COVID-19 vaccination campaigns have started in earnest in 2021. However, rollouts are having divergent impacts on diplomatic relations between states with some countries prioritising domestic vaccine rollouts and others sending a large number of doses overseas. 

Vaccine nationalism

Israel, the UAE, the UK, the US and Bahrain are leading the pack in doses administered per capita. Successful rollouts may bolster or restore domestic confidence in these governments, some of whose reputations have been battered by accusations of pandemic mismanagement. On the international stage, the reaction could be very different. 

Citing a “me first” approach to vaccine distribution, the head of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus on 18 January said that the world was “on the brink of a catastrophic moral failure”. A minority of wealthy countries – particularly in Europe and North America – have pre-purchased the majority of vaccine doses currently under order. Although other countries are increasing their purchases, many will have to wait until the second or third quarter of 2021 to ramp up much smaller vaccination campaigns. “Vaccine nationalism” has the potential to delay these campaigns further, fragment the global recovery to the pandemic, and even undermine multilateral cooperation on other issues.

India and South Africa in October requested that the World Trade Organization (WTO) waive parts of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), arguing that IP rights are inhibiting the scaling up of vaccine production. Opponents – mostly in Europe and the US – have argued that this will not resolve manufacturing and distribution bottlenecks. As more vaccines produced in the US and Europe come online, refusal to waive IP rights will remain a significant area of tension. 

The “me first” approach also has the potential to exacerbate tensions between countries that have purchased large numbers of doses from the same supplier. Following a dispute with one supplier, the European Commission (EC) on 29 January moved to impose export controls on vaccines entering part of the UK (Northern Ireland) via EU member state Ireland. Outrage in Belfast, London and Dublin over the EC’s effective imposition of a hard border between Northern Ireland and the Republic of Ireland – a longstanding area of diplomatic concern – led the EC to swiftly backtrack. The EU now requires vaccine producers to seek permission from member states before supplying doses beyond the bloc in many circumstances, a move that could limit exports to other regions.

The spat also saw European officials question the efficacy of one vaccine in elderly populations, with French President Emmanuel Macron describing it as “quasi-ineffective” in the demographic. The politicisation of particular vaccines as a result of diplomatic disputes has undermined confidence in vaccination among some citizens who are already hesitant to roll up their sleeves.

Vaccine diplomacy

Such squabbles stand in stark contrast to the way in which other states are increasingly leveraging vaccines as a tool of diplomacy. 

China has pledged to make its domestically manufactured vaccines a “global public good” and is promoting them as a tool to strengthen its global image. The country’s foreign ministry on 25 February announced that it is providing aid in the form of COVID-19 vaccines to 53 countries. It is also exporting vaccines on commercial terms, including to some countries that hosted clinical trials in 2020.

Beijing will continue to leverage its vaccine diplomacy to gain geopolitical sway in key regions, including South-East Asia. It will help to entrench China’s relationships in the Gulf, where thanks in part to Chinese vaccines, the UAE and Bahrain are among the world leaders in vaccination per capita.

The country’s vaccine outreach has not been without hiccups. Neither the Chinese government nor developers have released as much clinical trial data as their European and US counterparts. This has raised concerns among some prospective buyers about vaccine efficacy. While data from Turkey suggested that a vaccine produced by China’s Sinovac has an efficacy rate of 91%, Brazil put the figure closer to 50%. A continued lack of transparency could undermine global uptake.

India already manufactures approximately 60% of the world’s vaccines for various diseases and has been described as “the world’s pharmacy”. The Serum Institute of India has signed deals to produce billions of doses of vaccines developed by Western companies. At the UN General Assembly in September 2020, Prime Minister Narendra Modi gave assurances that the country’s vaccine production capacity would be used to “help all humanity”. Throughout the pandemic India has sent medication, COVID-19 testing kits and personal protective equipment (PPE) globally, including to wealthy countries such as the US and Israel.

India has demonstrated its “vaccine friendship” by delivering free doses to its regional neighbours (including Bhutan, Bangladesh, Nepal, Myanmar, Seychelles, Mauritius and the Maldives) within days of starting its own domestic vaccination campaign in mid-January. It has now reportedly exported three times as many doses as it has administered at home. India’s vaccine diplomacy is also being extended to other countries and regions where Beijing has a strong geopolitical footprint with New Delhi readying supplies to Cambodia, Mongolia, and the Caribbean and Pacific Island states.  

Russia is seeking to leverage its Sputnik V vaccine to demonstrate its scientific prowess. The vaccine was granted domestic regulatory approval in August 2020, despite not having completed phase three clinical trials at the time. President Vladimir Putin almost certainly made the somewhat premature announcement to secure a soft power coup. With some 1bn doses on order globally, Moscow will use the deployment of Sputnik V to expand Russia’s influence. Notably, Hungary on 21 January authorised its use, reflecting growing impatience with the speed of the EU’s vaccine rollout – another diplomatic coup for the Kremlin as relations with Brussels deteriorate over other issues.

Western diplomacy

In China and India, COVID-19 infection rates have remained persistently and respectively extremely low and falling for several months. This has alleviated pressure for quick domestic vaccination campaigns and made vaccine grants more feasible. The same cannot be said for the US and Europe where infection rates peaked into the start of the new year and are only falling now. In the coming weeks, Western governments will continue to prioritise national vaccination campaigns over charitable overseas outreach, in the hope that this will ease pressure on healthcare services and allow for some loosening of restrictions.

During this time, they will likely seek to counter the narrative that they are hoarding doses at the expense of the rest of the world. They have already committed large donations to the multilateral COVAX initiative and will also use it as the primary conduit to support low- and middle-income countries. At a virtual summit of the G7 on 19 February, leaders increased their financial commitments to the scheme. This included USD 4bn from the US after the new administration of Joe Biden committed to joining the scheme eschewed by his predecessor – a major boost to COVAX’s prospects and multilateral action on the pandemic. 

Nevertheless, COVAX only delivered its first shots on 23 February and its distribution will take time to ramp up. As wealthy Western countries complete vaccination of their most at-risk populations and key workers, pressure (including from some domestic constituencies) will mount for them to share some of their purchased supplies with other countries. On the eve of the G7 meeting, Macron proposed that members of the group provide up to 5% of their vaccines to poorer countries. At the meeting itself, UK Prime Minister Boris Johnson pledged to donate surplus doses.  

A new strain on relations

However, the arrival of concerning COVID-19 variants may upset current or prospective vaccine diplomacy. Reports have emerged to suggest that some vaccines may be less effective against existing more virulent strains. This increases the likelihood that booster shots will be needed and – in wealthy countries – deployed. Meanwhile, at-risk citizens in low-income countries will still be waiting for their first doses. As the rollout ramps up, concerns about equity and fairness will become an ever-greater fault line in international relations. Those that do not treat vaccines as a “global public good” will face criticism, especially as the virus continues to mutate outside their borders.

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