China and the World, Talking Point

Vaccine diplomacy

How the politics of Covid-19 is preventing a quicker victory over the virus


Biden discusses with European leaders a plan to outflank China with donations of a billion Covid-19 vaccines

After getting to know each other for just 49 days, Taiwanese actress Barbie Hsu and Wang Xiaofei, the mainland Chinese heir to the South Beauty restaurant group, were married in Hainan a decade ago.

The wedding (see WiC101) had a fairy tale feel to it but the marriage was symbolic of something greater during what was a ‘honeymoon’ period for cross-Strait relations. Ma Ying-jeou was about to win a second term as the island’s president and his ruling party, the KMT, was working on a trade deal with Beijing that brought Taiwan’s economy ever closer to the mainland.

But in a newer act of symbolism – this time reflecting the rapidly deteriorating relations between Beijing and Taipei – Hsu is said to have filed for divorce from her husband this month. One of the triggers, according to Taiwan’s newspapers, was the couple’s different values, underlined by Wang’s mocking rants on social media about Taiwan’s handling of its recent Covid-19 outbreak and its clumsy vaccine rollout (conversely, mainland media outlets have described the divorce as more of a case of a lovers’ spat).

One thing is more certain: continuing clashes over the distribution of Covid-19 vaccines isn’t just proving divisive in Taiwan. Last weekend it became a focal point on the wider international stage as G7 countries promised developing nations a billion vaccines as part of a bid to counter China’s longer-running vaccine diplomacy drive.

How has Covid-19 opened further divisions across the Taiwan Strait?

Vaccine availability around the world has tended to divide between Chinese, Russian and Western alternatives. In most countries, there isn’t a range of choices for recipients. Hong Kong is one of the few places that two of the most widely administered jabs – Sinovac (Chinese) and BioNTech (German) – are both abundantly available for free. And according to Hong Kong newspapers, families have had heated debates on whether to pick the more conventional vaccine developed by the Chinese biotech firm or the vaccine backed by 172 year-old Pfizer (the American pharma giant working with BioNTech) that deploys newer mRNA technology.

One reason for the hesitancy and debates among Hongkongers: China’s track record in food and medical safety could not be described as stellar. Before Covid-19, the last time that domestic vaccine makers were part of a WiC cover story was due to a damning scandal in July 2018. A sector-wide clean-up was ordered after a Shenzhen-listed pharmaceutical firm was caught fabricating its inspection and production records for a rabies vaccines (see WiC419).

But for most families in Taiwan – including the aforementioned Wangs and their two children – the choice of inoculation isn’t the pressing issue. The problem is that neither Western nor Chinese-made Covid-19 vaccines are available.

After undergoing three lengthy quarantines on both sides of the Taiwan Strait, Wang Xiaofei complained in a weibo post this month that his Taipei-based family was not able to get vaccinated, despite the worsening outbreak. The 39 year-old South Beauty group scion then contrasted this experience with the way that mainland China had been recovering from the pandemic, noting how its economy was thriving as well. “This is the gap,” he fumed, criticising the Taiwan government’s management of the pandemic as “shameless and low class”.

Wasn’t Taiwan praised for how it responded to Covid?

Under the independence-leaning Democratic Progressive Party (DPP), Taiwan had taken pride in its early handling of Covid-19 after the first reported case in Hubei’s provincial capital Wuhan in late 2019.

Just 300 or so cases were confirmed in Taiwan as of early April this year, mostly imported. For some this success made a strong case for why Taiwan should be represented at the World Health Organisation (at Beijing’s insistence the Taiwanese have been blocked from attending its annual assembly since 2016, when the DPP took office). However, in late April a wave of new infections started to spread across the population of 23.5 million people. As of this week, the number of confirmed cases had spiked to more than 13,000 with about 450 deaths, equating to a 3% fatality rate.

Worse still, cross-Strait tensions seems to have made the situation worse, with both sides accusing the other of curtailing access to life-saving vaccines.

Imports of vaccines from mainland China have been banned by the DPP but Beijing’s official stance is that it is happy to help by sending them, either through donations or commercial sales, for emergency use among its “Taiwan compatriots”. Beijing has also encouraged the Taiwanese to get inoculated in mainland provinces such as Fujian (the closest to Taiwan).

But the DPP government denounced the offers as insincere, saying they came with a “hidden political agenda”, and the island’s leader Tsai Ing-wen openly criticised Beijing for blocking her government’s procurement of BioNTech vaccines via its Chinese sales agent, Shanghai Fosun.

Instead Tsai expressed gratitude to the US and Japan for donating two million doses of the AstraZeneca vaccine. Irking Beijing further, the American share of the donation – about 750,000 doses – was flown to the island by a delegation of US senators. They arrived on a US airforce plane, enraging Beijing, which demands that America’s military forces do not set foot on the island.

As of this week, only about 3% of Taiwanese have been vaccinated against Covid, with most getting just the first of the two shots required. Tsai and the DPP are now counting on more donations from the US and its allies to contain the Covid-19 threat, as well as a future production of domestically-developed vaccines.

Why is ‘vaccine inequality’ a problem elsewhere in the world?

Taiwan has a decent standard of living and would not be bracketed as having ‘developing’ status. Looking beyond the debate about political interference, United Daily News says the island has suffered because it made too few initial orders for vaccines and was then caught out by a global supply shortage.

The World Health Organisation has maintained that ‘no one is safe from Covid-19 until everyone is safe’ and that the risk of infection will only subside when everyone on the planet is vaccinated. It hopes to see a fifth of the world’s 7.9 billion population inoculated by the end of this year. But that target is looking increasingly unlikely to be met: according to the WHO’s own data, nearly 88% of the global population is yet to have a single jab.

Vaccination rates are lowest in poorer countries. Last week, the WHO warned of a third wave of infections across Africa, where more than 3.6 million Covid cases have already been confirmed in 47 countries. Countries like Uganda have seen a rise in new cases – up more than 30% in a matter of weeks – and most African nations are likely to miss a target of vaccinating at least a tenth of their populations by September – unless the continent receives 225 million donated doses.

By comparison, richer countries are on course to see more than half of their adult populations vaccinated by the end of the summer. The US had fully vaccinated 145 million people, or 44% of its population, as of this week. This compares with 45% in the UK (but just 3.5% in India).

In a highly successful vaccine programme more than 80% of British adults have had their first jab. But in the weeks before last weekend’s G7 summit in the UK, developed countries were increasingly criticised for hoarding more Covid-19 vaccines than they actually need. The stockpiling was primarily a result of initial uncertainty over which vaccine would work best. Even so last December the People’s Vaccine Alliance, an organisation that includes Amnesty International and Oxfam, accused wealthy nations of buying up enough doses to vaccinate their entire populations three times over by the end of this year. G7 members alone had reserved more than a third of the world’s vaccine supply, despite making up only 13% of the global population.

The Chinese have done more to offer vaccines to other nations?

China’s Covid-19 outreach has seen it either donate or sell vaccines to nearly 100 countries. As of this week, it had provided about 350 million doses to other nations (having administered nearly 900 million jabs to its own population). Much of this comes as part of a campaign to launch a ‘Health Silk Road’, a phrase coined by President Xi Jinping early last year in talking about how China would turn vaccines into “global public goods”.

The sheer scale of these efforts have seen Chinese internet users mocking the US for contributing too little to the fight against Covid-19. In one example, there was widespread derision on social media after a statement by the American embassy in Trinidad and Tobago proclaimed that the US had donated 80 vials of the Pfizer-BioNTech vaccines to its Caribbean neighbour. By the end of May, Washington had still only pledged to donate about 25 million Covid-19 doses to other nations.

China has done much more, with a vaccination drive that has been welcomed in places like Southeast Asia, especially by countries whose alternative options are limited. At least 16% of Cambodia’s 16 million people have had at least one Chinese vaccine dose, according to reports from Reuters last week. “The question is asked whether Cambodia is too dependent on China,” its leader Hun Sen said in a recent speech. “If I don’t rely on China, whom should I rely on? Without the donations and sales of vaccines from China, we would not have vaccinated the Cambodian people.”

Indonesia is just as reliant on shots made by Sinovac, which account for 89% of the 95 million doses it has received so far. “It has certainly left an impression that when things were tough, the Chinese stepped up,” Evan Laksmana, a senior researcher at the Centre for Strategic and International Studies in Indonesia, told the Wall Street Journal this week. The region’s residents would remember “how China locked down quickly, got its own issues under control and provided vaccines,” he added.

Gratitude for China’s efforts has not been universal, however, mostly on concerns that the efficacy of its two main vaccines (Sinovac and Sinopharm) trails those from other international providers.

In the Philippines 63% of respondents told local pollster Social Weather Stations that they would prefer an American brand of vaccine, for instance, while only 19% of respondents were interested in receiving vaccinations from the more available Chinese equivalents.

The scepticism has been similar in parts of Latin America, which has received more than half of China’s total vaccine exports, or about 165 million doses.

In January Brazil’s Butantan Institute reported just over 50% efficacy rates for the Sinovac vaccine made in Brazil, barely enough to meet the WHO minimum standard. The findings led Jair Bolsonaro, the country’s volatile president, to deride the vaccine publicly.

In Chile, the authorities have also had to battle with scepticism about the Chinese vaccines after a surge in infections, despite comparatively high vaccination rates.

What did the G7 promise last week?

Amid growing criticism of America’s failure to distribute more vaccines to other nations, Joe Biden announced last week that the US would share at least 80 million doses by the end of this month. At the G7 gathering in Britain, leaders from the most developed economies concluded their first face-to-face meeting in two years by announcing that they would commit to sharing at least a billion doses over the next year with countries most in need.

Half of the donation, or 500 million doses, is to be contributed by the US, in what Biden described rather pointedly as “the largest single donation of Covid-19 vaccines by any single country ever”.

Are a billion jabs enough to stem the spread of infection, however? Not even close, sadly, with the WHO estimating that at least 11 billion are required to stand a chance of beating Covid-19. “We need more than that,” UN Secretary-General Antonio Guterres said of the G7 plan. “We need a global vaccination plan. We need to act with a logic, with a sense of urgency, and with the priorities of a war economy, and we are still far from getting that.”

In an op-ed published in the Guardian newspaper, Gordon Brown, a former UK prime minister, went further, warning that the summit would go down in history as “an unforgivable moral lapse” when wealthy countries had failed to deliver a comprehensive vaccination plan to eradicate Covid-19.

Does the G7’s vaccine plan target Covid-19 or China?

When China was providing medical equipment and protective gear to other countries last year, the efforts were derided in some of the international media as ‘mask diplomacy’. The criticism was that the Chinese were dispatching emergency supplies as a way of tempering allegations that the virus had originated in China or simply as a strategy to influence the recipient nations.

But politicians from Europe and the US now seem to be lobbying for their governments to perform the same trick with vaccinations. “Vaccine diplomacy would save lives, bolster national security, and help everyone but the Communist Party [of China],” US Senator Ben Sasse claimed in an op-ed in the Wall Street Journal last month. He called for the Biden administration to take the lead in stopping the pandemic as a means of countering Chinese influence around the world.

Message heeded? When the G7 did step up with its billion-jab offer it was after a summit in which Biden had sought to portray the future relationship with China as a case of democracies versus autocracy (see this week’s “China and the World”).

In this context, the offer to help other nations against Covid could be seen as as much as a battle of values as a vaccination race.

Could the two superpowers come together to defeat the disease?

According to a report posted on WeChat by Guangzhou-based think tank Intellisia Institute, the most successful earlier effort to eradicate an infectious disease came at the height of the Cold War in the 1960s through an unlikely collaboration between America and the Soviet Union.

At the time, smallpox was killing as many as two million people a year, and infecting 15 million more. The Soviet Union had basically eradicated the disease at home but was suffering from imported cases from neighbouring countries such as Afghanistan.

Meanwhile, America’s image was being damaged in the developing world by the Vietnam War. An overlapping interest thus dovetailed between the two superpowers: the US saw the public relations advantages of sponsoring a major breakthrough in disease prevention, while the Soviets concluded that killing off smallpox globally was less costly than attempting to insulate themselves from the disease every year.

The think tank says that over the next 10 years the Soviets would provide more than 170 million smallpox vaccines to other countries, with the Americans financing more than 90% of the cost of the jabs. By 1980, the world was free of smallpox.

“The logic of fighting infectious diseases requires every nation to part with short-termism and zero-sum thinking, and to put the well-being of humanity first. This is the most precious legacy of the so-called ‘smallpox diplomacy’ during the Cold War,” Intellisia Institute concluded.

Might China and the US come to a similar deal in confronting Covid? With enmity between the two governments showing little sign of subsiding, the chances of the same kind of superpower cooperation seem distant.

And last weekend’s G7 statement signals that vaccine diplomacy is more likely to be competitive in nature than coordinated in the months ahead.

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