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Geopolitics drives vaccine access in Asia

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Workers offload boxes of Oxford/AstraZeneca vaccines received under the COVAX scheme, Phnom Penh International Airport, Cambodia, 2 March 2021 (Photo: Reuters/Cindy Liu).

In Brief

From the start of the COVID-19 pandemic, vaccines were seen as critical to countering it. The World Health Organization (WHO) and other stakeholders created the COVID-19 Vaccine Global Access facility, or COVAX, to ensure equitable access worldwide. But countries with the means to make or buy vaccines locked up global manufacturing capacity and supplies. This vaccine nationalism generated urgent questions about when low-income countries will get vaccines. In Asia, geopolitics, not equity, are driving vaccine access.


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With the United States and other Western democracies pursuing vaccine nationalism, China exploited the global access crisis by selling and donating Chinese vaccines in Asia in ways that advanced its foreign policy interests associated with its Belt and Road Initiative. With a wary eye on China, India has donated vaccines regionally, and Russia has also sold and donated vaccines to Asian countries.

Even so, bilateral vaccine diplomacy has had limited impact on vaccine needs, and whether sold or donated doses materialise as promised remains unclear. China, India and Russia face domestic vaccination needs that could delay deals and donations. Questions have persisted about the safety and efficacy of Chinese vaccines, and comments by the head of China’s Centre for Disease Control and Prevention about the low efficacy of Chinese vaccines threaten to damage China’s vaccine diplomacy.

Vaccine diplomacy has produced political attention disproportionate to its health consequences. Rather than disavow vaccine nationalism at their February 2021 summit, G7 leaders engaged in geopolitical handwringing about China and Russia gaining influence through vaccine diplomacy. Thomas Bollyky observed that democratic and authoritarian countries have grounded vaccine diplomacy in geopolitics rather than epidemiology, resulting in the Asia Pacific region receiving over half of global vaccine donations despite reporting under 10 per cent of the world’s COVID-19 cases since November 2020.

The leading response to China’s vaccine diplomacy in Asia emerged from the Quadrilateral Security Dialogue (Quad) made up of Australia, India, Japan and the United States. At its March 2021 summit, the Quad pledged to produce at least one billion doses for the Indo-Pacific region by the end of 2022 — a promise that, if kept, will increase access in Asia even more. The initiative implements the US strategy to compete with China by strengthening collaboration among democracies, which aligns with Australian, Indian and Japanese worries about Chinese behaviour. China has criticised the Quad for attempting to contain its rise, so using the Quad for vaccine diplomacy sends an unmistakable balance-of-power message to Beijing.

Hopes for global, equitable access rest on the COVAX commitment to use financial support from high-income nations to provide vaccines to over 90 developing countries. Despite vaccine nationalism, COVAX is allocating and delivering vaccines to Asian countries. COVAX forecasts that it will supply nearly one billion doses to the region during 2021, an amount exceeding what bilateral vaccine diplomacy and the Quad initiative promise to provide this year.

But COVAX has not escaped geopolitics. The Trump administration’s ‘America First’ refusal to participate in COVAX provided China another opportunity to strengthen its vaccine diplomacy and global influence. To compete more effectively with China, the Biden administration reasserted US leadership by pledging US$4 billion to COVAX and hosting a COVAX funding event in April 2021. Geopolitical concerns also informed commitments other G7 countries have made to COVAX in 2021.

Through vaccine diplomacy, the Quad initiative and COVAX, geopolitical competition has boosted vaccine access in Asia. But vaccine nationalism remains strong and equitable access is not within reach. On 9 April, the WHO Director-General highlighted that, of the 700 million doses administered globally, ‘over 87 per cent have gone to high income or upper middle-income countries, while low income countries have received just 0.2 per cent’.

Whether vaccine access in Asia would have been more equitable absent the geopolitics is, however, doubtful. During the H1N1 influenza pandemic in 2009, high-income nations secured the lion’s share of vaccines, preventing global, equitable access without balance-of-power politics playing any role.

Geopolitical competition over vaccine access might dissipate. Progress with US and European vaccination campaigns should temper vaccine nationalism, increase global supply and reduce the diplomatic leverage that control over scarce doses creates. These conditions could encourage the United States to shift from the geopolitics of vaccine diplomacy to immunising people across the world as quickly as possible.

However, the emergence and spread of variant coronavirus strains that undermine existing vaccines could produce more vaccine nationalism and geopolitical competition over access to vaccines for variants. If this happens, the story of COVID-19 vaccine access will again demonstrate that countries think and act in terms of vaccines defined as power.

David P Fidler is Adjunct Senior Fellow for Global Health and Cybersecurity at the Council on Foreign Relations.

This article is part of an EAF special feature series on the COVID-19 crisis and its impact.

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