology to produce the highly-effective mRNA vaccines (Huang and Kennedy 7). Given that the efficacy of China’s Sinovac and Sinopharm vaccines are relatively lower against newer variants, it is then reasonable to conclude that giving China the technology (or licensing Chinese pharmaceuticals) to mass-produce mRNA vaccines would substantially address the world’s vaccine shortage (Huang and Kennedy 7). Furthermore, multiple routes already exist for China and the US to cooperate on the mass production of mRNA vaccines. Such cooperation can take the form of voluntary technologies sharing, given that the US government already has both financial and scientific influence over Moderna. Additionally, it can also take the form of expanding the existing Shanghai-based joint-venture of Germany’s BioNTech and China’s Fosun Pharmaceutical Group (“Production line of mRNA vaccine”). There are also some existing Chinese mRNA vaccines currently under development and trials. The US can certainly participate in further development of mRNA vaccines R&D based in China (Huang and Kennedy 7-8). In other words, it is possible for the US and China to cooperate and help address the global vaccine shortage by building on top of the existing international frameworks for vaccine development, manufacturing, and distribution.
Despite the potential for cooperation, one should still bear in mind that the current prospect for the US and China to cooperate is low. Existing tensions associated with Taiwan, the South China Sea, IP theft, and other issues of enormous importance have made reconciliation between the two great powers extremely difficult in the foreseeable future. However, addressing the even distribution of vaccines in Africa is still more possible than resolving the more contentious issues mentioned above. In fact, making vaccines more equitable for lower-income states does not pose an existential threat for both the US and China—the potential for vaccine distribution to be a realm of cooperation remains high.
This article addresses different manifestations of the US and China’s strategic rivalry amidst the pandemic and its associated vaccine shortage, a problem that unevenly plagues the lower-income states of Africa. China’s vaccine diplomacy, characterized by the country’s ability to ramp up the production of Sinovac and Sinopharm vaccines, has seen early success in the continent. However, as the efficacies of these Chinese-manufactured vaccines waned in the face of new variants, the US and its allies are keen on re-asserting their diplomatic presence on the continent, whether it is through donations or plans to expand local vaccine productions in Africa. As the supply of vaccines rises significantly in Africa, logistical and operation struggles also emerge as poor infrastructure, insufficient medical personnel, and vaccine’s short expiration date, among other reasons, constitute substantial obstacles to the rollout of vaccines. Lastly, the article discusses the potential for US-China cooperation on vaccine development and mass-production. While the outlook seems unlikely given the current hostility between the two great powers, cooperation is still possible based on some existing frameworks and entities for vaccine R&D, manufacturing, and distribution.
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