On New Year’s Eve of 2019, The World Health Organization (WHO) received an alert from local authorities about a pneumonia outbreak of unknown cause in the city of Wuhan, China. It was a seemingly small outbreak back then. Now, it is called the worst public health crisis in a century. “This is not just a public health crisis, it is a crisis that will touch every sector,” said Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General on the day they declared COVID-19 a pandemic. More than a year has passed since that statement and indeed, it has brought an unprecedented impact and deep-rooted mark on our way of life. Yet, after a year of strict restrictions on mobility and distancing measures to curb the spread of the disease, the end of this pandemic remains to be seen.
The developments and roll out of vaccines have shed a light of hope to control the virus. However, despite that, the vaccine also carries new challenges and uncertainties, including its implications in shaping geopolitics. With western countries securing vaccines for themselves, other emerging forces such as China, Russia, and India are using its vaccine technology to fill the vacuum left by the west vaccine nationalism, distributing vaccines all around the world even at the expense of their own people. In that effort, these countries use their jabs as a tool of diplomacy by asserting influence on poorer countries that are in dire need of the vaccine.
However, concerns are rising as these competing national interests have yet to address the tough challenge to fight the COVID-19 pandemic. While more than one billion vaccines have been distributed, it was mostly held by wealthy countries, and poor countries are struggling even to secure doses for their frontline workers. This stark inequity of vaccine distribution should be worrying as it could put our hard-fought battle of the coronavirus in jeopardy. A crucial question remains on whether our global efforts are enough to end this nightmare of a pandemic.
The Pandemic: A Global Crisis
The pandemic trajectory dates back to the end of 2019, in the city of Wuhan, China, where the first known cases were identified. A bustling city with over 11 million inhabitants, not to mention a transport hub for Central China, the virus spread quickly throughout the mainland and further across the world. In the coming months, Italy became the first country to surpass China in number of cases and became a hotspot of COVID-19 cases, and across Europe, COVID-19 has been devastating. Not long after that, by the end of March, the United States (US) overtook both countries, and until now remains the worst hit country in terms of case number. As of early May of 2021, COVID-19 cases have surpassed 150 million cases worldwide with over 3 million people becoming the victim of this novel virus.
The high number of cases and increasing death toll has put a lot of people’s lives to a halt as governments impose restrictive measures such as lockdowns, safety protocols, and distancing measures as the virus transmitted through direct contact of respiratory droplets brought out by the infected. After the WHO declared the virus a pandemic, many governments started to impose these restrictions. While this has arguably proven to limit the spread of the virus, on the other hand it has brought consequences in almost all aspects of society.
With the economy brought to a stop, businesses are struggling to cope and unemployment soars. In the US alone, at its peak in April 2020, unemployment reached an all-time high at 14.8%, even greater than the last 2008 great recession. The same can be said in some developing countries such as Indonesia with 2.67 million people have lost their jobs, and more than 25 million others have also been impacted by the pandemic. Besides that, international travel is mostly put to a halt, bringing impacts on the tourism and hospitality industry. Also, health systems across the world are facing tough challenges, as shortage of personal protective equipment in the early pandemic put burdens and high risk on health workers that were at the frontlines.
As these measures bring cases to a much manageable level, countries start to lift these restrictions, opening the economy step by step, while still putting measures like health protocols and physical distancing to avoid a second wave of cases. However, in some countries, this measure has failed as countries that reopen their economy face a second wave of cases that can be sometimes worse than the first one. Even countries like Singapore and Australia, who have been applauded for their handling of COVID-19 cases, are struggling as they have seen rising cases after the government lifted its measures. Countries are facing a dilemma, do an expensive lockdown or reopening economy and face surging cases.
Therefore, vaccines, while not the only measure, prove instrumental to the effort to the eradication of the virus. Fortunately, governments, institutions, and pharmaceutical companies alike have put huge effort into developing vaccines even at the early stage of the pandemic and has been in the rollout. But despite the global effort, vaccine production and distribution still face various obstacles ahead in its goal to bring an end to this pandemic.
Vaccines Developments and Distributions: A Global Challenge
Since its first inception on eradicating smallpox back in 1796, vaccines have proven instrumental in limiting the risk of infectious disease by training the immune system to recognize and defend people from harmful pathogens. With more people protected against an infection, transmission rate decreases and therefore it limits the ability for the virus to spread. However, in order for this vaccine to be applicable, it requires lots of steps and procedures in the making to make sure its safety and efficacy.
In general, there are 4 steps for a vaccine candidate to be submitted to approval. The first is the preclinical phase where vaccine candidates are tested with animals or human cells in order to ensure its safety before testing it on humans in clinical trials. Then, if it succeeds, there are three phases of clinical testing to be done. The first one involves a small number of healthy subjects to test primarily whether it is safe and also its ability to produce antibodies needed to trigger an immune response. Phase II trials bring a lot more people to determine doses, schedules, and assess the immune response from things like age, gender, and other variables. If promising, Phase III can start as these trials could involve up to tens of thousands of people, seeing the vaccine candidate effectiveness to prevent infections.
This rigorous process is important to keep vaccines from harming people, but as a consequence it needs a lot of time. As a matter of fact, it usually takes decades to develop a vaccine. Even the mumps vaccine, the fastest developed vaccine before COVID-19 took 4 years before it was licensed to use in 1967. Therefore, it is quite reasonable for some at that time to doubt that the vaccine for COVID-19 could be available by the end of 2020. But as COVID-19 pandemic has brought dreadful consequences to almost all parts of our society, stakes are high for the world to urgently find ways to end these challenging times including in forms of immunizations.
Before the pandemic even started, companies have funded and developed new technologies for decades, one of which uses messenger ribonucleic acid (mRNA) to provide information to cells on creating proteins that triggers an immune response. This technology is now used in the Moderna and the Pfizer-BioNTech vaccine. With these advancements, vaccine production can be faster and cheaper than conventional methods that necessitates growing the virus first.
As vaccine development is costly, funding is an integral part of making a vaccine development succeed. Nation-states, institutions, and pharmaceutical companies pour huge sums of money and resources into the development of vaccines. The United States, through its program dubbed “Operation Warp Speed” initiated over $18 billion dollars in vaccine development to a range of pharmaceutical companies in order to vaccinate hundreds of million Americans. Organizations like Coalition for Epidemic Preparedness Innovations (CEPI) has been credited for early vaccine development as it has poured millions in funding to numerous vaccine producers, including Moderna. Billions are also poured in order for the vaccine to be equally distributed to all. Multilateral organizations like the World Bank are helping in financing vaccine development and now are promising over $12 billion dollars to developing countries with the aim to inoculate up to a billion people. The WHO with the help of organizations like Gavi, the Vaccine Alliance (Gavi), and CEPI collaborate to create COVID-19 Vaccines Global Access or COVAX which is an initiative to provide equitable access to COVID-19 vaccines with the aim to deliver 2 billion doses of vaccines by the end of 2021. On a global scale, it is estimated that spending for vaccines could reach $157 billion dollars by 2025.
Fundings like these are crucial efforts in order for vaccine companies to take greater risks and speed up the process, starting different trials at the same time, and companies could even start the manufacturing process even before the vaccine has its stamp of approval. In early 2020, as soon as the SARS-CoV-2 genome is publicly released, the race to find a vaccine emerges. By 16 March 2020, Moderna vaccine became the first to enter human trials, and more follow suit. In June, a China based vaccine made by Cansino Biologics was approved for limited use in the military. In August, despite controversy, Russia granted emergency-use-authorization (EUA) for its own vaccine, Sputnik V even when phase III trials have not started. By 2 December, a vaccine made by Pfizer and BioNTech finally received EUA by UK authorities, and six days later, 91-year-old Margaret Keenan became the first person to receive the vaccine in the world. The development of COVID-19 vaccines broke records, providing a vaccine in just about a year.
There are lots of factors that lead to this accomplishment of humankind, from the effort on sharing genome sequences even before it is declared a pandemic, to extensive funding, and collaborations of institutions across national borders. This shows that the possibility to create such a vaccine in record time is a result of an unprecedented collective global effort.
Unfortunately, this is just the beginning. In order for this vaccine to effectively tackle and control the pandemic, at least 70 percent of the world’s population need to be vaccinated in order to limit the amount of spread, therefore achieve “herd immunity”. Besides that, vaccines have a limited time of immunity, therefore it is important for lots of people to be vaccinated at once. This means that approved vaccines should be manufactured and distributed to every part of the world in a short period of time, and this proves a huge challenge remains to be solved.
While global effort in development of vaccines should be applauded, how the vaccines are distributed as currently a stark inequality of distribution is threatening our efforts. 5 months after the global vaccine rollout, currently more than 1.43 billion doses have been given with 700 million people receiving at least one dose of the vaccine. However, WHO said that 87 percent of these doses are administered in upper middle-income countries while 0.2 percent go to low-income countries. This huge gap should be appalling and one of the reasons it happened can be traced back to how companies allocate its vaccine roll out.
Higher income countries have funded vaccine developments in the billions, and in return drug companies provide these countries with a secure dose of vaccine for its people. This is prevalent in the West, as they have the resources to take a risk of an investment, they are capable of making deals early on in the pandemic even when the vaccine has not yet proven effective. Moreover, these countries are buying much more doses than its population needs in order to substitute if a drug company vaccine fails to deliver. In fact, over 6 billion doses are secured by these upper-middle income countries, when they are only representing one-fifth of the global populace. With the current limited manufacturing capacity, almost all doses that are produced by Western manufacturers are near-full from deals with wealthy nations. This leaves poorer nations in the “back of the line.” A report by the Economist Intelligence Unit estimated that while rich nations could have their citizens vaccinated by late-2021, poor countries could wait until 2023 at the earliest.
Some of these nations have promised to share their vaccines. But most of these world leaders make it clear that their own countries come first, then the excess doses can be shared with the world. This nationalistic approach to vaccine procuring means that poor nation could not rely on the West. With the gap left by western democracies, China and Russia fill in, delivering their own desperately needed vaccines to those who need them. But everything comes at a cost, as vaccines give these powerful nations a strategic opportunity to further expand their influence and win the seemingly unopposed war of “vaccine diplomacy.”
Vaccines as a Diplomatic Tool and Weapon
Diplomacy is an art of influencing the decisions and conducts of foreign governments. Usually through dialogue, negotiations, and other non-violent means. Throughout history, leverages have been used as tools to help one country’s efforts in gaining advantages in these negotiations. Be it through the economy, military, social or other aspects of one nation. Vaccines are one of those leverages that can be used in diplomacy.
The concept and idea of using vaccines as a diplomatic tool goes back as old as the first vaccines themselves. The British doctor Edward Jenner in 1798, published his findings on the use of the cowpox virus to treat and create immunity against the smallpox virus. By the 1800 this vaccine had spread widely in England and shipped to France. Napoleon himself established vaccine departments in all France’s major cities when he became Emperor and Jenner was elected as a foreign member of the Institute of France. This came at a time of almost continuous war between England and France.
The use of vaccines as a diplomatic tool can be best seen during the global effort in eradicating smallpox in the late 1950s to the late 1980s. At the height of the cold war in 1958, Viktor Zhdanov the USSR Deputy Minister of Health, called upon the World Health Assembly to undertake a global effort in eradicating smallpox. The proposal was accepted a year later in 1959 and in 1966 an international team, the Smallpox Eradication Unit, was formed under the leadership of an American Donald Henderson. In about two decades later in 1980, smallpox, a disease which has plagued humanity from the time of egyptians pharaohs, was eradicated. During the efforts of eradicating it, the Soviet Union and the US, both rivaling superpowers with nuclear weapons, worked together in manufacturing, providing as well as distributing the smallpox vaccine especially towards developing nations. This global effort of cooperation especially between antagonistic nations was unprecedented.
Of course, this idealistic view of vaccines bringing people together is not 100 percent right. As much as vaccines can be used as a tool in developing geopolitical relations, it is also often a global security weapon that can be used to coerce, gain favours or force foreign governments in their decision making. There is also the issue of vaccine nationalism, in which a national government made an agreement with pharmaceutical companies to supply and prioritise their population first before selling the vaccines to other countries. This would mean a shortage of vaccine for poorer countries who cannot afford these agreements while wealthier nations hoard more than they need.
In the race for a COVID-19 Vaccine, there’s a trend in vaccine diplomacy that can be seen. Western countries such as the United States, United Kingdom, and the nations of European Union can be seen pursuing a policy of vaccine nationalism. Meanwhile, China has exploited the crisis by both selling and donating its vaccines in a way that advances its own foreign interest, especially its Belt and Road Initiative. India, long wary of a diplomatic encirclement by China influence in the region, has also donated its own vaccine regionally. Russia, meanwhile, has opted to go with its own kind of vaccine nationalism with some limited donations.
The effect of these various forms of vaccine diplomacy has in a way produced political intentions that are disproportionate to the needed response to the pandemic health consequences. It can be observed that many world powers that have the capabilities to develop vaccines distribute it in a way that’s grounded in geopolitics not epidemiology. This resulted in a situation where vaccine distributions worldwide are not equal. Nations that are considered to be geopolitically important might gain more vaccines faster than nations which are considered less important. For example, because of China vaccine diplomacy policies of distributing vaccines to advance its own foreign interest especially to its regional neighbours, and there are counter efforts by western powers to undermine China’s growing influence, the Asia-Pacific region has received over half of the global vaccine donations despite only reporting under 10 percent of the global COVID-19 cases.
The leading counter effort to China’s growing influence by using its vaccine manufacturing and distributing as well as donating capabilities has mostly come from the Quadrilateral Security Dialogue (Quad) which is made of India, Japan, Australia, and the United States. The Quad has pledged to produce one billion vaccine doses, especially for the Indo-Pacific Region. The Quad is a manifestation of the United States strategy to compete with China’s growing influence in the region by becoming a major player in vaccine manufacturing and distribution in the region. The alliance is in a way a clear message to China by the United States about power balance in the region.
It is not all about geopolitical games and foreign influence. However, COVID-19 vaccine has also pushed for a new global effort of cooperation as well. The Covid-19 Vaccines Global Access initiative or abbreviated as COVAX is a global effort aimed at creating equitable access to COVID-19 vaccines worldwide. It was part of the access to COVID-19 Tools Accelerator, an initiative started in April 2020 by the combined effort of the World Health Organization, The European Union, and the government of France. COVAX has currently 165 countries participating in it, more than half of the human population worldwide. Its mission is to coordinate the international resources to enable and ease low-income and developing countries access to COVID-19 tests, therapies and vaccines. COVAX has succeeded in providing vaccines to countries such as Ghana, Ivory Coast, Moldova, Bosnia and Herzegovina, Serbia, and Slovenia.
Vaccine is a powerful tool and asset a nation may have. Especially during a worldwide pandemic such as the one we are facing today. Be it as a way to gain influence, nurture relations or simply a morale act vaccine has many uses in diplomacy. And yet, it is the same exact reason why vaccine diplomacy can hinder efforts in ending the pandemic. COVID-19 vaccine being used as a leverage in diplomacy can already be seen used in ways that creates an imbalance in the vaccine supplying efforts. And yet, it can also be said that it is paving a way to a new era of global cooperation we’ve seen only glimpses of before.
As early as its first developments, the COVID-19 vaccine has already been subjected to a geopolitical game of its own. Every major power in the world from the United States to China has device plans of their own on what they want to achieve diplomatically from developing, manufacturing, and distributing their own vaccine. China, the first country that was hit by the pandemic, was seen by many globally as the major reason the pandemic spread as it does. China thus planned to in a way redeem themselves on the global stage as some sort of a saviour, not only to their own citizens but also to the populations of its regional partners. And yet, China doesn’t shy away either from using their vaccine to force its nation recipients to make policies advantageous to China’s foreign interests especially its Belt and Road Initiative and with the issue of Taiwan. Across the Pacific in the United States, at first the Trump administration wished to show their vaccine as a way of showing how the United States has the capability to accelerate the recovery of its economy through private scientific progress rather than restrictions. The new Biden administration, however, has focused its vaccine effort on immunizing the American population through a public effort in a struggle to return the United States to its pre-Covid power. In the European region, there’s a clear clash between the recently split United Kingdom and the nations of the European Union as well as Russia its east. The United Kingdom, recently ending their membership within the European Union with Brexit, wants to demonstrate how the country is better off alone without the European Union. The vaccine gave it a chance to show that it can be more efficient and faster working alone rather than in league with the rest of Europe. For the European Union, a strong cooperative strategy in procurement and distribution of the vaccine became center stage as a way of showing proof of unity and a cooperative spirit among its member states. To Europe east in Russia, the vaccine has become a way to establish Russia scientific prowess and in recent political turbulent, a way for its autocracy to keep hold on its powers. With all these various plans and geopolitical strategies using the vaccine as a catalyst, it is worth analyzing the results and impacts of each one.
Saying that China has gained a significant amount of influence in the global stage is an understatement. From developing one of the first working vaccines and an extensive distribution and donorship campaigns, China has framed itself as a solution to the pandemic rather than its origin for many. In Southeast Asia for example, 9 out of 10 of the ASEAN member countries currently have or are planning on using Chinese vaccines. This monopoly in vaccines in the region helped China in pushing its Belt and Road Initiative programs in the region. It is not only the Southeast Asia region, however; the Middle East and South America has also become dependent on China donors for their vaccines. Even nations that are historically opposed to China in the region like Honduras who recognize Taiwan have been willing to make concessions for the sake of getting the vaccines. This aggressive expansion of soft power has given China a leeway into the world stage as a major superpower. A new beacon of global cooperation perhaps, a title once reserved to its rival across the Pacific the United States.
The United States has been playing catch-up in its vaccine diplomacy since President Joe Biden took office. The previous Trump administration plans have been proven to be a complete failure, a major factor on why the United States has been lagging behind in the global vaccination drive. Despite his predecessor fumbling of the public-private initiative Operation Warp Speed, an initiative to facilitate and accelerate manufacture and distributions of vaccines, the Biden administration has proven to be successful in restructuring and running its own vaccine plans. In less than 100 days into his presidency it has succeeded in delivering millions of vaccines to its citizens. Having established control of the pandemic at home, the United States has started to push abroad in its vaccine diplomacy mostly for concerns of China’s growing influence in the global stage. From its recent announcement that the United States supports waiving intellectual property rights for COVID-19 vaccines from their domestic manufacturer, which allows poorer countries better access to its vaccines and make it easier for foreign manufacturers to develop their own vaccine, the United States hopes to gain favours with various third-world countries. This waiver came under the World Trade Organization’s Trade Aspect of Intellectual Property or TRIPs agreement which was proposed by South Africa and India back in October of 2020. Many on the global stage have seen the policy shift of the new United States administration as a resurgence of America’s role in the world. And yet the United States is very late in entering the race, it needs to push its vaccine production capabilities to go beyond its limits if it hopes to hold on to its remaining influence overseas.
Europe meanwhile can be divided into 3 sides on its vaccine diplomacy. First of all, the United Kingdom, one of the worst hit countries in the region, has coped with developing its own vaccine even though there have been challenges on its developments. The United Kingdom has fallen into what would be called a vaccine isolationism in the front and cooperation behind closed doors. The European Union has been in discreet quiet talks with the United Kingdom in bilateral cooperation in vaccine developments and distributions despite the latter’s rhetoric of doing everything on its own. The European Union has been pushing for cooperation in the vaccine race. Putting solidarity and collaboration ahead of isolationism and influence gathering. Many international think-tanks, donorship programs and initiatives on the vaccine can be traced to European Union efforts to develop stronger relationships not only with its own members but also globally through vaccines. Russia on the other hand has pushed hard on vaccine nationalism. It has refused other vaccines in favour of its own. Russia also doesn’t shy away from using its vaccine in gaining soft power globally although in a more discreet nature compared to China.
From all of this one thing is clear. The world will never be the same after the pandemic. The old perception of America leading the world has eroded. A new age of Chinese dominance is on the horizon. As Europe struggles with divisions and solidarity, Russia has been gaining new grounds globally. As many of the world’s developing countries can only struggle and hope for vaccines for their populations, many found themselves taking sides in future grand geopolitical games. And this coming giant shift in global geopolitics is all spearheaded by the power of vaccines.
References can be accessed through http://bit.ly/DipRevVaccineDiplomacyReferences
Shahravi Hatta and Denis Tahar are Staff of Research and Analysis Division of FPCI Chapter UI Board of 2021.