More than 20 million doses of COVID-19 vaccines have been donated directly to 81 low- and middle-income countries, as part of rapidly growing vaccine diplomacy.
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“Vaccine diplomacy is when you use a scarce medical resource — in this case, a vaccine — to further your diplomatic influence, and particularly in areas of geostrategic importance, for the country,” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law, told Devex. “So it's supposed to help the country that you're giving it to, but it also serves the interests of the donator of the vaccine.”
Leading the charge is China and India, now in neck and neck battle to be seen as the most generous vaccine donor. As of March 18. India, which prefers to “grant” vaccines, has announced 8.1 million doses supporting 37 countries. China has donated 7.9 million doses of COVID-19 vaccines to 33 countries.
Comparing vaccine diplomacy of China and India
As part of the donated COVID-19 vaccines, the focus for China has been on disseminating Chinese developed and produced Sinopharm and Sinovac vaccines. Sinopharm has so far been the focus of donations, accounting for 79% of the total.
Geographically, the focus has been diverse. Cambodia, Pakistan, and the Philippines have each received a total of million doses from China to date. But donations have extended beyond Asia and into Africa, Eastern Europe, South America, and the Middle East — including Belarus, Bolivia, Chile, Guinea, Hungary, Iraq, Namibia, and more.
“The goal is everyone vaccinated with something that's more or less efficacious sooner rather than later. [Currently] there's huge scarcity.”— Amanda Glassman, executive vice president, Center for Global Development
Direct country donations are just one part of China’s approach to vaccine diplomacy. More recently, China has announced a donation of 300,000 doses of COVID-19 vaccines to United Nations peacekeepers — with a focus on Africa. And business deals have been brokered with other countries including Brazil and Thailand, as well as a deal with the United Arab Emirates to locally manufacture Sinopharm.
Compared to China, India’s vaccine diplomacy is not focused on a locally developed vaccine but a locally manufactured one — Covishield, an Indian produced AstraZeneca vaccine.
The immediate focus for India is its neighboring countries. Afghanistan and Sri Lanka have each received 500,000 doses, Nepal 1 million, Myanmar 1.7 million, and Bangladesh 2 million. But they are now expanding upon their immediate region.
In Central America, Belize, the Dominican Republic, Guatemala, and Nicaragua have been “granted” 455,000 doses in total by India. And in South America, Guyana, and Suriname have received a combined 130,00 doses. But there is an increasing focus on Africa with Botswana, Ghana, and the Democratic Republic of the Congo among the nations granted vaccine supplies by India.
Supporting global mechanisms including COVAX in disseminating vaccines has also been a priority, with India estimating this has supported the delivery of an additional 16.5 million doses through this program. These “gifts” have opened the door to deals for Covishield with larger economies, including the United Kingdom and Canada, with the Indian-produced vaccine being supplied to 72 countries in total.
“The winners are those who can best distribute vaccines equitably,” Gostin said. “In my view, I think India is the closest to a winner, because the Serum Institute and their pharmaceutical industry. It could be the engine to vaccinate the world.”
The perception of a more reputable vaccine in AstraZeneca is supporting India, Gostin said, adding that there is distrust of Russia and China because “their vaccines have not been approved by a stringent regulatory authority.”
How does Russia compare?
When it comes to vaccine diplomacy, Russia is less focused on donations than on brokering business deals. Just over half a million vaccines have been donated by Russia to seven countries with the bulk directed to Uzbekistan, at 500,000. Palestine has received 10,000 doses and Belarus 100.
Sputnik V is the focus of Russian donations with EpiVacCorona also delivered. Donations from Russia have also been received in Angola, Nicaragua, Seychelles, and Zimbabwe, but the quantity is unknown.
Over 30 countries and territories now have given emergency approval to use the vaccine.
Through deals to purchase vaccines, the spread of Russia’s vaccine diplomacy shows a bigger geographic footprint — spreading into the Middle East, Eastern Europe Africa, South America, and Central America.
Who else is donating vaccines?
An additional 10 countries have announced direct donations of vaccines to countries — Australia, Barbados, Chile, Dominica, Israel, Romania, Senegal, Serbia, United Arab Emirates, and Venezuela.
Australia is the third-largest donor, with a grant of 3 million unspecified vaccines supporting Cambodia and 8,000 AstraZeneca vaccines heading to Papua New Guinea. The United Arab Emirates has donated 670,000 doses of Sinopharm and Sputnik V to countries in Asia and Africa. Other donors have offered less than 200,000 doses to neighboring regions.
What are the other approaches to vaccine diplomacy?
For many of the largest economies, vaccine diplomacy is either explained broadly or focused on the delivery of vaccines to low- and middle-income countries once local demand has subsided.
In France, President Emmanuel Macron has announced that France will donate 5% of its COVID doses to LMICs through COVAX. The U.K. has committed to donating its surplus to LMICs. And at the Quad meeting, consisting of Australia, India, Japan, and the U.S., it was agreed that by 2022 Asia-Pacific nations would be able to benefit from vaccine diplomacy as manufacturing increased to 1 billion doses — an agreement that is expected to benefit India.
But for Amanda Glassman, executive vice president and senior fellow at the Center for Global Development, vaccine diplomacy should be about the people it aims to support.
“I think a key point is that it's not a competition,” she told Devex. “The goal is everyone vaccinated with something that's more or less efficacious sooner rather than later. [Currently] there's huge scarcity.”