Why vaccine competition may now be world's best bet
LEFT BEHIND: Health workers bring Covid-19 vaccines to a site in Goma, Democratic Republic of Congo. Africa has received only 2% of the vaccines administered globally - Credit: Getty Images
In a special report, JOHN KAMPFNER explores the failure of the US, Europe, China and Russia to work together on global vaccine provision, and how the developing world can exploit their rivalry
Relations between the major powers are at their worst for decades with cooperation thin on the ground, and Covid-19 having deepened suspicions further. In April, the US Senate passed the Strategic Competition Act with bipartisan support, promising to “counter the malign influence of the Chinese Communist Party globally”.
In front of his American counterpart, China’s top foreign policy official denounced the effrontery of those who “smear” Chinese democracy. Joe Biden calls Vladimir Putin “a killer”, while the Kremlin has put the US at the top of its list of unfriendly countries.
Tension between China and India is high, the EU and UK are involved in repeated spats. Competition and mistrust are everywhere.
Far from producing greater collaboration in adversity, Covid has increased rivalries. Given that the tensions long pre-dated the pandemic and are unlikely to improve any time soon, it is hard to see how the major powers can be persuaded to cooperate better to tackle this crisis. Coronavirus is just the first test. Other crises will follow. If the disappointing results of the G7 are anything to go by, expectations should be managed even lower than they are already.
But experts I spoke to for a report commissioned by the international think tank Chatham House suggest there could be another way: the atmosphere of intense competition can actually be exploited to the advantage of developing economies.
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 final year of Donald Trump’s ‘America First’ presidency was characterised by a Covid policy of denial, denigration of science and, at that point, the world’s highest infection rate. The president launched repeated broadsides against the World Health Organization, denouncing its director general Tedros Ghebreyesus as a “puppet” of China; he announced the termination of the US’s WHO membership and $400m annual payment, putting its finances in peril just at a time when the organisation was most needed. Trump’s approach was borne partly of ideology, partly of a need to create a distraction from his administration’s incompetence.
Across the rich world, governments floundered in their initial response. Tedros himself summed it up as a year of extraordinary scientific success but political failure. 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, as it was called, 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.
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. Even when fully rolled out, it will still account for only 20% of global need, what it calls “the priority fifth”. Still, something was 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 as vindication of Brexit. For its part, the EU’s definition of solidarity was largely confined to the bloc.
On taking office in January 2021, Biden proclaimed that “America is back” in the mainstream of global affairs. He reversed the US decision to leave the WHO and turned around the domestic response with an impressively fast vaccination programme.
Yet the US rhetoric rarely matched the reality. Health policy was directed inwards: over-order on an industrial scale and vaccinate until the last person is done. Americans went from near panic to enjoying an oversupply of life-saving medicine, while death rates in poorer countries were growing sharply with vaccines desperately hard to come by. The West failed egregiously in the competition for goodwill, leaving a gaping vacuum for others to fill.
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.
By the end of May, China had sold or donated 700m doses in 90 countries. Russia was in 80. Each shipment carried national flags and was accompanied by photo-opportunities with grateful local dignitaries at the airport of arrival.
By late May, Latin America had exceeded one million deaths, the highest for any region in the world. It contains 8% of the global population but has 34% of infections. 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.” Euclides Acevedo, foreign minister of Paraguay, which was struggling to get Chinese vaccines because of its recognition of Taiwan, asked publicly of the US: “What use is fraternity if now they don’t give us a reply?”
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,” 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.
Africa has received 2% 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 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.
Africa imports 99 per cent of the vaccines it needs. The African Union has set a goal of 40% 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 looking at Africa’s predicament. Some of the politics have changed. Three of the 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. A series of regional summits with Africa are 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.
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 influence than before.
A recent Chinese White Paper on international development states: “China considers it a mission to contribute more to humanity. Its wish is to offer more public goods to the international community and join forces with other countries to build a better common future.” Humanitarian assistance merges with geo-strategic motives. Is that noticeably different to other countries’ international development policies?
Covid-19 has given China an opportunity to portray itself as a responsible, science-based global leader, a ‘pharma power’, helping to shift the narrative from its role in the cause of the crisis.
“There has been a significant shift in power. The West hasn’t quite learnt how to influence the Global South in these new times. It is relying on its old toolbox of persuasion – through aid for example – or diplomatic pressure or coercion,” says Champa Patel, director of the Asia-Pacific region at Chatham House. “What will not work is trying to instrumentalise emerging powers for Western capitals’ 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?
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% of the world leaders calling and asking, can we help them. We’re going to try.” He promised that the US would deliver 80m 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 70m vaccines had been sent through the multilateral facility – a tiny proportion of the not-so-ambitious two billion target.
In a report published in May, a 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 International Panel for Pandemic Preparedness and Response, as the group is known, called for a UN Pandemic Treaty and an International Pandemic Financing Facility that could mobilise funding of up to $10bn 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.
Yet in recent months, a series of meetings – from a Global Health Summit of the G20 to the World Health Assembly – have disappointed. On the eve of each of these forums, health experts and activists urged governments to do more. They cited compelling economic arguments. Fully financing Covax for 2021 would cost less than 1% of what governments have spent on stimulus packages for their own citizens. G7 nations could spend just 50p a week per citizen to help supply the poorest nations.
The task is enormous and urgent. The number of doses needed to vaccinate 70% of the world’s population is a staggering 11bn. So far only about 1.7bn 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.
In spite of all the entreaties, Covax remains low on nations’ priorities. One of the problems is that it deprives donor states of recognition or reward. 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 centralised 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, 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 1 billion vaccines that had been trailed beforehand, with no mechanism for delivery and with a vague deadline – was denounced by Gordon Brown as an “unforgivable moral failure”.
He wasn’t alone. Economist and long-time UN adviser, Jeffrey Sachs, described the G7 as an anachronism. “They give the appearance of solving global problems, while really leaving them to fester,” Sachs said. “We need Asia, Africa and Latin America at the table for any true global problem-solving.”
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, 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.
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. Perhaps with this in mind, American officials insist that they are not trying to pressurise countries to make a zero-sum choice. As Blinken told a Nato meeting in March: “The US won’t force allies into an ‘us-or-them’ choice with China”.
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 other 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 Jim O’Neill, the economist and former government minister who has been on a number of G7 and G20 working groups. “Who cares where they come from or which political system they belong to if they save lives?”
This is not as it should be. In a perfect world, multilateral and cooperation would be the guiding principles. 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 to the advantage of those who most need assistance. Vaccine competition may end up being the world’s best bet.
This is an adapted version of a long-read for Chatham House which can be found here
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