3/17/22, 11:15 PM Towards a Better Vaccine Diplomacy

COMMENTARY |
1 MARCH 2022

TOWARDS A BETTER VACCINE

DIPLOMACY
If vaccine diplomacy is the new great game, it is being played wrong by
all sides, with the risk that no one will be left a winner. Originally
published in The Diplomat.

ROLAND RAJAH, ALYSSA LENG, HERVÉ LEMAHIEU

COVID-19 has reshaped everything, not least global politics. In a world where access to
limited vaccine supplies is the only way to end the crisis, so-called “vaccine diplomacy”
has emerged as a new channel through which major powers seek to curry favor and
shape the international environment to their benefit, doling out vaccines to favored
countries according to perceived national interest.

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Billions of vaccine doses have now been pledged for international donation, with the
bulk coming from the United States and China, as well as the European Union and its
members. Although much has been achieved, there is nonetheless little doubt that the
global vaccine effort is falling short. Vaccine doses have been donated based on overly
narrow geopolitical considerations rather than need or equity. The multilateral COVAX
initiative remains underfunded and struggling to fulfill its mission for global vaccine
equity. And the technology behind the leading vaccines is not being shared widely
enough, despite the obvious need to expand global vaccine supplies.

In an age of escalating great power rivalry, overseas vaccination efforts are too often
mistaken for charity and pursuing the national interest conflated with playing for short-
term geopolitical gain. If vaccine diplomacy is the new great game, it is being played
wrong by all sides, with the risk that no one will be left a winner.

The heart of the problem is the failure to fully recognize that international vaccine
equity is a global public good in every major power’s self-interest. Anything less risks
prolonging the pandemic and fuelling instability. At present, less than two-thirds of the
world’s population have received at least a single vaccine dose. While around 70
percent of people in rich countries have done so, the figure is only about 10 percent in
low-income countries. The need for booster shots in response to the Omicron variant
will only widen the gap.

This is not only a moral failing but also means COVID-19 still has a pool of billions of
unvaccinated people among which to circulate and mutate into more dangerous forms.

The possibility of more dangerous future variants could prove especially dangerous for
China, given its reliance on less effective homegrown vaccines and its consequent
reliance on a costly zero-COVID strategy.

But Western powers are hardly immune. While the hope may be that widespread
immunity, due to vaccination or previous infection, can prevent a renewed health crisis,
there is no guarantee that some future variant will not evade this immunity and existing
treatments in dangerous ways. Furthermore, even an endemic COVID-19 could still
imply a high disease burden and repeated waves of infection capable of putting intense
pressure on hospital systems and creating substantial economic disruption.

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Moreover, persistent international vaccine inequity carries other important geopolitical

consequences for Western powers – weakening key emerging partners in the Indo-
Pacific vital to the regional balance of power amid a rising China and undermining the
liberal international order that the West seeks to defend.

Asia’s Balance of Power, Disrupted

There is a striking disjunction between the traditional security risks largely centered on
the shifting balance of power in the Indo-Pacific, and the fact that for the past two years
the world has been far more affected by the non-traditional security threat of pandemic
disease.

Quite apart from the human toll exacted by the pandemic, the Lowy Institute’s 2021
Asia Power Index shows that COVID-19 has also driven down the comprehensive power
of almost all states in the Indo-Pacific, weakening their capacity to respond to and
shape their external environment.

Uneven economic impacts and recoveries from the pandemic will likely continue to
alter the regional balance of power well into the rest of this decade. Taiwan, the United
States, and Singapore are now predicted to have larger economies in 2030 than
originally forecast prior to the pandemic. But emerging powers – including India and
much of Southeast Asia – have been badly damaged in comparison to their pre-COVID
growth paths. China’s comprehensive power consequently continues to grow in relation
to nearly every other emerging regional power in Asia.

This should be concerning to the United States and its partners seeking to build a
durable regional balance of power, with Southeast Asia at its center. A robust post-
pandemic recovery of developing Asia will be a prerequisite to ensuring a resilient and
prosperous region capable of restraining the excesses of China’s growing influence. The
ability of governments in this part of the world to procure and administer COVID-19
vaccines is crucial to determining their success. But so too is bringing the pandemic to a
heel globally.

The United States Is Still Leading

According to the Think Global Health initiative of the Council on Foreign Relations,
leading powers have pledged to donate around 2.7 billion vaccine doses to other
nations globally. The United States alone has pledged to provide 1.1 billion doses.
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China’s initial focus was on exporting its vaccines largely on a commercial basis. But
more recently it too has made significant vaccine donation pledges, now totalling 850
million doses, with the bulk destined for Africa. Meanwhile, the EU and its member
states have collectively committed to donate half a billion doses. Altogether, the three
superpowers account for about 90 percent of the doses that have been pledged for
donation in total.

After years of Chinese diplomatic momentum on the world stage and U.S. apathy on
transnational challenges under President Donald Trump, Washington turned a corner
by the middle of 2021 to begin a more concerted international vaccine push.

For all the handwringing about the U.S. turning its back on the world, it is now the
United States that has stepped up the most on international vaccine donations. The
U.S. alone accounts for 40 percent of total vaccine doses committed for donation. Its
pledge to provide 1.1 billion means it has effectively committed to provide three doses
overseas for every person in the United States, far higher than any other donor country.
Australia has been the next most generous in per capita terms, committing to donate a
little over two doses overseas per Australian at home. Most other countries have made
much smaller per capita promises, including China.

The United States has also provided relatively more funding to the COVAX Advanced
Market Commitment (AMC) facility, which aims to provide vaccines to 91 developing
countries on an equitable basis. Although COVAX remains underfunded, the United
States is both the largest single donor and among the more generous on a per capita
basis, providing about $10 per American. China, for its part, has largely spurned COVAX,
so far only providing the equivalent of about seven U.S. cents per capita.

For geostrategic reasons the Indo-Pacific has also been a key focus for Washington’s
vaccine diplomacy. By late last year the United States had delivered more than 90
million COVID-19 doses of its promised vaccine donations to countries in the region –
twice as many as China.

Washington also sought to broaden the appeal of the Quadrilateral Security Dialogue
(Quad) – alongside its partners Australia, India, and Japan – with an expanded remit on
the provision of international public goods, notably the supply of COVID-19 vaccines. In
March 2021, leaders of the Quad committed to deliver 1 billion COVID-19 vaccine doses
to the Indo-Pacific region by the end 2022. Under the deal, Japan and the United States

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agreed to finance – for an undisclosed sum – the production of COVID-19 vaccines in

India, from drugmakers including U.S. firms Novavax and Johnson & Johnson, which
Australia would then distribute across Asia.

China’s Vaccine Diplomacy Falters

Asia has similarly been a key linchpin in Beijing’s vaccine diplomacy, with the region
receiving the greatest number of Chinese vaccines to date, albeit largely on a
commercial basis.

While the United States and Europe were relatively late to the vaccine diplomacy game,
China expedited the export of its vaccines across the developing world. Reports suggest
that close to 1.7 billion doses have been sold by China so far throughout Asia, but also
Africa, Latin America, and the Middle East – with around 80 percent of those doses
already delivered. As a result, Sinovac and Sinopharm are thought to account for about
half of the total global supply of vaccines to date.

China’s vaccines held multiple layers of appeal for developing countries. First, supply of
Sinovac and Sinopharm was readily available and delivered quickly at a time when
leading Western alternatives were scarce due to hoarding and export restrictions in rich
countries. Second, the Sinovac and Sinopharm vaccines do not require cold-chain
storage as mRNA vaccines do, making them more viable options for developing
countries with weaker public health infrastructure. Third, the willingness of China to
partner with countries like Indonesia to produce and distribute vaccines, if even at a
basic level around packaging, was also alluring.

Yet despite early gains, China has failed to sustain its early mover advantage in vaccine
diplomacy.

Many developing countries – including key early beneficiaries in Southeast Asia –

turned away from Chinese-made vaccines once leading Western alternatives started
becoming available by the middle of 2021. This was at a time when their health systems
were coming under intense strain from the Delta variant and doubts began to grow
around the efficacy of the Chinese shots.

Thailand, for instance, announced it was changing its vaccine policy in July 2021.
Instead of receiving two Sinovac shots, the government announced its citizens would
receive a mix of Sinovac and AstraZeneca. Indonesia announced a similar move in July
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and began administering Moderna booster shots to healthcare workers previously

immunized with Sinovac.

The shift underscores the limits of China’s soft power push particularly in Asia, which
does not seem to have translated into substantial goodwill in recipient countries.

An expert survey conducted last year by the Lowy Institute as part of the Asia Power
Index showed that China’s vaccine efforts were only seen as somewhat constructive
among countries in the Indo-Pacific region. By contrast, U.S. efforts were seen as world
leading. Smaller powers, such as Japan, Australia, and New Zealand – which have given
far more doses per capita in the region than China – were seen more favorably.

One can speculate as to the reasons behind China’s poor performance, but the
commercial nature of China’s bilateral vaccine deals, its low per capita generosity, and
the fact that its vaccines appear less effective than Western alternatives, especially
against the newer variants of the virus, seem the obvious culprits.

Credibility Gap

Leapfrogging China in vaccine diplomacy, however, does not mean that the United
States and its partners will emerge from this global health crisis triumphant. China may
have proven itself unable to step up in the way required, but the world does not expect
as much of China to begin with. The task for the United States and its like-minded
partners, by contrast, is to convince the rest of the world that they are the principled
global actors they claim to be and that the much-fabled liberal international order for
which they stand is worthy of its status.

The billions of doses committed still fall well short of global demand for vaccines,
especially once the need for booster shots in response to Omicron and possible future
variants are factored in. Moreover, aside from the U.S., many of the biggest donors have
made relatively small donation pledges on a per capita basis. Only the United States,
Germany, and Australia have promised to donate a full course overseas for every person
in their domestic population.

Concerns are also rising around the practice by many rich countries of donating excess
doses close to their expiry dates, leaving poor countries little time to get jabs into arms
and forcing them to reject or destroy the donated vaccines instead.

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Timing is crucial. From both an epidemiological and economic standpoint, jabs in arms
today are far more valuable than vaccines delivered tomorrow, let alone years in the
future. Yet just a fifth of total doses promised by donors have to date been delivered. Of
the 10 largest donors, only the U.S., Australia, Italy, and Japan have delivered more
than a quarter of their commitments.

Few flagship initiatives have been so high profile and yet so afflicted by a yawning
delivery gap as the Quad Vaccine Partnership. The Quad’s headline commitment in
March 2021 was to deliver 1 billion COVID-19 vaccines to the Indo-Pacific by the end of
2022. However, only around 248 million – about a quarter – had been delivered as of
February 2022, nearly a year after the pledge was made.

The innovative partnership sought to leverage India’s vast vaccine production

capabilities and its role as the backbone of global vaccination supply for low- and
middle-income countries. Yet in a cruel irony, the world’s vaccine manufacturing
powerhouse was crippled by the Delta variant only weeks after the Quad leaders first
met. India effectively blocked exports of vaccines as its own hospitals were overrun
with COVID-19 patients in the spring and summer of 2021.

Fortunately, there are signs that global vaccine donors are beginning to accelerate
delivery on their promises. Data from Think Global Health suggests that the same
number of doses were delivered in the five weeks between the end of October and start
of December 2021 as in the first 10 months of the year. Much of this progress was driven
by European countries, including Germany, Belgium, Italy, and France, rapidly picking
up the pace of deliveries, giving between two to five times more in those five weeks
than during the first 10 months of 2021.

Moreover, in February 2022 the Quad foreign ministers’ meeting in Australia agreed to
resume and expedite the delivery of COVID-19 vaccines. The first batch of the Indian
manufactured vaccines under the Quad group’s initiative is now set to be rolled out in
the first half of 2022.

No Winners Without Global Vaccine Equity

Nonetheless, progress will remain fragile as long as potential for dangerous future
variants persists.

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The Quad Vaccine Partnership highlights a key problem with bilateral vaccine
diplomacy: Leading powers are donating strategically rather than equitably. The result
has been to skew the distribution of vaccines toward Asia as opposed to other parts of
the world where the vaccine gap is much starker, especially Africa.

The Quad’s Vaccine Partnership is clearly a means to counter China’s vaccine diplomacy
in the part of the world with the greatest geopolitical significance to its members. But a
more enlightened reading of the grouping’s geopolitical interests would urge that the
partnership go global in its scope and ambitions. When it comes to bringing a faster end
to the pandemic, global vaccine equity is what is needed most. Even success in helping
particular countries can be quickly undone by the arrival of more dangerous new
variants.

It is no surprise that the area of the world with the lowest vaccination rate, sub-Saharan
Africa, also appears to have provided the fertile ground for the Omicron variant to
develop. Moreover, not only are vaccination rates in Africa tragically lower than
elsewhere, but the region is also lagging well behind other parts of the world in
securing an adequate pipeline of doses from any source, be it bilateral donations,
COVAX, or their own commercial arrangements. Although there are concerns about
vaccine hesitancy and weak absorptive capacity, at this point the evidence does not
suggest this is the binding constraint to faster progress, except in a handful of cases.
Most countries seem capable of absorbing more vaccine doses if they were made
available.

Multilateralism Allowed to Fall Short

Relying on bilateral vaccine diplomacy was always a suboptimal strategy for ensuring
the equitable global distribution of vaccines. That is why when the pandemic struck the
World Health Organization and its partners were quick to establish the COVAX initiative
aimed at distributing vaccines on an equitable basis, particularly to developing
countries. Despite numerous challenges, COVAX has made admirable progress –
reaching the milestone of 1 billion doses delivered in January 2022.

Nonetheless, COVAX, and the multilateralism it represents, was undermined from the
start, first by vaccine nationalism on the part of richer countries and later by a
preference for bilaterally directed vaccine diplomacy over the multilateral kind. Rich
countries undermined the initiative at an early stage by moving quickly to strike their

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own bilateral deals with vaccine manufacturers to ensure their domestic supply. COVAX
was also severely hampered when India – which was to be a key vaccine supplier to
COVAX – imposed an export ban last year as it was engulfed by the Delta wave.

Most fundamentally, COVAX and the broader Access to Covid-19 Tools Accelerator (ACT-
A) program of which it is a part, run by the World Health Organization and its partners,
was underfunded and remains so, currently facing a funding gap of $20 billion.

Other forms of multilateralism have also underdelivered. The multilateral development

banks collectively allocated around $30 billion to support the vaccine rollout in
developing countries, with the World Bank committing $20 billion and the Asian
Development Bank separately making $9 billion of its own funds available. Other
development banks allocated smaller amounts.

Yet, to date, the majority of funds available under these facilities have yet to be
committed. Part of the problem has been with the banks themselves, which initially
imposed overly stringent controls particularly on which vaccines were eligible under
their programs (which have since been relaxed). Like COVAX, the banks’ vaccine efforts
have also struggled to compete with rich nation governments in securing relatively
scarce vaccine supplies.

More fundamentally however, the multilateral development banks’ vaccine response

simply lacked the required ambition from the international community. The vaccine
programs should have been made additional to the banks’ existing resources and
provided on the most concessional terms, given the scale of the crisis and the global
public good nature of the international vaccine rollout. This would have increased the
overall level of support to developing countries and promoted take up. Instead, the
money for vaccines came out of existing bank resources and, consequently, took the
form of a mixture of grants and concessional and non-concessional loans – with
populous middle-income countries like Indonesia and Philippines, important to the
global vaccine effort, only having access to non-concessional loans.

Sharing the technology behind the miraculous COVID-19 vaccines is another area where
multilateralism has fallen short. In October 2020 India and South Africa proposed that
the World Trade Organization agree to waive intellectual property rights for COVID-19
related health technologies, including vaccines, with the goal of expanding global

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supply and access. In May 2021 the Biden administration threw its public support
behind the waiver, though some would say the support was only lukewarm. In any case,
resistance from European powers means the proposal remains stalled.

The WHO has instead pressed ahead with its own technology transfer efforts, without
the support of the major vaccine companies. This year it announced that its newly
established mRNA technology hub in South Africa had successfully produced its own
vaccine based off publicly available information on the Moderna vaccine. This is a major
breakthrough. Nonetheless, the WHO says approval for use of the new vaccine will likely
only be achieved in 2024.

Toward a Better Vaccine Diplomacy

Despite significant strides in the right direction, the United States and its partners have
a long way to go to make a success of their vaccine diplomacy.

China may have proven itself unable to step up in the manner expected of a
superpower and aspiring alternate hegemon. However, the task for the United States
and its partners is not simply to outdo China – it is to convince emerging powers in the
Indo-Pacific, and the world, that the liberal international order for which they stand is
worthy of its name. Western claims to be principled global actors are discredited when
governments hoard vaccines, belatedly donate the excess, and allow multilateralism to
fall short at a crucial global moment.

Global vaccination efforts have more recently begun to move more forcefully in the
right direction. But the race to inoculate the world has only just begun. Further
challenges, setbacks, and plot twists no doubt still lie ahead. Vaccine diplomacy, as
practiced, leaves much to be desired. The answer, however, is not less vaccine
diplomacy but doing more and better to bring the global pandemic to heel.

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