Researchers developing Beijing-based Sinovac Biotech’s Covid-19 vaccine. | Photo Credit: Thomas Peter/Reuters

China’s Vaccine Diplomacy: Should Countries Be Wary?

China has mounted a global campaign to develop and share its vaccines in a venture termed as ‘vaccine diplomacy’. Should countries be wary of possible strings attached to participating in the venture, or do the benefits of an effective vaccine outweigh the costs?

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In 1798, British doctor Edward Jenner successfully engineered a vaccine against smallpox – a viral disease that claimed 400,000 lives in Europe per year in the outbreak of the 18th century. Jenner’s vaccine would then be shipped across the English channel and accepted by Napoleon in France, despite being at almost continuous war with Great Britain at the time.

This striking venture is what is known today as vaccine diplomacy.

Vaccine diplomacy is the use of vaccines to improve a country’s diplomatic relations and influence over other countries. Throughout history, it has remained a powerful tool in strengthening international relations.  

“The sciences,” said Jenner, “are never at war.”

At the World Health Organisation’s (WHO) annual assembly in May 2020, President Xi Jinping announced that China would make its vaccines a “global public good” as part of efforts to combat the Covid-19 pandemic. China has since mounted a large-scale vaccine diplomacy campaign – to develop and distribute its vaccines. The campaign can be seen as an effort to recover any political favour China may have lost as the pandemic’s “country of origin”.

“The idea that the Chinese vaccine is going to be a global public good is very important for China right now,” said Dr Mauricio Santoro, head of the Department of International Relations at the State University of Rio de Janeiro, “because it became the way they are fighting the propaganda war in the pandemic.”

However, the road to a successful campaign has been challenging. China has been receiving backlash over its ventures into vaccine diplomacy.

What Fruits Have China’s Efforts Borne?

To date, China has engaged over a dozen countries in its vaccine trials through its biotechnology companies Sinovac and Sinopharm. Many are developing nations with strong diplomatic ties to China, which have also been offered free doses and raw materials to produce the vaccine domestically. Countries such as Brazil, Turkey, Indonesia and the United Arab Emirates (UAE) are already carrying out late-stage trials.

However, China’s detractors, such as the United States (US) and India, maintain that China’s vaccine diplomacy is primarily to further its own geopolitical agenda instead of fostering good diplomatic relations.

In view of such criticism, the question is: should countries be wary of China’s vaccine diplomacy? 

That depends on which country you ask.

São Paulo state’s governor, João Doria, with a Sinovac vaccine. | Photo Credit: Amanda Perobelli/Reuters

What China’s Critics Say

China’s critics believe that the country has questionable intentions beyond establishing itself as a frontrunner in vaccine development. These intentions include furthering their own political interests overseas, such as China’s claims in the South China Sea and its Belt-and-Road Initiative. Through vaccine diplomacy, China may gain soft power leverage to push forward with its geopolitical goals.

Indonesia has been against China’s growing presence in the South China Sea. However, since participating in trials and receiving 1.2 million free doses of the Sinovac vaccine, Jakarta is now finding it difficult to openly oppose China on this matter.

“It would be harder for us to make a series of moves in foreign policy or something else that might (damage) the relationship with China,” said Evan Laksmana, a senior researcher at the Jakarta-based Centre for Strategic and International Studies.

Critical news agencies have expressed their dissent on China’s efforts. The Economic Times described China’s vaccine diplomacy as “devious” and focused on gaining “geopolitical clout”. In response to such statements, Chinese state media network Xinhua stated that China would “not turn Covid-19 vaccines into any kind of geopolitical weapon or diplomatic tool”.

The Question Of Efficacy

The efficacy of the Chinese-made vaccines has also been questioned. 

Moderna and Pfizer-BioNTech reported vaccine efficacy levels above 90 per cent and published its research to validate its findings. AstraZeneca did the same while reporting a 70 per cent efficacy.

However, information about the efficacy of Chinese-developed vaccines has not been reported as clearly as that of its Western counterparts, prompting international observers to question the companies’ lack of transparency.  

While Turkey reported promising results of a 91.25 per cent efficacy for the Sinovac vaccine, Brazil had initially reported a 78 per cent efficacy for the same vaccine, followed by a much lower efficacy of 50.4 per cent a few weeks later.

This lower figure is just over the 50 per cent efficacy benchmark set by the WHO. 

Sinovac has been criticised throughout its late-stage trials in Brazil for “incomplete disclosure of study results”, and for generating unrealistic expectations. The company defended its vaccine, stating that it is effective in preventing severe symptoms and that its efficacy could prove higher for the general public.

Butantan biomedical, the Brazilian firm partnered with Sinovac, also attributed the lower efficacy to the inclusion of data from “very mild cases” to generate the results.

This has not softened the blow delivered by Sinovac’s disappointing results. Brazil had long considered a vaccine as its only way out of the pandemic, which has claimed 200,000 lives in the country.

“We need better communicators,” said Gonzalo Vecina Neto, a professor of public health at the University of Sao Paulo.

However, public health experts said that the vaccine will nonetheless be a relief for Brazilian hospitals struggling under the daily caseloads.

“We have a good vaccine. Not the best vaccine in the world. Not the ideal vaccine,” said  Dr Natalia Pasternak Taschner, a microbiologist advising Brazilian health authorities.  

“It’s a vaccine that will start the process of overcoming the pandemic.” 

Sinopharm Biotech announced an efficacy of 86 per cent following late-stage trials in the UAE but also failed to release any data to corroborate its findings. Following this, a Beijing-based developer reported a lower figure of 79 per cent efficacy for the same vaccine.

Sinopharm maintained that both findings were “real and valid” and that the gap was due to differences in Covid-19 diagnosis procedures across different countries. Almost a million inoculations have also been reportedly conducted in China, without causing any major side effects. 

Engineers work in a cell culture room at the Sinovac Biotech facilities in Beijing in April. | Photo Credit: Nicolas Asfouri/AFP

Vaccine Technology 

The frontrunners of Covid-19 vaccines have been developed mainly using the traditional method of vaccine development or using messenger ribonucleic acid (mRNA) technology. 

Traditional vaccines – made from weakened, modified versions of the virus, have been developed and used against many fatal diseases, such as polio and measles. The conventional method of vaccine development is tried and tested. However, using weakened or killed viruses to stimulate immunity may lower a vaccine’s efficacy, such as in the case of the Sinovac vaccine.

It was only 30 years ago when scientists began exploring mRNA technology. Vaccines are manufactured from ribonucleic molecules carrying a virus’ genetic code. The body, upon translating the code, is able to produce viral particles which subsequently stimulate a strong immune response. 

The remarkability of mRNA technology lies with its potential for new vaccines to be produced in record time. 

mRNA technology allows developers to standardise and upscale vaccine production. Upon identifying the genetic sequence of a virus, researchers may only need to modify the vaccine to include the specific sequencing, before large amounts of mRNA molecules may be synthesised in a short time.  

This cuts down the time researchers need to oversee the purification, cultivation and modification of the original virus under the traditional method. 

The four main types of Covid-19 vaccines in development. | Photo Credit: CNN Reporting/Will Mullery, CNN

The Problem of Cold Storage 

However, while mRNA vaccines set a precedent in modern vaccine development, they require specialised storage under extremely low temperatures. 

The Moderna and Pfizer vaccines employ the mRNA technology and require storage at -20 and -70 degrees Celsius respectively. The AstraZeneca and Chinese-made traditional vaccines may be stored between two and eight degrees Celsius. 

In this aspect, China has a considerable advantage in being a global supplier of vaccines. 

Since traditional vaccines do not require the same level of intense cold storage, they are easier to transport and store. This allows Chinese vaccine makers to provide the vaccine to a wide range of countries with fewer logistical woes.

A worker passes a line of freezers holding Pfizer vaccines at a facility in Puurs, Belgium. | Photo Credit: Reuters

Are Countries Justified In Being Wary Of Chinese-Made Vaccines?

Overall, countries may have reasons to be wary of China’s vaccine diplomacy on a political and scientific basis. They may be justified in their expectation that dealings with China would come with strings attached if China exerts its soft power in the future. Furthermore, with other vaccines being developed internationally, a wealthy country may easily opt to buy a more “trustworthy” vaccine. 

However, China’s allies have expressed strong support for the Chinese vaccine developments. The Association of Southeast Asian Nations (ASEAN) members have reportedly refuted a claim that ASEAN was stepping away from Chinese vaccines, cementing their acclaim for China’s efforts.

Such positive sentiments highlight an important fact: many countries have much to gain from accepting China’s aid.

Why Developing Countries May Need To Rely On China

Developing countries have arguably the most to benefit from an accessible vaccine that is as affordable as it is effective.

The Moderna and Pfizer vaccines may be expected to be priced between US$10 to US$50 (S$13.30 to S$66.40) and US$15 to US$20 (S$19.90 to S$26.60) per dose respectively, while AstraZeneca may cost between US$2 to US$4 (S$2.65 to S$5.30) per dose.

Sinovac vaccines may be priced between US$10 and US$60 (S$13.30 to S$79.70) depending on the destination country, while Sinopharm quoted a price of US$145 (S$192.60).

These steep prices may be reduced through vaccine diplomacy initiatives or borne by the government in various public health schemes. 

Ultimately, however, Western-developed vaccines may be relatively costly for lower-income countries due to transport and cold storage. The “cold-chain” requires countries to invest in specialist equipment, such as freezer trucks to transport vaccines from airports to healthcare facilities, and specialised freezers to store the vaccine once delivered. 

Not only may the costs be astronomical, but countries with unstable power supplies and poorly-connected rural areas may struggle with keeping the vaccine viable from start to finish. 

Aware of these hurdles, China has offered its vaccines as a more accessible alternative to developing countries through its vaccine diplomacy initiatives. It has actively engaged them to participate in trials, in exchange for free doses and raw materials for domestic production. China has also assured that its efforts will be a “contribution to ensuring vaccine accessibility and affordability in developing countries”, and has collated a list of developing nations that will receive “priority access” to its vaccine. 

Although recent trial results of Chinese-made vaccines have not proved as promising as that of Moderna and Pfizer, developing countries such as Brazil may have no other alternative. 

“Brazil is not in a place where it can compete with very rich countries to buy vaccines like the ones by Pfizer and Moderna,” said Dr Pasternak, “and then to have the capacity to transport them, implement them and maintain them in the required low temperatures — we can’t do it as a developing country.”

President Xi Jinping also reportedly pledged to set aside US$2 billion (S$2.64 billion) for African countries, while also offering Latin American and Caribbean countries a US$1 billion (S$1.32 billion) loan to buy vaccines, although the terms of such loans are unclear. 

These efforts, if they come to fruition, may considerably reduce the financial strain of securing vaccines on lower-income countries, giving them much to gain from accepting China’s vaccines. 

Without vaccine diplomacy, poorer nations would have difficulty vaccinating a significant percentage of their populations due to vaccine hoarding. The BBC reported that although rich nations represented just 14 per cent of the world’s population, they have bought up more than half of the most promising vaccines, decreasing the supply available for developing countries. 

The luxury to be discerning China’s political agenda may be rendered unaffordable for developing nations facing these challenges.  

Chinese-made vaccines being loaded onto an Ethiopian Airlines aircraft for transport overseas. | Photo Credit: CNN

Setting Politics Aside

While criticism of China’s vaccine diplomacy gives wealthier countries reason to remain wary of the Chinese-made vaccines, the benefits for developing countries may outweigh its costs. Acknowledging the importance of an accessible vaccine offers a more positive perspective of China’s vaccine diplomacy. 

“We should focus more on effectively dealing with the issue (Covid-19 pandemic) than on the public relations countries place around those efforts,” said Dr Jason Young, a researcher at Victoria University and director of the New Zealand Contemporary China Research Centre.

In a world struggling to find a way out of a global health crisis, political differences may need to take a backseat if countries are to succeed in eliminating the pandemic on a global scale. Every country’s efforts towards mass-producing a Covid-19 vaccine is valuable and necessary.The Chinese, Russian and Western vaccines may just be the light at the end of the tunnel, and the beginning of a long road to recovery.

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