Power Play

A booster shot for US vaccine diplomacy

America and fellow G-7 countries are ramping up supplies, catching up with China in providing vaccines to poorer countries after a slow start.

At the Group of Seven summit, US President Joe Biden announced he would buy another 500 million Pfizer-BioNTech doses and donate them to poorer countries.PHOTO: AFP

Power Play is a weekly column that looks at various facets of US-China rivalry and its implications for Asia.

The first half of 2021 was the golden time for China to practise its vaccine diplomacy, as senior fellow for global health at the Council on Foreign Relations Huang Yanzhong put it.

The United States and other major Western democracies were absent from the scene, preoccupied with vaccinating their own people against Covid-19 first and with few doses to spare for other nations. The stock of Russian and Indian vaccines remained limited.

But China, which by then had largely tamed the coronavirus outbreak within its own borders and ramped up vaccine production, could supply much-needed doses to countries otherwise unable to get any - and in doing so established itself as the only game in town.

Chinese donations - led by state-owned Sinopharm - have prioritised participants of China's Belt and Road Initiative, with Cambodia and the Philippines getting particularly large donations, the Economist Intelligence Unit said in a report.

The Chinese Foreign Ministry has not released a full breakdown of where its doses are going, but said last week that it has provided more than 350 million doses so far to the international community. Foreign Minister Wang Yi said that 100 million doses have already been delivered to South-east Asia.

But China's golden window is now closing, as the US increasingly has more vaccines than it needs at home.

Before last week, the US pledged to send 80 million surplus doses abroad by the end of this month, out of which 20 million will be a mix of the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines that it has approved for use. The remaining 60 million will be AstraZeneca vaccines, which the US has not authorised for use in America and will send after they clear a federal safety review.

At the Group of Seven (G-7) summit, US President Joe Biden announced he would buy another 500 million Pfizer-BioNTech doses and donate them to poorer countries, with delivery scheduled to start in August and be completed in the first half of next year.

In coordination with America, the other G-7 countries followed up with their own pledges to donate a combined one billion doses.

America's vaccine pledges make clear that China now faces a formidable competitor.

"One of the important objectives of Biden's foreign policy is to claim back America's global leadership. And a relatively easy way, a low-hanging fruit, is to send vaccines overseas. The US has the ability now. It now also has the political will," Dr Huang told The Straits Times.

Said University of Minnesota Duluth's College of Liberal Arts dean Jeremy Youde: "The Biden administration came into office wanting the US to re-engage with, and take a more active role with, global health, and these announcements are part of that strategy."

For China, its vaccine pledges have helped it to portray itself as a reliable friend of lower- and middle-income countries in their time of need, in contrast to America and other Western powers.

At a China-Indonesia high-level dialogue on June 5, Mr Wang was quoted as saying by China's Foreign Ministry: "A handful of developed countries have hoarded vaccines, leaving developing countries struggling with insufficient vaccines."


ST ILLUSTRATION: MANNY FRANCISCO

For America, its newly charged vaccine diplomacy is a chance for it to repair the damage to its reputation and show how democracies can deliver, while casting doubt on Beijing's motives.

Said Mr Biden pointedly last week: "Our vaccine donations don't include pressure for favours or potential concessions. We're doing this to save lives, to end this pandemic. That's it. Period."

Their competition is a win for South-east Asia and the world, with any increase in vaccine supply potentially saving lives. Nonetheless, analysts say there are several factors in favour of America catching up and even overtaking China, despite its head start.

Opportunities for catching up

There is still scope for the US to catch up in South-east Asia if it acts quickly, said S. Rajaratnam School of International Studies senior analyst Hannah Sworn.

"Governments in the region - especially those like Malaysia which are experiencing devastating second and third waves - are desperate to inoculate their populations quickly and will welcome whatever vaccines that can be provided swiftly, which accounts for China's vaccine distribution success in the region thus far," said Ms Sworn.

South-east Asia still has a relatively low vaccine coverage rate of below 4 per cent, with the exceptions of front runner Singapore and runner-up Cambodia. Given this, the region would welcome stocks of Pfizer-BioNTech and Moderna to boost its inoculation programmes, especially against the new variants, she said.

There are pros and cons to both sets of vaccines. China's are easier to store and transport in countries that do not have the ability to sustain a cold chain, while the Pfizer-BioNTech and Moderna doses that America will be donating are mRNA vaccines with higher efficacy rates, although the Chinese vaccines can still be effective in terms of preventing severe cases.

Given a choice, the US vaccines would appear to have a "market edge", judging by the huge crowd of Filipinos who started queueing as early as 2am last month outside a vaccination site in Manila offering the Pfizer-BioNTech jab, which was previously available only to healthcare front-liners. The unexpected turnout came about despite the availability of Sinovac and AstraZeneca vaccines at many other sites.

"Efficacy rates seem to become an increasingly important concern for countries that intend to achieve herd immunity. They increasingly value these highly effective mRNA vaccines," said Dr Huang in an interview. "The US will become a game changer here."

Fear of strings attached

Geopolitics also favours America catching up.

"Governments in the region will likely welcome the political implications of diversifying their vaccine supplies and avoiding overreliance on Chinese vaccinations, which could be leveraged by Beijing to obtain favourable compromises on its security interests, for example, in the South China Sea," said Ms Sworn.

"While Beijing would never explicitly use vaccine supply for security reasons, this would become yet another elephant in the room alongside the region's economic dependence on China when it comes to the resolution of these sensitive issues," she added.

Beijing is primarily distributing its vaccines directly to recipient countries - out of its hundreds of millions of doses pledged so far, only 10 million are through Covax, the multilateral global procurement scheme which aims to distribute coronavirus vaccines equitably around the world.

In comparison, all but 20 million of America's 580 million doses pledged so far will go through Covax.

While getting doses from China will likely involve less red tape and be faster, its recipients may also be more vulnerable to diplomatic pressure.

America is also donating rather than selling its vaccines, unlike China. According to Bridge Consulting's China Covid-19 Vaccine Tracker, China has sold 742 million doses and donated 22 million.

Countries will have to consider these differences between the Chinese and American approaches to vaccine diplomacy and make their decisions based on their needs, said Dr Huang.

In practice, most countries are choosing both - so the success of the US' and China's vaccine diplomacy will likely come down to who can actually deliver the vaccine doses.

Here, domestic vaccination - the factor that held America back in the beginning - will hamper China in the near future, said Dr Huang.

With China prioritising its domestic vaccination needs - likely until the end of this year - it will not be able to release significant amounts of vaccines to compete with the US, he said.

America will also be producing its donated doses at home, said Mr Biden. This will help it avoid the production slowdown that befell Covax earlier this year. Covax had relied on India to produce doses for other countries, but the plans were derailed when India diverted the supplies for its own people amid its Covid-19 surge.

That said, unexpected production mishaps - like that behind the 60 million Johnson & Johnson vaccines that federal regulators have said had to be discarded due to possible contamination - might well slow down America's own donations.

Going beyond handouts

Arguably, what many countries in South-east Asia and beyond truly want is not just more doses for themselves, but the ability to manufacture vaccines on their own. Doing so would ease their reliance on the largesse of superpowers, and their vulnerability to the vagaries of trade.

Vietnam and Thailand have developed home-grown vaccine candidates undergoing clinical trials, while Vietnam is also seeking the technology to produce mRNA vaccines on its own soil.

Indonesia is partnering China to host a regional vaccine production centre, while Pfizer's partner BioNTech will build a facility to make Covid-19 vaccines in Singapore by 2023.

"Charitable donations of spare vaccines are nice. But countries demand the right and urgently need the know-how to make their own vaccines. Handouts aren't enough," said Georgetown University global health law professor Lawrence Gostin on Twitter, calling for intellectual property waivers and technology transfers to empower low- and middle-income countries.

Said Dr Youde: "How the geopolitical narrative plays out will go beyond vaccines, though; it will also depend on efforts to change intellectual property rights for vaccines, reforms to the global health system, and continued funding in the future."

Both superpowers have backed waiving intellectual property protections of Covid-19 vaccines - but just waiving patents will not be enough to boost vaccine manufacturing and supply both globally and in South-east Asia, said Ms Sworn.

There are the added challenges of securing scarce raw materials and the technological capabilities required to manufacture complex mRNA vaccines, she said.

"Currently, South-east Asia's domestic drug companies produce mostly generic drugs that are not particularly difficult to manufacture, although there have been recent efforts by governments to encourage the innovation and production of more complex medicines. This highlights the need for technology transfer to take place alongside patent access," she said.

Whether the US - which is facing strong lobbying from its drug companies - will encourage technology transfers to overseas manufacturers remains to be seen, she added.

Dr Youde said it is unlikely that Washington would do so, although it might change its mind if China were to take more active steps in promoting these long-term changes. "Overall, though, I'm sceptical that the US, China or European states will actively try to make wholesale changes to these systems - though I would love to be proven wrong on that, because changing these systems could make the global community better prepared to respond to the next pandemic," he said.

While America and China's vaccine deliveries are appreciated, and their competition to supply vaccines a helpful impetus, it is taking steps to help more countries manufacture vaccines of their own that would truly be a game changer for South-east Asia and the world.