A global lifeline, with strings attached: How China stepped into the gap of vaccine diplomacy

India was one of the first countries in the world to realise the potential of “vaccine diplomacy” last year, leveraging its position as a global pharmaceutical powerhouse and relatively mild first Covid wave to launch a hugely ambitious programme dubbed “Vaccine Maitri” - Hindi for “vaccine friendship”.

Yet one year later, India has banned exports and is struggling to produce enough vaccines for its own people – while it is China delivering tens of millions of vaccine doses as gifts to friendly nations and making a profit by selling hundreds of millions more.

Many rich nations have prioritised vaccinating their own citizens above exporting doses to other countries while also having the most advanced research facilities for developing new vaccine candidates. It has created what the WHO calls a “two-track pandemic”, with wealthier countries opening up and vaccinating younger generations while poorer nations struggle to inoculate even the most vulnerable.

China has stepped into this gap. According to Beijing-based Bridge Consulting’s “China Covid-19 Vaccine Tracker”, so far, China has sold for export close to 853 million doses of vaccine, of which 405 million have been delivered, and donated another 25 million to countries across the world. Buyers include countries across the Asia-Pacific region, Africa, Europe and Latin America.

Zhiqun Zhu, chair of the department of international relations at Bucknell University in Pennsylvania, says that according to Chinese statistics, Beijing is by some distance the largest donor of vaccines globally, reaching more than 80 countries.

“Whatever motives China may have, this ‘vaccine diplomacy’ is part of China’s efforts to boost its global image as a responsible and caring power,” Zhu tells The Independent. “China stepped up to help middle- and low-income countries when the west was too slow or unwilling to help.

“Most countries accepted Chinese vaccines on a voluntary basis and were grateful that China was the only power offering help, especially at the early stages of the pandemic,” he says. “Some people allege that China has strings attached. It is possible from the realist perspective, but which country conducts diplomacy without any conditions?”

Early on in the pandemic, the WHO, alongside the GAVI vaccine alliance, launched the Covax initiative with the precise goal of taking diplomatic considerations out of the equation. It requested donations from vaccine-producing nations that would then be distributed equitably – promising two billion doses to 92 of the world’s poorest nations by the end of 2021 to ensure they could inoculate at least 20 per cent of their respective populations.

Poor supply stopped the initiative from taking off, with only around 90 million Covid-19 vaccine doses split between 132 countries in the past few months. But things are starting to change, thanks to a mix of factors that include concerns about China’s dominance in this field, high rates of vaccination among developed nations and fears about new variants emerging among unvaccinated populations.

Last month the G7 committed to sharing at least 870 million doses of Covid-19 vaccines with Covax – coincidentally just a little more than China – and aiming to deliver at least half this amount by the end of 2021. In a statement, the G7 leaders called Covax “the primary route for providing vaccines to the poorest countries”.

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They have a lot of ground to catch up. Professor Zhu says that while “China hawks will never give Beijing any credit no matter how much China contributes to the global fight against Covid,” objectively, it has done better than the US or any other major power at controlling the virus.

“The origin of the coronavirus is still unclear, and more investigations are needed, and China should cooperate with such international investigations,” he says. “China could have handled the outbreak more transparently and in a more effective way at the early stage. But this will not change the fact that China emerged stronger from the pandemic, and people in China feel more convinced that their system is better equipped to deal with such crises.”

The fact is that China is already seeing the benefit of being the global leader in vaccine diplomacy, earning messages of respect and concrete foreign policy shifts in its favour. For instance, last month, the influential Association of Southeast Asian Nations (ASEAN) said it appreciated China’s provision of vaccines, medical supplies and technical assistance to its member states during the pandemic.

Recent reports suggest Honduras, a Central American nation that has been a longstanding ally of Taiwan and does not have formal diplomatic relations with China, could open its first trade office in China, specifically focussing – for now – on Covid vaccines.

China’s support fairly openly comes with strings attached, says Dr Jabin T Jacob, associate professor at the department of international relations and governance studies at Shiv Nadar University in India. “China, more than other [nations], expects political or diplomatic returns from aid or help extended in terms of Covid-19 vaccines.”

Nonetheless, he says, China has come out of the pandemic, and particularly during the second wave of Covid in many countries, “looking better by the way it has gone about its vaccine diplomacy – without overcommitting [like India] or being absent like was the case with the US”.

“Beijing acted swiftly wherever others failed in fulfilling commitments,” he says. “It convinced a significant section of an international audience about its capabilities and reliability. It has pushed the narrative that the US has been selfish and self-centred while China delivered in time of need.”

China successfully seized on western nations’ decisions to corner the bulk of the early global supply of vaccines, what Professor Richard J Heydarian at the Polytechnic University of the Philippines describes as nothing short of “unabashed vaccine apartheid”.

The result was that poorer countries, even those previously critical of China, noticeably toned down that rhetoric while they were scrambling for vaccines, and Beijing was the only viable supplier.

“But the perception against China’s culpability and lab leak theory is still strong. I believe two years down the line, the picture will be different, and the welcoming tone of many countries towards China may change,” Heydarian says.

Both Heydarian and Jacob point to another aspect to all this that may indicate China’s reputation at the forefront of vaccine diplomacy may already have peaked – emerging issues around the efficacy of China’s vaccines.

“Places like Chile and Seychelles which used Chinese vaccines are still witnessing a spike in Covid-19 cases,” Heydarian notes. Jacob says, “there are increasing reports about the failure of Chinese vaccines in controlling outbreaks in countries where they were used.”

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Indonesia, one of the first countries to start rolling out Chinese jabs, and where 80 per cent of 152 million doses administered have been China’s Sinovac, is giving health workers the US-made Moderna as a second dose. And Thailand announced earlier this month that it recommended people who had Sinovac as their first dose take the Oxford University-AstraZeneca jab for their second.

“The perception [of China] may change when developed countries such as the US [ramp up] their contributions to Covax, which is distributing vaccines to many countries across the world,” Heydarian says.

As for India, whose own vaccine rollout has slowed down despite repeated warnings that a third wave could be on the horizon, experts are divided on how to view its early foray into vaccine diplomacy.

Heydarian says India’s role in the vaccine supply chain last year cannot be undermined as it “helped so many countries before the domestic issues forced a rollback”.

But Jacob says the way India overreached means the country “lost face… not only for its failure to meet commitments on vaccine supplies to many other nations but also because of its complete lack of preparation for the second wave and the breakdown of the healthcare system in the country”.

“Many countries accepted China’s vaccines because no one else was offering them anything, and India was busy managing its domestic mess. India will eventually recover from this setback because vaccine production should soon get back on track. But many, including American policymakers, may become more unsure of India’s ability to manage crises,” he says.