Dash for the cure and dose diplomacy
The health crisis triggered a frenzied race to develop vaccines to defeat the coronavirus, with pharmaceutical companies from advanced and emerging countries ramping up their medical research and development programs. Prestige, profit and influence provided key motivations. Traditional and novel approaches to vaccine development were pursued. Chinese and Indian vaccine makers, for instance, used tried-and-tested inactivated viruses, while Western manufacturers worked on new scientific interventions such as viral vector, DNA and RNA-based vaccines. Each approach has its own upsides and weaknesses. For instance. inactivated virus-based vaccines are mature platforms and can be rapidly produced, while messenger RNA-based ones are low-cost, can also be swiftly produced but have more stringent cold storage logistical requirements, a major consideration in transporting to less developed countries.
The pandemic also provided an opportunity for some emerging countries to grow their influence by engaging in health diplomacy. Taiwan, South Korea, Vietnam, and China donated masks and personal protective equipment in the early months of the pandemic, with Beijing upping the ante by launching its own vaccine diplomacy, leveraging vaccine donations to enhance China’s global profile. Vaccine developers from China and Russia bankrolled by state resources helped their sovereigns promote their foreign policy agendas, earning the goodwill of recipient countries and buttressing their leadership credentials at a time when many Western countries appear to be busy trying to corner the vaccine market. Governments where Western vaccine makers are based, on the other hand, are hampered. They cannot impose on big established private companies, although they may demand to have the first crack, or place caps on exports until such time that the local market is satisfactorily served.
Emerging countries made their immediate neighborhood priority recipients of their vaccine donations. Beijing donated doses to Mongolia, Nepal, Kyrgyzstan, Pakistan, Afghanistan, Myanmar, Laos, Cambodia, and the Philippines. New Delhi did the same to Nepal, Bhutan, Bangladesh, and Sri Lanka, while Moscow sent vaccines to Uzbekistan, Belarus, and Armenia. The pandemic also provided Beijing a chance to shape its Health Silk Road, extending medical outreach to countries taking part in its massive multi-year connectivity vision. Beyond its Southeast and Central Asian neighbors, it also donated jabs to Sri Lanka, Iran, Iraq, Syria, and Belarus. In Africa, it shared doses to Egypt, Algeria, Tunisia, Guinea, Sierra Leone, Equatorial Guinea, Congo, Namibia, Mozambique and Zimbabwe. It also gave to Bolivia and Guyana in South America. India’s Act East policy saw it making vaccine donations to Myanmar and Cambodia, as well as to Mongolia, Afghanistan, Oman and Zimbabwe. India likewise extended donations to countries in the Western Hemisphere, including Guyana, Suriname, Dominican Republic, Jamaica, Nicaragua, Guatemala, and Belize. Similarly, Russia also donated vaccines to Nicaragua and made pledges to donate to Angola, Zimbabwe and Belize.
Even before the search for a remedy reported any breakthrough, vaccine nationalism was already on the rise. Wealthy countries locked in limited supplies to prioritize inoculating their own people, leaving few doses for less privileged ones. The existential threat posed by the pandemic, domestic pressure, and the gradual erosion of multilateralism in recent years contributed to this brazen competition to hoard scarce vaccine supply. Pre-orders were oversubscribed with some affluent countries buying enough doses to vaccinate their population several times. While such measures may sound good to countries like the United States and Europe who were ravaged by the contagion, it disadvantages many vulnerable countries with weaker public health systems like those in Africa who could not engage in the bidding war.
Furthermore, manufacturers may likely face pressure from their home governments to prioritize domestic supplies before fulfilling export orders. This may affect the delivery timelines for orders coming from abroad. Thus far, developed and emerging economies are already ahead in the vaccine roll-out. But as the success of economic reopening hinges on access to vaccines, governments worldwide are under duress to secure enough doses to achieve herd immunity. The health crisis also gave local drug companies a shot in the arm in terms of state support. While access to the vaccine is urgent, aspiring pharma firms and ambitious leaders will not let the opportunity to make homegrown therapeutics pass. Vietnam, for instance, is developing its own dose.
Moreover, for countries whose current administration faces the prospects of near-term leadership change, the pressure is even greater. In Asia, pandemic response and economic recovery were key voter agendas in legislative elections held in South Korea and Singapore last year, and in the Communist Party of Vietnam Congress in early 2021. The same is expected of the coming presidential elections in the Philippines and South Korea in 2022. The handling of the unprecedented pandemic can shape the legacy of incumbent leadership, and either strengthen or undermine a leader’s ability to endorse a potential successor.
Renewing global health multilateralism
Recognizing the “catastrophic moral failure” that would follow if countries continue to procure vaccines on a to-each-his-own basis, the international community has come around and recommitted to multilateralism.
The creation of COVAX in April 2020 to fast track vaccine development, pool procurement, and ensure equitable distribution is a big step in the right direction. The arrival of the first COVAX shipment to Ghana in West Africa in February signals hope for many poor countries. Inter-governmental efforts were also complemented by welcome steps taken by some manufacturers. AstraZeneca, for instance, pledged to sell their vaccines at-cost to developing countries.
To have both the United States and China on board COVAX was a welcome development. Beijing joined the global initiative last October and Washington followed suit last January under the new Biden administration. COVAX may provide a venue for pandemic cooperation for the two great powers. Their participation in the global drive raises the bar for multilateral partnership in combating Covid-19. Curiously, West Africa was also the scene for U.S.-China cooperation in the fight against Ebola in 2014.
Notwithstanding its noble goal, COVAX is beset by many challenges. It’s unlikely to upend the flurry of pre-order deals reached by developed and emerging countries with vaccine manufacturers. Commercial non-disclosure agreements make it difficult to ascertain actual prices and terms and conditions under which countries corner limited doses. Can calls for transparency trump the confidentiality of such deals? Furthermore, many manufacturers hope to be exempted from liabilities arising from adverse vaccine reactions, which were rolled out under emergency authorization. Indemnification is therefore a sticking point in acquisition negotiations.
Indeed, the pandemic has exposed self-serving tendencies of states and companies, with those tendencies inevitably fueled by domestic pressures, a desire to remake international image, and the lure of profit windfall. Despite this, the global health crisis also renewed commitment to multilateral work in confronting a common scourge.