Vaccine diplomacy at a time of extreme rivalries

John Kampfner

Good afternoon, everybody, and welcome to this Chatham House event, Vaccine Diplomacy at a Time of Extreme Rivalries. I’m John Kampfner, Author and Broadcaster and Consultant Fellow here at Chatham House. In a moment, I’ll be introducing our excellent panel and setting out some of the areas for our discussion. First of all, though, just a few housekeeping points. This event is recorded and it is on the record. We’ll be discussing the issues among the panel for about 40 minutes or so, then there will be 20 minutes opportunity for questions, please use the ‘Q&A’ button. If you would rather not pose the question yourself in audio and rather have me pose it for you, then please say so’ when you press the button.

Before we – one other thing, on Twitter, please do tweet your comments, your thoughts on this at Chatham House and the hashtag is CHEvents. Before we get going, I’m delighted to invite Dr Renata Dwan, Deputy Director and Senior Executive Officer at Chatham House to say a few introductory remarks. Renata.

Dr Renata Dwan

Thanks, John, and great to be with you all today. Hello, everyone, and thanks for joining us for our meeting today. I’m really just here to introduce the topic and the approach of this event today, which is that our desire in Chatham House to unpack and perhaps explore some of the complexity around this moment we’re in, in the world today where the need to come together, to work together to solve global challenges has never been as great, and yet the environment for coming together, for states working together, has arguably never been so fraught in as many decades. And we’re seeing this huge challenge facing us at the global pandemic level and all of the questions around collaboration in an era of rivalry are being brought to bear in the question of how we respond, how we engage and how we manage. So, it’s a fascinating discussion today and that’s my bell going, so let me say look forward to this, this is the first of a series and we look forward to you joining us. Thank you very much indeed.

John Kampfner

Thank you very much indeed, Renata. So, to our panel, Professor Michel Kazatchkine is a Senior Fellow at the Global Health Center of the Graduate Institute of International and Development Studies, joining us from Geneva, and Michel is an expert on HIV/AIDS and on other past health crises. Alongside him, we have two of the contributors to this report and senior Chatham House figures, Dr Champa Patel, who is Director of the Asia-Pacific Programme, and Rob Yates, who is Director of the Global Health Programme. So, in this paper, which was published early this morning, which I’ve written – which I hope encompasses the scope of Chatham House expertise, which is wide-ranging in so many different areas. And, as Renata was pointing out, the aim of this is to be cross-cutting, to try to draw together some of the strands, whereas on the more specific areas, individual Chatham House programmes dig deeper into the detail.

As Renata said, this is the first in a series of three, this one focusing on COVID and the wider health ramifications. A second one will be published around the end of September, also focusing on cross-cutting Chatham House expertise, and that will be looking at the threat of the climate emergency with regard – within this era of big power rivalries, and a third one will be published, the final one in this series, at the end of the year, the start of January.

And so to the substance, so the apparent vaccine’s success in the richer nations has led to competitiveness within these countries. It has led to stockpiling and to almost an obsessive sense of who’s at 60%, who’s at 55%, who’s at 75%, whereas, as we all know, developing countries are in absolute low single figures. The suffering is acute, it’s immediate, and it is immense, and in so many ways, I contend, the West, as it used to be known, or the richer nations, have fallen short. They have fallen short, in terms of the multilateral commitment and they are falling short in the – in bilateral commitments and solidarity as well. Into that breach have come China and Russia and other participants, and what are the causes of that, what are the ramifications of that, in geostrategic terms? We’ll also be looking at that as well.

And then, we come to the conclusion of the report, which could be seen by some as controversial, which is actually an exhortation to developing economies to say it isn’t perfect, the world certainly isn’t perfect, and the collaboration has been disappointing, so far, to say the least. So, if we are living in a world of extreme rivalry and competitiveness, then maybe those countries, particularly if and when the supply of vaccines and other medical assistance increases, could play on that competitiveness and turn it to their advantage.

More on that anon, but I want to first ask the three panellists for some introductory thoughts, and first to you, Rob, and in the report you – I quoted you as saying the following very standout sentence and you said this, “This has been a story of extraordinary scientific success and extraordinary political failure.” Could you work from that and explain to us your view of the situation, as we find it?

Robert Yates

Yes, absolutely, John, and thank you very much for inviting me on today’s programme, and, if I’m being strictly honest, I was paraphrasing the UN Secretary-General there, when he said that the Scientists have succeeded and the Politicians are failing. And I think that’s the situation we find ourselves in 2021, that in 2020 the Scientists delivered technologies that would get us out of this crisis, and we have a whole slew of vaccines that have proved to work now, and then the baton was really passed on to our governments and the pharmaceutical industry to deliver these to the world, in an efficient and equitable way, you know, and it is absolutely clear as day that our strategy for coming out of this crisis is primarily around everyone getting vaccinated.

Now, it’s not exclusively, we will still need some other public health measures, but we can see in our own countries that, you know, here in the UK one almost has the impression everything is fine now. You know, all the papers are full about stories about football and going on holidays, and there’s a real, sort of, sense of optimism in the air that, you know, everything is done and dusted now. But if you do delve into the deeper pages of the newspapers, one can see that in countries like Uganda and Indonesia and Bangladesh, it’s a desperate situation at the moment, with 1,000s of people dying, economies shutting down, and a real, sort of, panic amongst populations about what’s happening next.

So, there have been frequent calls, you know, this year for the multilateral system and in particular, the West to step up and be serious about vaccinating the world equitably. And I think, in particular, there were huge expectations put on the G7 Summit that was held here in the UK in September, about, you know, the need to vaccinate the world and some very, very clear asks from the United Nations, the World Bank, IMF, WHO, there were three basic asks: to share vaccines now equitably, you know, to really start this transfer of vaccines to countries that need them most. To put a lot of public financing in to make sure that there are more resources to buy more vaccines and diagnostic tests and strengthen the health systems, and that’s about $50 billion was expected, and also, to speed up tech transfer to countries, so they would have greater ability to do these things. And, frankly, the response of the G7 was utterly pathetic.

There was, you know, some attempts to reallocate about 870 million doses, there was no money for the ACT Accelerator, and practically nothing on tech transfers as well. So, our former Prime Minister calling this an unforgivable moral failure. Jeff Sachs really questioning the whole point of the G7, you know, if at the time of greatest crisis, you know, it can’t really do anything, well, then, what’s the point of it? And I think very much the focus of your research was that, you know, were you a developing country, perhaps they give up on the West helping out and then starts to look around a bit to people who are going to help out and maybe even, sort of, attempts within developing countries to band together and not be so dependent on the West or even other superpowers. So, I think that’s the, you know, the situation we find ourselves in at the moment, that the West has failed spectacularly and what happens next?

John Kampfner

Which perfectly brings us to – really to the core of the discussion. Champa, I’ll also quote at you something that you said for the report, and it was this, “There has been a huge shift in power. The West has not quite learnt how to influence the Global South in these new times. It’s relying on its old toolbox of persuasion through aid, for example, or diplomatic pressure or coercion, and that will not work.” Can you set out, from maybe the perspective of the Asia-Pacific region, your interpretation of the failures of multilateralism so far?

Dr Champa Patel

I think, for many countries, not just in Asia-Pacific, more broadly, if you look at emerging economies, I think there’s a mixture of incomprehension, some surprise and dismay at the slow pace in which Western countries responded to COVID, which has then conditioned how they then see Western engagement now, through the lens of vaccine diplomacy. So, I think, you know, if you look in Western capitals, a lot of the debate focused on, you know, the impact of lockdowns, economic impacts, impact on civil liberties and individual freedoms. But this really masked a lot of failures that were happening in Western countries around testing, tracing, and quarantine, they were much more notable. Whereas what you saw in Asia-Pacific similarly, you know, what some people have called the ‘gold standard response’ in some of the countries in East Asia and the Pacific is a really swift move to take action, stringent measures, a more, sort of, public health approach that was not really about individual freedoms, so much as the – preserving the kind of benefits to as many people as possible. So, I think there’s lots of reasons that people have talked about why that might have happened.

I think what we’ve seen is a – not a hostility or a suspicion. I think emerging economies in the Asia-Pacific still want to engage with Western actors, still want to engage through the multilateral system, but some hesitancy around the level of commitments made, you know, the lack of binding commitments, lack of clarity on timescales. So what they’re looking at is how can we engage with a mix of partners and not be reliant on one set of stakeholders. So, I think what you’ve certainly seen across the Asia-Pacific is the level of need is just not going to be met by Western capitals alone. So, in that instance, they’re not going to wait for somebody to offer help, what they’re going to do is take it from whoever is offering it. So, whether it’s Chinese vaccines, whether it’s the Russian initiatives, they’re going to look at a wide range of stakeholders and think about how can we engage with all of these, in order to ensure our populations are protected? So, I think what you’re seeing is, you know, that old multilateral system, Western-dominated, Western-led has just been really slow to move off the starting blocks. So now, they’re playing catch-up with other actors who have moved a lot more swiftly, and are offering credible alternatives. So, I think in that sense, the West has a long way to go to not just only catch up, but to really impress on emerging economies why they should be a partner of choice.

John Kampfner

And, Champa, just to follow-up on that, is that a process that has been accelerated by COVID, would it have happened anyway, or has it been caused by COVID?

Dr Champa Patel

I think it’s a process that was in motion anyway, and I think, you know, we talk a lot about vaccine diplomacy, vaccine nationalism. But if you look at an actor like China and how it’s engaging with emerging economies in the region and more broadly, it’s not just about vaccines. It’s the level of health co-operation that they initiate in sending experts overseas, investment in health systems, you know, negotiating with states for them to be manufacturing and distribution hubs, so that element of tech transfer as well. So, I think to look at it through this lens of just vaccine diplomacy, really misses the sophisticated way in which China is engaging with lots of countries. So, when Western capitals come along and say, “Well, we’re going to deliver X number of doses, but we can’t tell you when and how,” and it’s nowhere near the level that’s needed, you know, emerging economies are looking at an actor like China that’s offering a lot more to them than somebody like – than through the multilateral system or individual Western donors. So, I think, in that sense, it has to be seen in the round of smaller nations, emerging economies, thinking what can we get out of this that meets our needs, and not just on vaccines but more broadly, in terms of health systems?

John Kampfner

Michel, coming to you, I’d like to quote to you something that I used for the piece, it was from Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention, and he said this, “Our worst nightmare has come to reality. When this pandemic started, we cautioned that if we do not work in a co-operative way, and express global solidarity, we may run into a moral catastrophe.” And he said this before the G7, which, as Rob says, was characterised by failure or certainly a great weakness.

Now, we’ll have a lot of opportunity to talk about the future, but I was just wondering for a moment if you could reflect a little bit on the past and on previous health crises, HIV/AIDS and whatever, we’ve had the Cold War for a very long period, we only had a very short period perhaps in the early to mid-90s into the early noughties of comparative global solidarity and the big powers working well with each other. How did it work in previous health crises and is the failure to collaborate now anything new [pause]? You’ll need to…

Professor Michel Kazatchkine

Thank you, John, and thank you for the invitation to this panel. You know, I’ve known John Nkengasong for years actually, from the times of when we were working together in Cote d’Ivoire in the late 90s on HIV/AIDS, and I fully support, you know, his statement here. I’d like to look at two different perspectives. One is that of international scientific collaboration and there, I think, we’ve done better than in the past. And the other is the international, sort of, institutional system response and then, of course, we’ve failed.

With regard to scientific collaboration, I’d like to say that the Chinese consortium published the genomic sequence of the new virus in Gene Bank, which is a public bank of data, on January 5 2020. And the sequencing of the genome and then the dissemination of the data obviously enabled the development of assays to diagnose COVID-19 and triggered vaccine research and research on monoclonal antibodies and so on, and that is different in the past.

Remember in 2005, Indonesia withholding H5N1 sequence, fearing that if it provides the sequence to the world, that would lead to a vaccine made by, let’s say, Americans and then the United States selling it or firms saying – selling it at prices that would be unaffordable to the developing world. Another, I think, striking example of a remarkable and unprecedented open science collaboration is the amount of papers, it’s 100,000 scientific reports in a year, and this new way of disseminating rapidly science, with unrefereed pre-prints, that has pluses and minuses, I’m not going into that. But I really find, from a scientific perspective, scientific international collaboration as very different and much better than in the past.

In contrast, of course, as others have said, the international institutional system has failed. The system to respond to early warnings and the independent – the so-called Independent Panel for Pandemic Preparedness and Response, IPPPR, of which I was a member, concluded that the alert system didn’t operate with sufficient speed, that the legally-binding International Health Regulations are more constraining rather than facilitating rapid action, and that the precaution, the reprints have always not applied when the PHEIC, the Public Health Emergency of International Concern, declaration by the WHO DG was then declared too late.

Not only was it declared maybe, let’s say, a week or ten days too late, but the main fact is that it was not followed by any forceful and immediate emergency responses in most countries, despite the evidence. Only a minority of countries set in motion co-ordinative measures, but most countries – for most countries, February 2020 was a lost month. So, a failure in the system. Then, of course, a failure in the international political community.

The Security Council, remember, met in March 2020 and failed to adopt the Resolution, China being reluctant for the Council to get involved, saying it was not within its mandate, while the US were insisting that any Council action would – should refer to the origins of the virus, as the Chinese virus. And this is in sharp contrast with what happened in HIV/AIDS when the world came for the first time together with a Security Council Resolution and UN General Assembly Special Session 2001, a Session that is now occurring every five years to monitor international progress on – in the fight against HIV, and then the Ebola Resolution that was unanimously adopted in December 2014 to respond to the Ebola crisis and calling to – countries of the world to refrain from isolating the affected countries.

Another feature of the failure of the institutional system, to me, is the failure of the Executive Board of the World Health Assembly, which is basically the governing board of the World Health Assembly, to meet until October 2020. Can you imagine any company, you know, about – in a major crisis, not calling on its Board until – for six months?

Then, of course, there were the delays and failures in delivery of funding by the international funding institutions, World Bank, International Monetary Fund, and then, there is the vaccine crisis that you’re – that we’re discussing today, the stark contrast between what’s happening in the rich countries and the developing countries. And these inequalities, I agree with what has been said so far, are fuelled by a combination of the current saturation of the manufacturing capacity, we’ll come back to that possibly, except maybe in China, vaccine nationalism, which you mentioned, by wealthy governments securing 4.3 billion doses of vaccines for a population of 1.16 billion people. And then, a COVAX system that is not an inclusive system, that is not a global system, and the fact that our international current system lacks what we call in, you know, in our report of the panel, an end-to-end international system with R&D, clinical trials, manufacturing processes, guided by the goal and strategy for equitable and effective access. Whereas at this time, in the current model, corporations develop, with a lot of public funding, a product, then they sell these proprietary products to wealthy country markets and they leave the rest of the world dependant on the goodwill of donors, of development assistance, charity, to eventually gain access to those life-saving health technologies. That model cannot continue.

John Kampfner

So, that’s an extraordinarily detailed and captivating and depressing catalogue of multilateral failure, and before opening it out among ourselves, just to audience participants, please do start thinking about your questions because we’ll come to you in ten or 15 minutes’ time, as I say use the ‘Q&A’ button and we’ll go through them as we go along. So, Rob, to Michel’s excellent introductory remarks, I mean, call me a sceptic, call me a cynic, but if you look at the state of the world and you look at the rhetoric that has been deployed between the major powers, maybe it was naïve of all of us to think that, both in the general terms, the world would come together on this, rather than trying to score points. But also on the specifics of COVAX, it was only ever designed to address 20% of need and has fallen to a fraction of that. But it goes against the whole tenet of current nations, state, sort of, bragging geopolitics of the moment, if you’re just going to give either finance or medicines through a multinational vehicle, there’s no reward for it. There’s no so-called soft power reward for it, that’s why you had the Brits trying to get the Union Flag on original packets of AstraZeneca, that’s why you had the European Union trying to get Team Europe on crates and that sort of thing, were we all just a little bit naïve?

Robert Yates

No, I don’t think so. I think, in many respects, we were all, sort of – the whole world has been spectacularly unlucky, and to be a bit controversial here, to have the group of leaders that we had at the time the crisis broke. I mean, don’t forget just how damaging it was, you know, having President Trump, almost going out of his way to undermine anything multilateral, you know, in 2020, including the World Health Organization. And I think as well, you know, there’s just been this vacuum of leadership, you know, but I don’t think it has to go back that far into history and think of other leaders that would have stepped up, and I think wouldn’t have wanted to plaster flags on everything.

You know, I would say going back to the Gleneagles Agreement of 2005, you know, that, you know, we had leaders there I think were genuinely serious about, you know, ending poverty, reducing inequalities and were much more focused on global development issues. I think in the batch that we had in 2020, you know, and particularly the fights that the UK was having with Europe over Brexit, which, again, overshadowed the G7, you know, when they should have been concentrating on that, there was still a lot of attention being paid to point scoring between the UK and Europe, that we’ve had a collection of leaders that have let the world down. So, I don’t think we were naïve, I think we were expecting better from what we’ve seen before, and it’s not too late for those leaders to redeem themselves. So, I’m not – I don’t think we should give up on multilateralism and the West, but, you know, that the G7 really does show that, you know, we are still failing and were I a developing country in need I wouldn’t be banking on this lot to solve the problem.

John Kampfner

So, to you, Champa, I mean, given this vacuum, China has been a big player, there’s the shadow over the origin of it, interesting that Joe Biden is playing to that question in a different way, but not that different, a different rhetoric, but not different in substance to Trump, and should we – there’s lots of discussions around why is China doing what it is doing? Why is Russia doing what it’s doing? To what degree is it focused in China’s terms on Belt and Road, and is there a quid pro quo, in terms of voting at the UN and other international fora the Chinese interests in return for, or is it an exchange, in terms of raw materials and that sort of thing? So, a short question to you, do motives matter?

Dr Champa Patel

I really think it depends on whose perspective you’re looking at it from. So, certainly from a geopolitics perspective, these are seen as great existential questions that people have to work through, they want to maintain their own power, they want to maintain their own supremacy in world affairs. I mean, it’s interesting that we talk about the multilateral system like it isn’t a system that was created in a particular historical context, and I agree with Michel, if you look at the system, it really does preserve and defend Western interests. So, in that sense, if you’re an emerging economy or even a new power like China, you don’t have the same power or decision-making within some of these institutions, so it’s not an inclusive multilateral system in the first place.

I think what’s more important is the perspective of those populations that really need the vaccine, and I think there the geopolitics is a distraction because for those populations what they want is access to the vaccine and they want it quick. So I think in that respect all the politicking, all the power playing is basically undermining efforts to be able to vaccinate as many people as possible and ensure as many people are protected. And I think what often happens is, understandably, people want to focus on US, China, Russia, but there are other actors here who are important.

India was an important actor, you know, it also played a very positive role early on, in terms of its vaccine diplomacy. But I think oftentimes it’s seen as, you know, oh, it’s supporting the good cause, but if you’re somebody who needs access to vaccines, you don’t care what’s driving that, you just want the vaccine. So I think even with India, if – it doesn’t matter who the actor is, they all have their own soft power considerations. So, I think it’s important to remember that when people want to question why China is doing this, why Russia is doing this, it’s not really that different to why the EU might be doing it or the US is doing it, or the UK is doing it. It’s all about trying to curry favour, but at the end of the day, what can get affected populations what they need fastest should be what guides us.

John Kampfner

So, given these – and a reminder to audience members, please do pose your questions, we’re looking for you to challenge us, to critique us, if you’ve read the report to give your observations, and just to ask questions of our panel members. So please do put your questions in the ‘Q&A’ box. Michel, given what Champa has just said, is there any room left for allegiances, do – if it is just a scramble to get medicines, to get vaccines in people’s arms, could developing economies necessarily and morally now be neutral as to where they come from?

Professor Michel Kazatchkine

I think it’s both a scramble, but there’s still room for multilateralism, and that multilateralism will have to find its space in a different space from where it has been. I agree with Robert and Champa that the times of the G7 are over. That these were the times when there was a rich North and a poor South and the vertical relationship between the two. These were the times where the world and the G7 generated the Global Fund to fight AIDS, TB and malaria. Nowadays, the two spaces for multilateral discussions will be the G20 and that’s where Russia, China, of course South Africa, Brazil, Indonesia are also, and let’s challenge them on being a new, sort of, G7, of what the G7 has been in the time of HIV. They will be meeting in October and they are expected to the main source of financing for pandemic preparedness and response and, remember, they’ve done reasonably well in the financial crisis with the creation of the Financing Stability Board.

The other space will be the United Nations General Assembly, and I am – I so far feel frustrated that the General Assembly has not yet met into a Special Session, as it had for HIV, as it had for Ebola. I think the – our panel has recommended such a session. There will be a briefing of the General Assembly by the panel in July. Hopefully, there will be a meeting of the UN GA with a pre-negotiated resolution of Heads of State in the Fall.

John Kampfner

So, to any or all of you, what can realistically, as Michel was pointing out with referencing to the G20, what can realistically be expected in specific terms? We are surely just going to see more point scoring and more geostrategic rivalry and rhetoric being played out, or, again with reference to the IPPPR report and other practical, very sensible recommendations that have been made by elders and by so many people, is there room for realistic hope that the G20 can turn some of this multilateral co-operation around, or will be having this same conversation in early November, or end of October, following another disappointing route? Who would like to answer that?

Robert Yates

Yeah, if you like I can maybe, sort of, kick off there. I do still think that the three key asks remain the same. You know, it’s unfortunate that we’ve wasted these, sort of, three or four months, but they are around vaccine sharing money and tech transfers, and on all of those there can be movement. And, you know, maybe being sort of optimistic, and we’ve had this discussion before, John, you know, I am an optimist and, you know, that we are going to be seeing things like, you know, the US and the UK and I think increasingly Europe going into vaccine surplus. And I think, you know, sort of, potentially, you know, sort of, people recognising that, you know, we can donate more vaccines into the international system and that will be a start.

I think Michel’s very much, sort of, focused on financing, you know, this really has to be where, you know, the G20 comes up with the money and that that’s done on an equitable basis, and there have been formula worked out to show that. I think it’s roughly 30 billion from the G7 countries and about another 20 billion from the G20 and the Gulf States, that would do the job and, you know, that would be a step, and then the tech transfers as well. So, I think, on all agendas, the G20 could make progress, but I do agree that, sort of, given the performance of the G7, you know, the track record is not looking too smart, is it?

John Kampfner

Champa, any thoughts on that, before we go to questions?

Dr Champa Patel

I agree with Rob, I think we’re going to get more out of the G20, not least it’s a much wider, more diverse, more representative group of countries, many of which have been impacted also quite severely. I guess the question I have is ,I think with China – I think China will see going into the G20 as a space to make very high level commitments to show that it wants to be a responsible actor in this space, and others then trying to also show that they are being responsible actors. Now, if that means that people want to commit more, that’s great for the money that’s needed, right? I think the issue is, is it going to be like the G7, in terms of, you know, lack of detail on binding commitments or timescales? In that case, we may see a lot of high-blown pronouncements, we’re going to donate X money, but no clarity on when that’s actually going to happen. But I do agree with Rob, I think the G20 is a more credible platform and vehicle through which we will see meaningful contributions made that could help start to shift this around.

John Kampfner

Michel, I’m going to just hold your thought for one second, because, as is often the case in these events, you wait for the questions and then they all start coming in at the same time. So we have quite a few now, so I’m going to open the floor and therefore ask the organisers to unmute. First of all, Ibrahim Yeesa, from Nigeria, and then, apologies for the pronunciation, Didjik Badgpi, and then Anthony Dworkin, and then Kasia Madera. So, first of all, and we might take the questions in groups, so first of all, to you, Ibrahim Yeesa.

Ibrahim Yeesa

Thank you very much. I want to commend those who have already spoken. My first question is, given that the COVAX vaccine for Africa has been arranged, don’t you think the pledge by the United States and perhaps some other countries to commit some vaccines will cause more chaos than having this streamlined agreement that is globally supported? So, that is my first question, and then the second one is, is this not the time for developed countries to organise and do some, kind of, technology transfer, and perhaps support resources to developing countries to help vaccine manufacturing hubs and to avoid chaos and a catastrophe in the future? Thank you.

John Kampfner

So, maybe Michel, I’ll come to you first on throwing everything in with COVAX and the question of tech transfers. Thank you, Ibrahim.

Professor Michel Kazatchkine

Yeah, thank you, and thank you to Ibrahim for the question. Well, I wouldn’t fear unco-ordinated efforts here. First, I’d like to say Africa has been remarkably cohesive and has remarkably come together in this crisis, in terms of vaccines, with structuring its effort, having a special continental taskforce, chaired by President Ramaphosa from South Africa. And since COVAX is not delivering, for a number of reasons that we didn’t have time to discuss so far, one of them being that India at this time cannot deliver on the AstraZeneca vaccine that it was to manufacture for COVAX, I think we don’t have time to lose. We – and then there is the scandal of the four billion doses secured for the rich world when it only needs two billion doses at most. So, the vaccine dose sharing is the absolute emergency and the only way to go at this time.

At the same time, we have to start a process of building and manufacturing hubs in the – sorry, of building manufacturing hubs in Africa and other regions of the world and going for technology transfer, and that requires goodwill agreements and hopefully voluntary licensing. Our panel has said that the issue is not just in the licenses and let’s not jump too fast into, you know, compulsory licensing and IP waivers. I think, to me, the story should start with WTO, WHO coming together with the manufacturers, agreeing on voluntary licensing to the international community and that’s where I expect the funding from the G20 to go in large part, to build manufacturing hubs that could then manufacture the needed vaccines. That will still require 12 months at least, if not 18 or two years, before these hubs can effectively manufacture.

John Kampfner

Thank you. Now, I’ve got a lot of questions, so we’ll rattle through them as much as we can, and [inaudible – 43:09] has asked me to ask this question, “You paint quite a negative picture about the West’s role in vaccine diplomacy, in contrast to China, but do you foresee a potential role reversal as efficacy concerns grow about Chinese vaccines and Western countries step up vaccine exports, as they complete their inoculation programmes at home?” Champa, this one for you?

Dr Champa Patel

I don’t think it’s so much a negative picture in contrast to China, what we’re – I don’t think what we’re saying is that China is more successful. China has been faster in reaching out to other countries, and I think then, you know, when you’re in the position of playing catch-up, it’s a lot harder to kind of impress yourself as the partner of choice when others are far ahead of you, so I don’t think that’s the issue. I think the issue will be is, the commitments sound great, but how quickly are they going to deliver on them? As Michel has noted, the surplus in richer countries that they just don’t need. There’s no need for delay, these could be dispensed now, so what is the issue that’s stopping rapid, kind of, sharing of these vaccines? So, I think it’s looking beyond the headlines of these big, bold announcements to think, well, it could be done now, what are we waiting for? It doesn’t need to take ages, why is there such a lack of clarity on timescales? So, I think it’s more that, that they’ve got a harder job to do in some respects, and if they only look at it through the lens of vaccine sharing, what they’re missing is what China’s doing, which is broad in support – which is supporting broader health systems, as well as sharing expertise that gives it the edge. So, it’s saying to, you know, Western capitals or platforms to think more creatively about how they want to support emerging economies. But let’s not forget the emerging economy is not a passive actor who’s at the, you know, mercy of all of these big players deciding what they want to do, they also have agency. So, for a country like Indonesia, it’s got AstraZeneca, it’s got Moderna and it’s got Sinopharm, so it’s going to, you know, try and play these off to its own advantages as well.

John Kampfner

We’ve got a question coming up on the soft power side of things. A question now from Anthony Dworkin, Anthony, over to you.

Anthony Dworkin

Thanks. I, kind of, have a lot of sympathy with the points that you’ve all made, but at the same time, I wonder if you’re not setting unrealistic expectations of what political leaders, from the wealthy countries, are going to be ready and able to do at a time when their own countries are facing extraordinary national emergencies. I mean, it seems that if they have the possibility, which they do, to hoard doses, would be one way of putting it, but to direct the doses that they can get their hands on first to their domestic populations, it’s not surprising that they’re going to do that. And I think arguably, it would even be politically unsustainable if they were to take a, kind of, global view and allocate everything, 20% globally through COVAX. So, to expect a completely different approach, I think is unrealistic, and perhaps what we should be thinking about is how to take that kind of approach, but to argue with it for the kind of mollifications and here, bringing it on to where we are now and looking forward, I wonder if – I mean, we’ve all quoted these lines about the moral failure of the West, but I wonder if morality is perhaps not the best way of looking at it. And it’s actually for – you know, everyone says it’s – no-one is safe until everyone is safe, better to think about it not as a question of morality and global development, but as a question of health security within the wealthy world and that would lead perhaps to some kind of recalibration of how they’re thinking about it. Thanks.

John Kampfner

Thank you, Anthony, and in the report I used the term “the language is becoming ever more instrumentalist” and the term self-interest in and of itself has become too tame and some people are now talking about return on investment, in other words it’s in our interest to do X or Y, and certainly, you know, the language has become less moral in tone. But, Rob, maybe you will answer Anthony’s questions about are we expecting too much?

Robert Yates

Yes, certainly, and I think that things are going to change and can change, and clearly there has been this political imperative to vaccinate as many people in the UK and countries like this as possible, and, you know, we are getting to the stage now that, you know, the vast majority of adults are covered and I think there is a, sort of – I think the political atmosphere is changing. I think there would be scope now for, sort of, recognising that rather than, you know, starting to vaccinate children and, you know, to provide booster shots for everyone, that, you know, people of my age would be saying, “Well, come on, this is ridiculous, you know, we’re going – we should have three shots and, you know, sort of, health workers in Kenya are dying, you know, this is completely unacceptable.” So, I think there would be scope now and I think that, you know, the British people do believe in solidarity and solidarity in health and, you know, I think that were the case made, and I think you make a very good point about, you know, looking at the self-interest case about how important it is to the world economy and our future development that everyone gets vaccinated, that the argument could be made that we should be thinking more about sharing vaccines, or at least the vaccines that are due to come to us now being put into a common pool and allocated more efficiently. And I think what clearly is completely unacceptable is stockpiling, the fact that we have them sitting in warehouses in the UK, not knowing which ones are going to be most useful, you know, that if new variants come along, and literally we sit on them, whilst these new variants are emerging in other countries. That is absolutely crazy, and I – but we are moving to that stage that we will be stockpiling and I think that, you know, that’s where we ramp up the arguments that that needs to change.

John Kampfner

And next question is from Kasia Madera and known to all of you, I’m sure, as presenter on BBC World and elsewhere on the BBC, and Kasia has bashfully asked me to ask the question for her, but, Kasia, are you there, would you like to ask it, or would you like me to ask it for you?

Kasia Madera

John, I am here actually, and it’s a fantastic discussion and actually, Robert has already touched upon what I’ve asked – what I’m asking, but just to hammer it home, it’s a question that I regularly get asked, when interviewing experts, and so I’m putting it to your guests. Okay, so, don’t stockpile, of course, but when richer countries are then talking about vaccinating their child population, how do they bring the population with them and say, “Okay, wait, don’t inoculate the children, let’s distribute vaccines to those countries that need it,” because that’s really emotive, the US is already there, so how do you bring the public with them?

John Kampfner

So, Michel, that’s maybe a question to you, every leader has their voters and the voters vote on the immediate rather than what’s happening on the other side of the world, and people are thinking not just about the Delta variant, but about the variants that follow, and about the autumn and the cold winter in Europe and elsewhere. And is it realistic to expect governments not to prioritise their own, you know, to paraphrase those questions that Kasia is getting on the BBC?

Professor Michel Kazatchkine

It’s a very difficult question to answer. Obviously, without vaccinating children, we will not reach herd immunity and without vaccinating all of those who are not vaccinated yet we’ll not reach herd immunity. Whether that herd immunity, with the first generation vaccines, will be protective against future variants is still an open question and what is certain is that there is a moral and an economic argument for vaccinating the rest of the world, as people have said. But there is also a medical and scientific argument, which is that partial vaccination, or poor vaccination, in the rest of the world is – will lead inevitably under an inappropriate and weak immune pressure to the generation of variants, potentially variants that will overcome neutralisation by the antibodies generated by current vaccines. So, it is a bit of a race. And my personal view is that the emergency now is in allowing the rest of the world to get the vaccines and that, for now, with our strategies in the high income countries, if not stopping and preventing new infections with new variants, as we see with the Delta variant in the UK now, at least we’re stopping those viruses to be as damaging as they have been last year.

John Kampfner

Actually, I think we’ve got time for a couple more questions. This is a question from Maria Anderson, who has asked me to read it out, “Has the varying effectiveness of vaccines, in terms of their ability to combat the virus led to certain countries seeing their soft power reduced, as the efficacy of Sinovac means the questions around AstraZeneca led to reduced power for China and Britain in those two instances?” You could also make the case, with regard to Sputnik, whether a few Russians are – want themselves to be vaccinated. Whereas Russia is exporting, you could throw in this whole question of efficacy also with sell-by dates, use-by dates, or for vaccines, this whole question of can we trust them? And the read across with all of that, this sort of faux generosity of some countries to give vaccines that they don’t fully trust or that may not be working at their optimal rate. Who would like to answer that? Michel, over to you.

Professor Michel Kazatchkine

Yeah, well, first, let’s be very careful about what’s called efficacy. It’s based on clinical trials, and clinical trials is not necessarily what will happen at the population level. So, let’s wait for the data at population level. We have it for the Pfizer in Israel, we don’t have it yet at largescale elsewhere. Then, let’s be careful about, you know, our judgements. The Chinese vaccine has now been approved by WHO, at least one of them, and my – as far as I know, the Sputnik should be also approved, within the coming two or three months. The issues there are around manufacturing, not around the vaccine itself. So, I personally think that, you know, we have to go to – and we’ll have the cumin vaccines soon and we have already three Indian vaccines.

I am disappointed that the speed at which WHO approves these vaccines is somehow disconnected from the needs and obviously does not prevent, as Champa has been saying, countries that are facing the realities of buying whatever they can buy. But I think we’re not yet in a position where we can have, at population level, a strong judgement about the efficacy of these vaccines. And I would go even for a partially effective vaccine, you know, because what we want is no deaths and no suffering, even if we have some infections.

John Kampfner

So we’ve just got a few minutes left, we’ve got one remaining question, which I’ll read out, because it does overlap with some of the other questions, and I just wanted to pose one of my own briefly to the panellists, as we are at five to the hour. This is from Johannes Guelker in Germany, “Do you also see a domestic influence on decision-making of Western countries? Geopolitics are, for sure a motive, but from a general perspective, the population here would unfortunately have had trouble accepting the helping others before helping us argument,” and which is a really good question, but in some ways we’ve talked about the pressures on Western Politicians up to now.

I suppose I just wanted to throw the conclusion that I give to this report, which is about the agency of developing nations and in this next period of the next six months, particularly if or when the flow of vaccines increases, then we will – we may begin to have a more equitable outcome, albeit with many tens of 100s and millions of people suffering that otherwise might not have done. But I suppose it’s on the geostrategic level, people won’t forget, will they, who was where when they were needed. So, almost it’s ridiculous to ask you, sort of, each in a minute, because these are very complicated questions, your perspective of the effect on allegiance that the vaccination process and the COVID performance will produce, how different if you’re in Niger or if you’re in Peru or if you’re in Cambodia, how will these allegiances have changed? Champa, why don’t you start with that, and, as I say, we would like to finish on the hour, we’ve literally got two minutes, so just very, very briefly each of your thoughts.

Dr Champa Patel

Yeah, what I would say is that, you know, it’s not just about COVID, what we’re seeing happen through COVID are trends that were in motion anyway. So I think what you’ll have is a group of countries who don’t want to be in any camp, and they’ll play off the big players against each other. You’ll have countries that are in one camp, for example, Myanmar, Cambodia and China’s sphere of influence, who will want to look to other partners to counterbalance against Chinese influence. There will be others who will want to join the US because they want to present a collective counterweight to China. So, I think all of these dynamics will be in play, but they’re not because of the pandemic, they were in play anyway, the pandemic has just intensified them. So, I think in that sense what it means for geostrategic alliances, it’s still yet to be seen, but I think people will be a lot more circumspect about who they choose to align with, because I think it will really depend on what happens in this next phase of how quickly we can get vaccines out to emerging economies in those countries in need, and I think then everything is up for play. So, I don’t think there’s any kind of known knowns at the moment other than it really will depend on what happens in this next phase.

John Kampfner

Thank you, admirably brief. Michel, equally just a couple – a few sentences on where – how it will all look and how it will all be.

Professor Michel Kazatchkine

Yeah, two things, one is I agree, and there will be complex dynamics that we cannot yet foresee, and, second, I am hopeful that the crisis will lead to a renewed interest to multilateralism because people will realise the interdependency of national health security, for example, with the health security at international and global level.

John Kampfner

Thank you. Rob, final words to you.

Robert Yates

Well, I think it’s all up for grabs, and I think that it’s all about, sort of, political leadership, which has been lacking so far, and we’ve seen some leaders fall due to the crisis, you know, it’s been the end of the Presidency of President Trump, and, you know, the G7 has dropped the ball again. And I think, you know, the – it’s just an open vacuum at the moment for who steps in and shows great leadership, and I think people like President Ramaphosa is stepping up, people like President Kagame in Rwanda, you know, is making it clear he would like to see Rwanda become a hub for making vaccines for Africa. So, I think for smart political leaders, now is your chance to shine, you know, now is the time for world heroes to step forward and it’s not clear where they’re going to come from.

John Kampfner

What better way to end than on that exaltation for some stronger leadership. So, the report is called Vaccine Diplomacy at a Time of Extreme Rivalries. It’s published on the Chatham House website, if you haven’t had the opportunity yet to read it, it’d be great if you would like to and do share it, it’s open sourced. I would be delighted, personally, to have your comments. You can email me on [email protected], or any of the routes to Chatham House. As I say, this is just the start of a wider discussion about big power rivalries at this time of crisis.

I’d like to thank very much the Chatham House Team, the Comms Team, the Events Team, I’d like to thank Renata for her introductory remarks, I’d like hugely to thank Michel, Champa, and Rob for sparing your time for what I hope you will agree with me was an excellent discussion, I certainly learnt a lot and I’m very grateful to them. And I’d like to thank all of you, the audience, for listening, asking some great questions, and participating. As I say, do keep in touch, do engage with us on these issues, and thank you all very much indeed for attending. Good afternoon.