Welcome back to the Ethical Reckoner. Today, we’re talking about a topic related to ER5’s discussion of vaccine distribution inequities: vaccine diplomacy.
Issues of unequal global access to vaccines continue. North America has administered 25 doses per 100 people, Europe 15, South America 7.8, Asia 4.7, and Africa just 0.7 doses per 100 people. Most of Africa still has yet to begin vaccinations, and the COVAX program that is aiming to provide 2 billion doses by year’s end is facing delays due to production difficulties and reluctance by the Indian government to approve exports. With most available doses purchased by wealthier countries, the other venue less-wealthy countries have to obtain vaccines is through donations. Unsurprisingly, some countries are donating more than others.
Outside of COVAX, America has taken an expressly “America-first” approach to vaccinations, incorporating clauses requiring American-made vaccines to be offered to America first, and while the EU has been exporting doses, recent political outcry may soon see that halt. On March 25, the EU announced that it would not ban exports outright, but that AstraZeneca must “catch up” on its obligations to the EU before exporting doses.
Imagine we're all on a plane and the oxygen masks have just dropped. The West is just putting their own masks on before assisting others, like we’re told to do, right? Well, there are a few issues with this metaphor. First off, the plane doesn’t first auction oxygen masks to the highest bidder. Also, whether or not others get their oxygen mask on has no impact on your own survival (while allowing uncontrolled spread could give rise to variants that affect everyone). Lastly, helping someone else with their oxygen mask may make them grateful, but doesn’t have a significant political impact on a global scale. So, it’s important to get everyone their vaccines for everyone’s sake, but we also need to be aware of the consequences of our vaccine distribution strategies.
You know who’s helping others with their masks right now? China. China is exporting about 62% of the doses it’s making. It has donated doses to 69 countries and is commercially exporting to 28 more. The US is making almost as many doses as China is, but contracts between manufacturers and the government means that few are available for export. Meanwhile, Iran, Mongolia, Montenegro, Nepal, Pakistan, the Philippines, Uganda, and Venezuela, among other countries, have received donations from China. This is raising concerns that China is engaging in “vaccine diplomacy,” or strategic donations of vaccines to improve its relations and image abroad; Yanzhong Huang summarises it as “where Beijing’s inoculations go, its influence will follow.”
China claims that this is a politically slanderous and “sinister” implication, stating through the official Xinhua News Agency that “In advancing cooperation in combating the pandemic, China has never pursued any geopolitical goals, is making no economic interest calculations, and has never attached any political conditions;” rather, it is creating vaccines to serve as a “global public good” and promoting a global “human health community”… purely out of the goodness of Xi’s heart? Even if there are no direct quid pro quos trading vaccines for influence, serving as the global leader in providing immunisations will obviously improve a country’s image and soft power, which China really wants after it took a hit for the coronavirus originating within its borders and the uneven quality of medical supplies provided during its wave of “mask diplomacy” in 2020.*
This was part of what President Xi called the “Health Silk Road,” which is now a key component of the Belt and Road Initiative (BRI), a multi-billion (and perhaps soon multi-trillion)-dollar set of overseas construction and infrastructure projects that has been called “economic imperialism,” as it gives China enormous leverage in less-wealthy countries. The BRI has raised concerns in the West: it’s assumed that it’s “a blueprint for an emerging international system in which China will play a leading role,” but it’s unclear to what extent the system will be multilateral and allow for global cooperation from many different countries, or if it will lead to a “bipolar order” where the US and China are each “[carving] out spheres of influence” (Freymann, 2021). This latter approach could see a destabilisation of the world order “in which America’s traditional tools of power projection—security treaties, international institutions, and soft exports like popular culture and democratic ideals—aren’t as effective as they used to be.” It represents “a working model for a future geopolitical bloc led by China,” which is obviously an enormous threat to the global status quo, and the West currently does not have an answer for it (Freymann, 2021). Health diplomacy is a fundamental part of the Belt and Road infrastructure and influence project, and it is clear that vaccine diplomacy is joining the caravan.
So, how is China going about this? China is taking a two-pronged approach to its vaccine diplomacy efforts. The first is rewarding their existing allies. This is nothing new—of course countries will prioritise their allies first; you’d put an oxygen mask on your friend before a stranger (or enemy). For China, it means that there is zero overlap between countries that recognise Taiwan as an independent nation and countries that have received Chinese vaccines. The US and EU aren’t giving vaccines to those challenging their geopolitical goals, either; the US is giving vaccines only to Canada and Mexico, because “They are our neighbours, they are our partners.”** China, like other states, is reinforcing that it’s better to be their friend than their enemy.
The second, more concerning, approach is the wooing of new allies. For instance, Brazil seemed to be going along with the Trump administration’s efforts to get its allies to freeze out Huawei, one of the biggest telecommunications companies in the world and one of China’s flagship corporations, in bids to build out national 5G infrastructure. President Bolsonaro’s son, a member of Congress, called to create a 5G system “without Chinese espionage,” and sentiment against doing business with China extended even to Bolsonaro himself disparaging Chinese vaccine trials—until Brazil’s hospitals started becoming overwhelmed, underscoring the need for vaccines. With none forthcoming from Brazil’s traditional allies, something strange happened: in February, Brazil’s communications minister met with Huawei executives in Beijing and asked the telecommunications company for vaccines. Huawei said that they could help with “communication in an open and transparent manner in a topic involving the two governments.” And, while both sides claim there was no quid pro quo, two weeks later, it was announced that Huawei would be able to participate in Brazil’s 5G auction, and millions of Chinese vaccines have been pouring into Brazil. Now, it seems like China is offering oxygen masks to others on the plane—but for a price. And, more importantly, it’s potentially wooing new allies to its side, building its global influence as countries in Europe and North America squabble amongst themselves.
One question that ER5 raised but didn’t answer was whether we have a moral imperative to share vaccines. In the plane metaphor, you’re under no obligation to help others before your own safety is secured, and you certainly aren’t obligated to give someone else your own mask. However, few would argue with the assertion that if you can help others without putting yourself at risk, you are obligated to do so. Thus, I came down hard on countries who are hoarding doses, and once a country has more than they need for its population, or more than they can use at one time, they should share those doses with others.
So while there may be no moral obligation to share vaccines that could otherwise be used domestically, this is more complicated than a crashing plane. There are other geopolitical factors at play, which may impact how a country should use their supply. It’s within a country’s rights to prioritise its own population for vaccination. However, the current dynamic where the West is only vaccinating its own population while China vaccinates the rest of the world and builds its influence is dangerous. There are preliminary countering efforts underway; the US, India, Australia, and Japan just announced the “Quad Vaccine Partnership” to “strengthen and assist countries in the Indo-Pacific with vaccination, in close coordination with the existing relevant multilateral mechanisms including WHO and COVAX,” which aims to distribute 1 billion doses by the end of 2022. It’s unclear whether this will be fast enough. There are claims of an approaching tipping point where the US, having vaccinated its own population, will be able to distribute vaccines more widely, and also concerns that China is exporting so many vaccines that it won’t have enough left for its own population; it’s currently administered just 7 doses per 100 people. However, it’s far from certain that the US will be able to marshal vaccines for donation on the scale that China is already doing. Also, it’s unlikely that China will end up with egg on its face and a larger outbreak, since the virus is under control, decreasing the need for a rapid rollout. Also, China’s goal is to have 64% of the population vaccinated by year’s end, and if any country can rapidly mobilise personnel and resources, it’s China.
Ultimately, why does this matter? Beyond the moral questions of who should send vaccines where, vaccine diplomacy is making biopower, the control of citizens’ bodies and health, a new source of geopolitical tension. It’s not just the US and EU versus China—India is getting into the vaccine diplomacy game to counter China’s influence in neighbouring countries supported by Belt and Road and Chinese vaccines.*** If the West—and especially the US—wants to maintain its soft-power leadership, it needs to start countering China’s BRI vaccine diplomacy with motions of its own. China is still less trusted than the US; nearly three times as many thought leaders in Southeast Asia considered the US a “trusted power in the region” compared to China. But, if China starts pulling countries out of the pandemic months and years before COVAX and donations get to them, that could change. Loans and promises of surplus donations down the line won’t cut it.
The risk, though, is that the West has put themselves into a lose-lose situation. Because they didn’t control the pandemic effectively, they can’t share vaccines because they need them to stop the pandemic and so sending them elsewhere would be politically infeasible, and they can’t not share vaccines because they need to counter China’s growing geopolitical influence. The US and EU may have to broaden their vision of what an effective vaccination distribution plan looks like, incorporating geopolitical dynamics as well as public health concerns, which may see some doses being diverted from within a country to places where China is building influence (and would require an enormous PR campaign to ensure that the public supports it while not deepening the horrific anti-Asian sentiment exploding in many areas).**** As much as we dislike it, we may have to take a gulp of air, put someone else’s mask on for them first, and hope that competition over where masks are going doesn’t down the plane.
*Similar concerns have been raised due to the fact that Chinese-made vaccines seem to be less effective in trials, but when your choice is between a less-effective vaccine and no vaccine, you’re going to take the one that keeps your people from dying. This also raises implications that shots like Pfizer and Moderna may become the “luxury” vaccines of the elite.
**Also, this isn’t charity—the 4 million doses are a loan, expected to be repaid with “doses in return.”
***This creates opportunities for savvy countries like the Seychelles, which is playing India and China off each other for donations and is currently second in the world in percentage of population vaccinated.
****This also creates concern that a country’s priority in vaccinations will be determined by how much China is wooing them, deepening the political dynamics and possible inequities in distribution, as well as concerns that having fewer doses within a country will deepen distribution inequalities within that country. I didn’t say this would be easy; that’s why we’re talking about it.
Prompt generated by DALL-E 2 with the prompt “belts and roads and planes, oh my! abstract impressionist”.
Non-linked works cited:
Freymann, Eyck. One Belt One Road. Harvard University Press, 2021.
Thanks for reading.
Emmie is an MSc student at the Oxford Internet Institute. Check out the archive of past Ethical Reckoner issues here. If you haven’t already, click the big “subscribe” button to get the Ethical Reckoner biweekly, and help the ER grow by spamming all your friends with the “share” button.
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