China’s coronavirus vaccine diplomacy has already begun

“A global public good.”
“A global public good.”
Image: REUTERS/Dado Ruvic/Illustration
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China began the year with its international reputation tarnished after anger that it quelled early reports of a new respiratory virus. It hopes to end it on a better note—by dispatching vaccines to countries who might otherwise have to wait longer for the shots.

Over the weekend, Indonesia received 1.2 million vaccine doses from Chinese pharmaceutical firm Sinovac, prompting a major discussion on social network Weibo, where the topic garnered 120 million views. Headlines from Chinese media outlets highlighted Indonesian president Joko Widodo’s gratitude, and discussions from Chinese internet users took on a patriotic hue, with many saying the shipment confirmed China as a responsible player leading global efforts to fight the pandemic.

“Indonesia should thank us Chinese people, even we are yet to be vaccinated,” said a user on Weibo under the news. Indonesia will receive another 1.8 million Chinese coronavirus vaccines in January, according to Widodo.

Indonesia has been one of the most important testing grounds for Chinese coronavirus vaccines overseas, and the headlines this week illustrate China’s effort to restore its standing via so-called “vaccine diplomacy.” Although China has yet to approve any vaccine for widespread use domestically, Chinese president Xi Jinping said earlier this year that its Covid-19 vaccine program would be made a “global public good” to ensure developing nations can access and afford the medicines.

Beijing hopes its stance will compare favorably against the “America first” vaccine policy of outgoing US president Donald Trump, who is expected to sign an executive order today (Dec. 8) to prioritize US citizens in its vaccine distribution.

China is relatively new to the global vaccine market. If it can produce vital vaccines safely and cheaply, not only for Covid-19 but for other diseases, it would advance public health for millions of people. To get there, it will have to address fears about the safety of its health supply chain—a challenge given the system’s tendency toward opacity—and questions about the business practices of its vaccine developers.

“As with everything else that Beijing promotes as a public good…vaccine development will prioritize the interests of Chinese companies. Nevertheless, Beijing is better positioned than the US to assume global leadership in the march to vaccinate the world,” wrote Jacob Mardell, an analyst with German think tank Mercator Institute for China Studies in a November note.

Mapping China’s coronavirus vaccine aspirations

Early into the pandemic, China made it clear that it wants to be seen as a major force and benefactor in containing the outbreak—not merely as the origin of the pandemic. The country sent medical experts and equipment to countries including Italy and France, and has joined COVAX, an initiative backed by the World Health Organization that aims to ensure fair distribution of the vaccines globally. This is part of China’s endeavor to repair its reputation damaged by Beijing’s alleged cover-up of the Covid-19 outbreak in the early days, say analysts.

The development of effective and safe vaccines, which would allow developing countries to begin restoring their economies, is one of the most important aspects of this effort.

Three major Chinese vaccine makers, including Sinovac, have all conducted late-stage clinical trials of thousands of volunteers overseas, a choice useful for making sure the drug works for different demographics, but also helpful for promoting acceptance and paving the way for selling the drugs  globally. The United Arab Emirates, where the first late-stage trials of state-run Sinopharm’s vaccine candidates took place, became in September the first foreign country to approve the emergency use of the shots. And Indonesia and Brazil, among the biggest of more than a dozen Phase 3 trial locations, are set to become major buyers of the Chinese doses.

According to an initiative tracking vaccine pre-orders at Duke University, Chile has signed up for 60 million doses of Sinovac’s CoronaVac, its biggest order of any of the vaccines in development globally. Indonesia has placed 50 million orders for that vaccine—as well as 60 million doses of one of the vaccines developed by Sinopharm—and Brazil has ordered a similar number of the Sinovac candidate. Turkey said it has ordered 50 million doses and expects the first batch to arrive in coming days.

Meanwhile, most western countries, such as the UK, are purchasing vaccines from non-Chinese pharma firms like Pfizer and Moderna, whose late-stage trials suggest the shots are quite effective. On Tuesday, the US Food and Drug Administration said its analysis of Pfizer trial data showed it conferred protection soon after the first shot. Chinese vaccines have yet to release any data from their final trials, though a top official on China’s vaccine task force signaled an announcement could come in weeks, and the country is gearing up to mass-produce doses. Some countries in which the testing has taken place, such as Brazil, could also release some trial data themselves.

Potential backlash

China’s efforts to build ties abroad sometimes face criticism at home, from citizens who say the country is spending overseas at the expense of its own people. Already, China’s promise to give priority access to the nationals of other countries is drawing discontent among some at home.

“Foreigners first, such is the style of a great country,” said a sarcastic comment voted to the top (link in Chinese) under an article from state-run Global Times.

On Weibo, many also complained about Sinovac’s decision to send the vaccines to a country that has long been hostile toward those of Chinese-origin.

“Why do we want to give the vaccines to Indonesia? Have we forgotten about the pain inflicted by the murdering of Chinese people in the country?” asked a user. In 1998, over 1,000 Indonesian Chinese were killed and thousands saw their shops smashed when riots targeted them during the Asian financial crisis.

Another layer of risk for Beijing’s vaccine diplomacy could, ironically, come if the shots are widely adopted and complaints arise linking it to side effects.

For example, earlier in the year some European governments rejected testing kits and medical masks sourced from China for the products’ failure to meet the authorities’ quality standards. And in November, a Brazilian trial of the Sinovac vaccine was briefly suspended.

“If China faces any of the same problems with its vaccines as it did with its faulty PPE [personal protective equipment], it could suffer serious reputational harm. Even if the vaccines perform well, unscrupulous Chinese individuals and companies might work in countries with poor institutional oversight to undermine the China brand,” wrote Mardell. “Beijing might also find itself exposed to an expectations gap between its rhetoric and what it can actually deliver.”