Vaccine Nationalism, Vaccine Diplomacy

If you remember flying, then certainly you will remember the injunction during the safety presentation. 

“Should the cabin lose pressure, oxygen masks will drop from the overhead area. Please place the mask over your own mouth and nose before assisting others.”

That, in the context of COVID-19 vaccinations, is an example of vaccine nationalism. It wasn’t until earlier last week that we began exporting vaccines to our neighbors, Canada and Mexico. And it wasn’t Pfizer or Moderna, but AstraZeneca’s – make of that what you will. We are not the only ones with an us-first attitude. The EU, faced with a slow vaccination roll-out and rising cases, is not restricting exports so much as requiring companies to meet their contractual obligations to the EU. A difference in words, but not intent or actions. They continue to supply the UK rather than make Brexit have a genuine and unintended impact. 

“I support the fact that we must block all exports for as long as some drug companies don’t respect their commitments with Europeans.” French President Emmanuel Macron

Far more disruptive is India, where only recently have rising rates of COVID-19 infection displaced the idea that somehow India had reached herd immunity. The Serum Institute of India, their largest manufacturer of vaccines and one of the largest suppliers to lower-income countries, and Covax, the UN’s vaccine effort, is “pausing” production for exportation. 

Vaccine Diplomacy

On the other side of the vaccine ledger, we find China and Russia, who continue to follow a well-known playbook. Russia’s Sputnik V vaccine is being exported to other countries while at the same time they are quietly importing the same vaccine, outsourced to Korean manufacturers, back into the country. Production has been slow, as has the vaccine roll-out. So Russia continues to over-promise and under-deliver.

China is a different tale. China has very few COVID-19 cases. According to Reuters, they had 5 cases in one day, all from outside visitors. With little internal pressure to vaccinate to tamp down infections, their manufacturing power is directed at supplying the rest of the world. And in the chess match that is global diplomacy, the US, EU, and India all have begun to serve that clientele hence the term vaccine diplomacy. But as the Financial Times reports,

“…in recent weeks, China’s role in the global vaccination drive has been overshadowed by concerns over supplies, high prices, and unexplained instances of low immunity.”

Shoddy quality and unreliable service from China – say it isn’t so. A lack of transparency in reporting efficacy either by the manufacturer or in peer-reviewed studies makes the recent missteps by AstraZeneca seem like more of a rounding error than problematic science. And the FT reports that the vaccination is priced at about $40 a dose – not a bargain. But much like Amazon Prime, delivery is almost immediate. For countries without the ability to make vaccines and continued COVID-19 infections, prompt delivery is well worth a premium price. 

“While these affluent countries are busy stockpiling [Covid-19 vaccines], who is helping countries in Africa, Latin America, the Caribbean and Asia? The answer is China.” State broadcaster CGTN

China is not shy about sharing its planned good deeds. But again, with China, you must always consider deeds as well as words. Despite indicating that African nations would be a priority, you must be a part of China’s Belt and Road Initiative to move up in the queue. 

To be fair and honest, you have to applaud China’s apparent effort to be a better global citizen, having exported nearly 500 million doses, especially after their not-so-good citizenship, in reporting the problem initially. But one cannot resist the thought that this gift comes with an obligation to perhaps bend to China’s needs on another occasion – turning a gift more into a bribe. 

Returning to my airplane analogy, there are several reasons that now that we appear to be on our way to protecting ourselves, we may now “assist others.” In addition to being an ethical responsibility, it will allow the world, which is, after all, our marketplace too, to reopen and for everyone’s economy to improve. More importantly, it is a moment when we can increase our national resilience by increasing our ability to manufacture vaccines, especially those mRNA ones, that seem to be possibly having a role in treating other diseases. The marginal cost of producing a vaccine dose is dropping rapidly, and dollars spent there will return to us in many ways. 

We continue to remain in competition with China, and undoubtedly that competition will shape this century. We should move now to resume our moral obligations to the rest of our species. There may still be something to learn from the words of President Johnson, "the ultimate victory will depend on the hearts and minds of the people who actually live out there." Hopefully, we will be more successful than we were in Viet Nam.