from Rome, Italy
What is vaccine diplomacy?
When the covid-19 pandemic broke out in 2020, it was clear that a vaccine was necessary to be developed and shared in the whole world. The pandemic has literally changed and affected our way of living, our habits and our daily activities. As the scientists say, vaccines nowadays are safe and effective, and represent a powerful tool to eradicate the virus. The evidence shows that people have better protection against covid-19, if they are fully vaccinated. As a matter of fact, if the herd immunity occurs, the whole community can be protected against the virus: the passage of the infection from person to person in this way becomes more difficult, allowing for more protection and avoiding illness complications.
In this context, vaccines act as powerful instruments used to affect the relations among states and to influence each other. Several countries, in fact, have put in place this new type of diplomacy, trying also to have a role in the geopolitical game. It is also a matter of “nation branding”, enabling to connect more deeply with other countries, developing a favourable self-image at the international level (Lee, 2021). Here is why vaccine diplomacy is considered as a form of exercising soft power, as Nye (2008) defines it as the ability to affect others without using coercion.
The historical perspective:
The origins of cooperation in matters of health can be traced back to the 14th century: in the 1850s, the first International Conference at the European level was held with the aim of preventing infectious diseases, such as cholera, plague and yellow fever. Diplomatic cooperation, over the years, developed also because of the diffusion of unknown problematic diseases: the potential threats caused by bioterrorists, increasingly widespread cases of AIDS/HIV and the avian influence are just some examples (Hotez P., 2014).
Some key elements of the modern health diplomacy are the following (Hotez P., 2014):
- Foreign ministers discuss not only with other their homologues, but especially with experts, scientists and health advisers;
- There is a strong bond between governments and private companies, foundations and intergovernmental organizations;
- Conferences about health issues are often held both in bilateral and multilateral sessions, with summits including various international organizations or agencies (e.g. G8; G20; OIC; BRICS).
Some relevant cases in which health diplomacy occurred during the past years, include the outbreak of SARS in 2003: in this case, China and the USA developed a close health partnership which included a collaboration in the analysis and surveillance of data. Moreover the American health department created an international centre for the epidemics and the infections, sending staff in different regions of the whole world. There were also multilateral cooperation initiatives, especially evident through the presence of WHO (World Health Organization) and their experts (Fazal T., 2020).
The Chinese and Russian vaccine diplomacy nowadays:
In this context, China is one of the most relevant actors, and the Chinese vaccine diplomacy is peculiar: it associates the meaning of “public good” with something that deals with governmental affairs. Its model is based on the concepts of leadership, self-confidence, cultural exchanges and on the image that derives from them. China’s vaccine diplomacy was one of the first dealing with the production and the distribution of Covid-19 vaccines among different countries in the whole world. For instance, China held a press conference in Serbia, one of the countries receiving the Chinese vaccine Sinovac, with the presence of the Chinese Ambassador in Belgrade. Other players, like the European Union and UK, preferred to involve pharmaceutical companies: for example, they had the tasks of deciding quantities and directions of the vaccines (Lee S., T., 2021).
More than 80 countries are currently using Sinovac to fight Covid-19, including countries of the likes of Indonesia, Malaysia, Vietnam, Chile, Brazil, Turkey. Therefore it is clear that China uses these tools as soft power instruments, also with the aim of creating a “Health Silk Road”: the goal is to improve public health in different countries through the Belt and Road (Lancaster et al, 2020).
Moscow has opted for a vaccine diplomacy characterized by the massive use of social media and propaganda. However, Russia’s vaccine diplomacy was not particularly successful among its neighbour countries, as in Romania: on the contrary, Chinese actions have moved forward especially among countries that were traditionally under Russia’s influence, such as for example Georgia and Ukraine. Also, the initial lack of data related to the Russian vaccine Sputnik V, has raised concern and doubts. Moreover, domestically, Russia is striving to vaccinate its own population, having difficulties in ensuring the supply to its international clients (Cenusa D., 2021).
The role of India:
Since the beginning of vaccine production worldwide, India has always been referred to as the “pharmacy” of the world, very well able to develop the necessary supply. The foreign policy carried out by the Prime Minister of India, Mr. Narendra Modi, was influenced by the desire to go beyond the economic interests: he underlined the need for a more humane international order focused on the interests of the whole of humanity. India, with its humanist tradition, has made many efforts for international health cooperation: during the first phases of the pandemic, it supplied medical support and essential medicines towards 150 countries (Misra D., 2021).
India committed to send its vaccines, both through bilateral meetings and international fora, to provide vaccines to countries around the world. Its major partners were Bhutan and other countries of Latin America (Barbados, Dominica, Mexico, El Salvador, Brazil). The geopolitics of vaccines entailed several consequences: it is possible to talk about “competition” between India and China, so that many news reported a clash between “Vaccine Maitri” and “Health Silk Road”. Many countries purchased vaccines from both, and in this way both India and China tried to exercise their power on them (Misra D., 2021).
Covid-19 vaccines inequalities:
Vaccine inequalities are evident in the Covid-19 scenario. Most of the available vaccine doses went to advanced countries, while on the contrary, low-income countries have obtained a small part of them. Some examples include the doses acquired by Canada being 34 times higher than the ones acquired by Sudan. The same goes for the ones purchased by Italy, 13 times those of Uganda, and the ones currently being inoculated in the UK, 12 times those of Kenya. In this sense these inequalities are equal to health inequality. While North America and Europe have already vaccinated the majority of the population, Latin America, Africa and some Middle Eastern countries struggle to receive the doses. Brazil, Peru, Rwanda and Yemen are experiencing difficulties in getting vaccines, not only to protect their citizens from deaths, but also to avoid humanitarian crises. Studies have also found that vaccine diplomacy has its pros and cons: it acts like a powerful instrument of cooperation, with the aim of trying to reach the end of the high rates of mortality caused by the pandemics; at the same time, it appears biased if we consider low-income countries that could not benefit from the doses (Su Z., et al., 2021).
According to the United Nations (2021) vaccine inequalities will have important consequences on the achievement of the Sustainable Development Goals. People will be pushed directly into poverty, exacerbating their already existing difficulties. Research provided by the UN suggests that many wealthy countries have decided to reserve a booster dose for their citizens, rather than prioritizing poor countries. Providing equal access to the health sector and, especially, to vaccines, will be crucial in overcoming the pandemic and in achieving SDG3 “good health and well-being”.
The COVAX project:
International cooperation activated and different initiatives have been set up to provide vaccines to poorer countries: single and regional donations, as well as bilateral partnerships.
The COVAX project is co-led by Gavi (Global Alliance for Vaccines and Immunisation), CEPI (Coalition for Epidemic Preparedness Innovations), WHO (World Health Organisation) and UNICEF. Through these important partnerships, some relevant goals are set:
- Vaccine distribution for at least the 20% of the population;
- Active administration (of vaccines);
- Immediate delivery (of vaccines);
- Focus on local economies
This UN project was born to accelerate and maximize the chances of developing safe Covid-19 vaccines, with a focus on the distribution to poorer countries. Therefore the Facility is funded by wealthy countries, NGOs, public donors and private institutions. This initiative aims at distributing, by the end of 2021, 1.3 billion doses, even though there are many difficulties at the logistical level.
What are the challenges? First of all, it is necessary to remind people who are reluctant to vaccinate because of fear or fake news about the safety of the serums. Secondly, an important challenge is managing the refrigerate storage of the doses: vaccines need to be carried at low temperatures, and this could be a problem especially in countries with hot weather and temperatures. The supply chain also needs to take into consideration the facilities and infrastructure of low-income countries: new know-how and logistic procedures have to be developed. Eventually, “nationalism” of vaccines needs to be shot down, avoiding the “me first” logic of some developed countries.
As Tedros Adhanom Ghebreyesus (General Director of WHO) said, “No one is safe, until everyone is”.
Bibliography (B-M):
BBC news, Covid: what do we know about China’s coronavirus vaccines? Available at https://www.bbc.com/news/world-asia-china-57817591
Cenusa D., China, Russia and covid-19: Vaccine Diplomacy at Different Capacity, 2021, available at https://www.ispionline.it/it/pubblicazione/china-russia-and-covid-19-vaccine-diplomacy-different-capacity-31070
Fazal T., Health Diplomacy in Pandemical Times, in International Organization 74 (S1), Cambridge University Press, 2020.
Hotez P. J., Vaccine Diplomacy: Historical Perspectives and Future Directions, Sara Lustigman, Lindsley F. Kimball Research Institute, New York Blood Center, United States of America, 2014.
Lancaster K., Rubin M., Rapp-Hopper M., Mapping China’s Health Silk Road, 2020, available at https://www.cfr.org/blog/mapping-chinas-health-silk-road
Lee S. T., Vaccine diplomacy: nation branding and China’s COVID-19 soft power play. Place Branding and Public Diplomacy, 2021, 1–15. Advance online publication. https://doi.org/10.1057/s41254-021-00224-4
Mayo Clinic, Herd community and COVID-19 (coronavirus): What you need to know, 2021, available at https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunity-and-coronavirus/art-20486808
Misra D., India’s Vaccine Diplomacy: Able Intenationalism or Abscondence of Responsibility?, 2021, available at http://www.cries.org/wp-content/uploads/2021/09/013-Comentario_Misra.pdf
Bibliography (S-W):
Su, Z.; McDonnell, D.; Li, X.; Bennett, B.; Šegalo, S.; Abbas, J.; Cheshmehzangi, A.; Xiang, Y.-T. COVID-19 Vaccine Donations—Vaccine Empathy or Vaccine Diplomacy? A Narrative Literature Review. Vaccines 2021, 9, 1024.
UNICEF, COVAX: ambizioso maxi-progetto per un’equa distribuzione globale dei vaccini, 9 febbraio 2021, available at https://www.unicef.ch/it/lunicef/attualita/blog/2021-02-09/covax-equa-distribuzione-globale-dei-vaccini
United Nations, UN News – Covid Vaccines: widening inequality and millions vulnerable, 19 september 2021, available at https://news.un.org/en/story/2021/09/1100192
WHO, COVAX, working for global equitable access to COVID-19 vaccines, available at https://www.who.int/initiatives/act-accelerator/covax
Autore dell’articolo*: Alessandra Spadafora, Dottoressa in Relazioni Internazionali presso l’Università LUMSA di Roma.
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