Vaccine competition may now be the world’s best bet

A few weeks into the crisis, Ricardo Lagos, former president of Chile and a member of the Elders group of international leaders wrote: ‘Hopefully the international institutions will rise to the challenge of responding to this pandemic with the force that it demands, because this crisis will not be overcome by defeating the disease in any one country alone, but by guaranteeing an end to the affliction throughout the world.’

The first reaction of nation states was to protect their own, hoard, close borders – and indulge in nationalist points-scoring.

The more the US and its allies blamed China, both for the outbreak in Wuhan and for what many considered to be a cover-up, and the more China refused to provide the necessary access or information, the more distrustful and disjointed the global response became.

The medical and health community rallied early, creating an initiative designed to distribute vaccines, even as they were still in the early stage of development. The aim of COVAX was to produce and make available two billion vaccines by the end of 2021. ‘No-one is safe until everyone is safe’ became the mantra of collaboration.

Solidarity was not the problem among the organizations – Gavi, the global vaccine alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI) worked with the WHO to get access to the COVID -19 Tools Accelerator, ACT-A, up and running.

COVAX was heralded as the ‘only truly global solution’, but it was a mix of ambition and acknowledgement of the limited commitment of the big powers to collaborate to vaccinate the world. Still, vaccinating ‘the priority fifth’ of the world’s population is better than nothing.

From the start of the pandemic, in the provision of masks or personal protective equipment (PPE), nation states indulged their competitive instincts. Vaccine diplomacy and its alter ego vaccine nationalism followed this trend.

Public relations battles were fought out not just between rivals, but also among supposed allies. The British government juxtaposed its mass purchase of vaccines with the early failures of the European Union (EU) as vindication of Brexit. For its part, the EU’s definition of solidarity was largely confined to the bloc.

China and Russia’s vaccine influence

In poorer regions, the vaccines of choice were Sinopharm and Sinovac of China and Sputnik-V of Russia. Choice is perhaps the wrong term; they were the only ones made available, even though the Chinese brands had not yet been certified for use by the WHO. The Russian one has still not been, although a peer-reviewed paper in the Lancet has demonstrated its efficacy and safety’.

Chinese vaccines were present in, or pledged to, 90 countries. Each shipment carried national flags and were accompanied by photo-opportunities with grateful local dignitaries at the airport of arrival.

By the end of May, China had sold or donated 700 million doses worldwide. Chinese vaccines were present in, or pledged to, 90 countries. Each shipment carried national flags and were accompanied by photo-opportunities with grateful local dignitaries at the airport of arrival. The biggest deals were geographically and politically disparate – from Chile to Egypt, Mexico to the Philippines. Russia was in 80 countries. As Champa Patel, director of Chatham House’s Asia-Pacific programme, notes: ‘Russia and China are not new actors on these continents and are sometimes capitalising on long-established political or economic relationships.’

The key question is why China and Russia were faster. China’s heavily enforced early lockdowns kept numbers at home far lower than elsewhere in the world. In Russia, COVID-19 spread rapidly but much of the public was wary of accepting the home-produced vaccine, leading to one of the lowest take-up rates among industrialized nations. At least that freed up stocks to enable the Kremlin to go on a global charm offensive.

By late May, Latin America had exceeded one million deaths, the highest for any region in the world. The region was long considered to be the United States’ backyard. Frustrated at the lack of vaccines, several leaders took to social media diplomacy to ‘vaccine shame’ their traditional ally.

In March, president of the Dominican Republic Luis Abinader tweeted: ‘President @JoeBiden, less-developed countries and traditional allies of the USA, like Dominican Republic, have approved the AstraZeneca vaccine and we need it urgently’ while Paraguay was struggling to get Chinese vaccines because of its recognition of Taiwan.

Latin America didn’t help itself. ‘The region has failed to coordinate through existing mechanisms or to act as a bloc,’ says Chris Sabatini, senior fellow for Latin America at Chatham House. ‘Combined with the absence of the US, this has enabled others to fill the vacuum and split the region even more deeply.’

Shortly after delivering 400,000 doses to Bolivia, the Kremlin trumpeted access to its resources. ‘We are sure that Russian-Bolivian ties will expand, especially in sectors such as energy, mining and the peaceful use of nuclear technologies,’ Vladimir Putin said after meeting President Luis Arce. Bolivia has the world’s largest supply of lithium – an indispensable component in batteries for mobile phones – but has struggled to attract foreign investment to extract it.

Goodwill was thin on the ground in contract negotiations. The Bureau of Investigative Journalism alleged in February that Pfizer had insisted to several Latin American governments that they put up sovereign assets such as embassy buildings and military bases as collateral against the cost of potential future legal cases.

Impact of vaccine nationalism in Africa

Africa has received two per cent of vaccines administered globally. The crisis was worsened by India’s decision to divert vaccines from the Serum Institute, the world’s largest vaccine manufacturing facility, which had been earmarked for export to deal with the country’s own COVID-19 emergency.

By May 2021, of 36 countries where death rates were rising, all but four were low- or middle-income countries. The cumulative effect has been to eradicate years of development, leading to a further division of wealth between nations and regions.

The African Union has set a goal of 40 per cent of vaccines to be produced on the continent within 20 years. Reforms such as these, vital though they are in the medium-term, will not alleviate the present crisis.

At first glance, the situation suggests a reversion back to the old paradigm of dependency. Yet there is another way of way of looking at Africa’s present predicament.

‘We are playing out the same thing again – but this time the politics are different,’ says Yates. This, he says, is reflected in the leadership of international agencies as three major UN institutions are now run by Africans. World Trade Organization (WTO) Director General Ngozi Okonjo-Iweala is a former Nigerian government minister; UNAIDS’ Executive Director Winnie Byanyima was a Ugandan MP who then ran Oxfam International. The head of the WHO, Tedros, was an Ethiopian minister.

Alex Vines, director of the Africa Programme, notes a series of regional summits with Africa planned for 2022 (several of which had been postponed because of the pandemic), including the EU, China and Turkey. Everyone is piling into Africa – and Africa knows it. ‘The trend is towards multi-polarity,’ he says. 

Discussion of big-power winners and losers may actually be missing the point. This narrative assumes that recipient countries have little or no agency and are unable to disaggregate the various motivations and decide for themselves. Therefore, it may not feel like that now, as populations reel, but developing economies have more agency, more influence, than before.

Patel points to a failure of analysis among Western powers. ‘What will not work is trying to instrumentalize emerging powers for Western capital’s strategic interests. This is as true for China attempting to do as much as for Western capitals.’

In any case, do motives matter that much in a time of crisis, particularly when the other side is absent from the pitch?

At the start of 2021, the immediate tasks for the world were: share more vaccines now, provide more money for that international endeavour, and get serious about tech transfer to allow production to take place in more facilities around the world.

Just how committed is the Biden administration? A number of its initiatives seemed designed more to project systemic rivalry, particularly against China, than to embrace multilateralism. In early May, US Trade Representative Katherine Tai announced that Washington would support a waiver on intellectual property for vaccines. A number of countries, led by India and South Africa, had long been calling for the removal of restrictions on the transfer of patents in pharmaceuticals, something that had been agreed at the WTO in 1995. It had become an emotive issue.

Tedros hailed it move as ‘a monumental moment’. The move delighted civil society groups, but startled allies. A number of biotech-strong countries, including Germany, Switzerland, Canada and Britain opposed the idea. The White House is likely to have assumed that it would not prevail, but the initiative secured two goals: it put pressure on big pharma to do more to free up licensing and transferring technology, and it made America look good.

In the same week, Biden declared: ‘Our nation is going to be the arsenal of vaccines for the rest of the world. I literally have, virtually 40 per cent of the world leaders calling and asking, can we help them. We’re going to try’. He promised that the US would deliver 80 million vaccines, including from AstraZeneca, which had not been approved by his own country’s regulator, the FDA.

By this point, the US had not exported a single vial. A whole year after the establishment of COVAX, a mere 70 million vaccines had been sent through the multilateral facility – a tiny proportion of the not so ambitious two billion target.

To compensate at least in part for the political failures, a number of non-governmental organizations (NGOs) worked hard to find practical solutions to help alleviate the suffering. For its part, Chatham House brought together big pharma, leaders of international organisations and health experts in a global vaccine supply chain and manufacturing summit to look for an agreed set of measures to tackle shortages. The March 2021 summit led directly to the establishment of a COVAX Manufacturing Task Force to address bottlenecks.

Yates, who helped to bring the parties together for that summit, also points to the work of the International Panel for Pandemic Preparedness and Response (IPPPR). In a report commissioned by the WHO and published in mid-May, the group of 13 global statesmen and women, led by former New Zealand prime minister Helen Clark and former president of Liberia Ellen Johnson Sirleaf, sketched out a credible road map across all areas of COVID-19 policy, providing a midway point between radicalism – what should be achieved – and realism – what, given the disappointing circumstances, could be achieved.

The IPPPR called for a UN Pandemic Treaty and an International Pandemic Financing Facility that could mobilise funding of up to $10 billion per year. It also proposed a new global surveillance system, in which the WHO would have explicit authority to publish information about outbreaks without the prior approval of national governments and to dispatch experts to investigate pathogens with guaranteed right of access.

In spite of the exhortations and the clear proposals, the chances of countries coming to any form of meaningful consensus on the pandemic remained elusive. Meeting in Rome, the Global Health Summit of the G20 proposed a watered-down push for waivers and stopped short of committing wealthier states to provide more funds for the WHO. A few weeks later, the World Health Assembly, the WHO’s policy-making body, stepped back even further, delaying even consideration of a convention, agreement ‘or other international instruments on pandemic preparedness and response’ until a special conference in November.

On the eve of each of these forums, elder statesmen and women, health experts and activists urged governments to do more. They cited compelling economic arguments. Fully financing ACT-A for 2021 would cost less than one per cent of what governments have spent on stimulus packages for their own citizens.

The task is enormous and urgent. The number of doses needed to vaccinate 70 per cent of the world’s population is a staggering 11 billion. So far only about 1.7 billion have been produced; far, far fewer have been equitably distributed.

On the eve of the G7, the director of the Africa Centres for Disease Control and Prevention, Dr John Nkengasong, declared: ‘Our worst nightmare has come to reality’. He added: ‘When this pandemic started, we cautioned that if we do not work in a cooperative way and express global solidarity we may run into a moral catastrophe’.

The messaging NGOs have used to persuade governments has become ever more desperate and ever more instrumentalist. ‘Self-interest’ became too tame. ‘Return on investment’ – a curious term for saving lives – started to be used.

One example spoke volumes. French president Emmanuel Macron and European Commission president Ursula von der Leyen toyed with the idea of circumventing COVAX by donating directly – with supplies labelled ‘Team Europe’ alongside colour-coded maps to track the destinations of vaccines from rival producers. In the UK, Boris Johnson was reported to have wanted the AstraZeneca vaccine, developed in conjunction with Oxford University, to be labelled with Union Jacks. Compassion wrapped up in a logo. Why bother with a centralized distribution network when you can earn plaudits for ostentatious generosity?

Considerations such as these formed the backdrop for the G7 summit in mid-June. For the first time since the pandemic started, leaders of the richest nations gathered by a Cornish beach to discuss COVID-19, climate change – and the rise of China. Their deliberations were not helped by a renewed bout of in-fighting between the UK and the EU. Biden used the meeting to frame geopolitics as a contest between democracies and autocrats and called for a Western infrastructure alternative to China’s Belt and Road.

The final decision – to provide fewer than the one billion vaccines that had been trailed beforehand, with no mechanism for delivery and with a vague deadline – was denounced by experts and activists. Gordon Brown, the former British prime minister who had been one of the most active lobbyists for radical action, called it an ‘unforgivable moral failure’.

China and Russia lost no time in denouncing both the tough tone of the G7 communique towards both countries and the weakness of its vaccine response. A few days after the summit, the US said it was sending 80 vials of vaccine to Trinidad and Tobago, a decision that was mocked in the Chinese media. ‘Would this be selected for the Worst Public Relations Award of the Year?’ the official Xinhua news agency asked in a carefully coordinated set of social media posts.

Because of the length and breadth of the G7 closing statement, some useful decisions received less prominence than they otherwise might have done, such as the agreement to establish a Global Health Board that could improve the early-warning system for future pandemics. Few would disagree however with an assessment that the G7 had fallen woefully short, suggesting that this gathering of nations which now constitutes less than half the world’s GDP is losing ever more influence.

The economist and long-time adviser to the UN, Jeffrey Sachs, was scathing in his assessment. Describing gatherings such as the one in Cornwall as an anachronism, Sachs argued: ‘The G7 is particularly irrelevant because its leaders don’t deliver on their promises. They like making symbolic statements, not solving problems. Worse, they give the appearance of solving global problems, while really leaving them to fester. This year’s summit was no different.’

Will the G20 meeting in Rome at the end of October, with its wider representation, do any better? More nations and more political systems will be represented. That is an opportunity to do business face-to-face. It is also opportunity for more grandstanding between systemic rivals.

Even at the height of Cold War tensions, the US and Russia were part of a global coalition to eradicate smallpox. Yet with COVID-19, big-power collaboration has been virtually non-existent, with little prospect for improvement.

Biden’s instruction to his intelligence to ‘redouble’ their efforts and identify a ‘definitive conclusion’ within 90 days on how the virus was first transmitted in humans has enraged the Chinese government.

In February, when urging rich nations to agree a target of sending five per cent of vaccines to poorer ones – something they are as far away as ever from achieving – Macron said: ‘It is an unprecedented acceleration of global inequality and it is politically unsustainable too because it’s paving the way for a war of influence over vaccines. You can see the Chinese strategy, and the Russian strategy too’. In other words, competition should be the key driver.

The question now is: have the US and its allies left it too late? The poorest countries hit hardest in the last few months may well remember the fact that America was planning to inoculate its children while the elderly and frail and key workers in Africa and Latin America were dying.

Those countries who were helped out at their time of most need may retain a residual sense of affinity, perhaps obligation, towards China and Russia. Chatham House’s Yu Jie quotes a Chinese proverb: ‘You always offer the burning coals at times of heaviest snow’.

Perhaps with this in mind, American officials insist that they are not trying to pressurise countries to make a zero-sum choice, on health or broader partnerships. As Blinken told a NATO meeting in March: ‘The United States won’t force allies into an ‘us-or-them’ choice with China’.

Donating vaccines as an opportunity

Several Chatham House experts argue that if the US and its allies act quickly and deftly, they may be able to repair some of the damage. ‘Helping developing countries to vaccinate their populations represents a tremendous opportunity for the West to make up lost ground,’ Yates argues. ‘Not only will this potentially win over wavering non-aligned nations; it will accelerate the end of the pandemic and bring disproportionate benefits to their own economies as the world economy recovers.’

Vines says of Africa: ‘There is plenty of room left for the Americans to re-engage and be involved. This is also where the EU has a role.’ He adds: ‘African countries like choice.’

Perhaps developing countries can make a virtue of this unrelenting soft-power rivalry. Imagine a situation in which production increases and the competing powers vie to entice recipient countries. They would compete against each on the efficacy and reliability of vaccines, on cost and terms – and on geo-strategic allegiances. 

‘Is it the end of the world if America, China and the others compete to ensure vaccinations?’ asks Chatham House chair Jim O’Neill, who has been on a number of inter-governmental preparatory groups for the G7 and G20.

This is not as it should be. In a perfect world, multilateral and cooperation would be the guiding principles. And where such collaboration exists, it should be promoted and pursued. But this crisis has shown the world at its most imperfect. If rivalry has to prevail, it can be turned around to the advantage of those who most need assistance.

This is the first in a series of three reports on cooperation in an era of rivalry, drawing on expert analysis and recommendations from Chatham House. 

The next report will look at systemic rivalry and the climate emergency.