Vaccine diplomacy: China moves to fill gaps the West leaves behind

This is part two in a series. Read part one here.

Fed up with being left behind in the global COVID-19 response, nations in Latin America, Africa and the European Union (EU) have turned to new saviours: Russia and China.

China has been very proactive in promoting its vaccines produced by Sinovac and Sinopharm, donating doses and offering loans to low-income nations.

While it’s a blessing to many countries which have little hope of vaccinating citizens before 2022, it also presents risks — for both recipient countries and for China.

Like aid, vaccines will be leveraged

The Chinese Ministry of Foreign Affairs has stressed the “accessibility” and “affordability” of its vaccines, advertising them as a “global public good”.

But state media has also tried to undermine the public trust in Western-developed vaccines. Early on, Chinese officials questioned the safety of the mRNA vaccines. State media said deaths in elderly patients in Norway after receiving the Pfizer vaccine were “likely related to the vaccine” despite no specific safety risks being found. Chinese health experts advised Australia to stop the vaccine’s approval.

Early on in the pandemic, high representative of the European Union Josep Borrell warned of a “battle of narratives” and called Beijing out for its “politics of generosity”.

The Chinese government has since offered US$1 billion to Latin America, the Caribbean and Africa to help them acquire COVID-19 vaccines and is donating millions of doses to South Asia. After denouncing the EU, Serbia’s president kissed the Chinese flag after vaccines arrived in the Balkans.

Mercator Institute for China Studies analyst Jacob Mardell told Crikey China had a history of health engagement in Africa and South-East Asia. Donations like this aren’t rare, he said, but they will be strategically leveraged.

These initiatives are forming part of the health silk road, a global health cooperation with China at its centre.

“It’s mainly about soft power and providing evidence for the narrative that China is a leader and friend of the developing world, especially against the backdrop of Western absence,” Mardell said.

James Laurenceson, a professor from the University of Technology Sydney’s Australia-China Relations Institute, told Crikey that Beijing used both the carrot and the stick in its diplomatic efforts — and Australia was currently facing the stick.

He doesn’t believe the loans or donations will come with strings attached.

“It’s both goodwill and strengthening diplomatic ties, and you often do strengthen diplomatic influence if you engage in acts of goodwill,” he said.

On whether China’s diplomatic efforts risked undermining Australia’s, Laurenceson said foreign aid shouldn’t be framed as a competition.

Let’s not forget profit

China has said that while reasonable profits for companies are permitted, COVID-19 vaccines should be priced close to cost.

China’s vaccines reportedly range from around $18 to $40 per dose. By comparison, the US is paying around $25 per dose of Pfizer’s vaccine and around $47 per dose of Moderna’s vaccine.

AstraZeneca is the only major vaccine candidate which promised to keep its vaccines available on a not-for-profit basis during the pandemic. These come in a lot cheaper at between $3-5 per dose.

“There’s money to be made in the vaccine game,” Mardell said.

“Even aside from the purchase of COVID-19 doses, it will be great for the reputation of these brands and Chinese pharmaceuticals (and products in general) if vaccination drives are a success.”

There are also risks

The World Health Organization (WHO) is currently reviewing China’s two top vaccine candidates for emergency use. Phase three trials of Sinovac’s CoronaVac vaccine have taken place in Brazil, Indonesia and Turkey, though the data has not yet been subjected to peer review.

China granted approval for emergency use of the vaccine early on, and other countries have recently followed suit. The ruler of Dubai, Sheikh Mohammed bin Rashid Al Maktoum, was one of the first in the region to get the Sinopharm vaccine. He was followed by Bahrain’s 70-year-old king, Hamad bin Isa Al Khalifa. The presidents of Indonesia, Turkey and Seychelles, as well as the Jordanian prime minister, have also been inoculated with Chinese vaccines.

But Adam Kamradt Scott, a global health security expert and associate professor at the University of Sydney, told Crikey the lack of peer-reviewed data is a concern.

He said his concerns were twofold. Firstly, if steps have been skipped in the clinical trials there may be risks of adverse side-effects or fatalities associated with the vaccine. Secondly, there are questions around the vaccine’s efficacy.

Turkey reported CoronaVac was 91.25% effective at preventing symptomatic disease, though Brazil found the vaccine was just 50.4% effective at preventing severe and mild COVID-19. Vaccines must have an efficacy rate of greater than 50% to get approved by WHO.

“[If the vaccine is ineffective] countries will then have to look at spending more money and valuable resources to acquire other vaccines,” Kamradt Scott said.

But while providing a COVID-19 vaccine could be beneficial to China’s brand, it could also be damaging if poorly managed.

Early in the pandemic, thousands of testing kits and medical masks sent by Chinese manufacturers around the world were found to be faulty or defective. Medical donations which arrived in Kenya and Tanzania were allegedly sold on to Tanzanian companies. And members of WHO have warned against falsified vaccines entering the supply chain line in developing countries.