Vaccine wars: Nations race to win friends and influence through vaccine distribution

It all seems so long ago now, but as 2019 drew to a close there was a lot of talk about a new "space race."

In November 2019, a Japanese spacecraft headed back to Earth after a successful landing on a moving asteroid. The following month, President Donald Trump created the new U.S. Space Force with a $20 billion (Cdn) budget. Two weeks after that, on January 4, 2020, China made history by landing an unmanned spacecraft on the dark side of the moon. 

But news on that same day about a "mysterious and growing cluster of unexplained pneumonia cases in the Chinese city of Wuhan" would soon consign the space race to second billing.

Sputnik flies again

Perhaps the Russians were thinking of the space race analogy when they decided to name their COVID vaccine Sputnik V, in honour of the launch of the first artificial satellite in 1957. Russia approached the vaccine race much as the former Soviet Union approached the space race — by forging ahead, cutting corners on safety and gambling on the outcome.

Although Sputnik V was deployed without going through full human trials, it has since turned out to be a triumph of Russian science. This week, The Lancet published the results of a full placebo-controlled study with more than 20,000 participants and found "a consistent strong protective effect across all participant age groups."

Better yet, the Lancet reported "the lessening of disease severity after one dose is particularly encouraging for current dose-sparing strategies."

Vindication in Argentina

That means two other countries that also gambled on Sputnik — Argentina and Iran — have something to celebrate after a brutal year. Argentina's vice-president Cristina Kirchner, whose personal relationship with Vladimir Putin was instrumental in obtaining the vaccine, celebrated the result with a one-word tweet:

Sputnik's adherents in Argentina may feel vindicated after weathering considerable resistance from the medical community and ridicule on social media, where satirical memes warned of Sputnik side effects such as involuntary Cossack dancing.

Doubts, then relief

Victor Ingrassia is a scientific journalist in Buenos Aires who has covered the country's pandemic and clinical trials extensively.

"It generated a lot of doubts and uncertainty," Ingrassia told CBC News. "Sputnik's approval here in Argentina coincided with the approval of Pfizer and AstraZeneca by the U.S. Food and Drug Administration and the European Medicines Agency, the two biggest regulators in the world.

"But those vaccines had presented clinical data, while in Argentina we had a Russian vaccine that hadn't presented any data in a peer-reviewed international journal. Argentina's drug regulator ANMAT had never before approved a drug that hadn't already passed muster with either the FDA or the EMA. So there was a lot of concern in the Argentine medical establishment.

"Then, overnight, we learned that the Ministry of Health had approved the drug without waiting even for approval from ANMAT."

Ingrassia said public consternation only increased when neighbouring Chile began to receive the Pfizer vaccine, even though more than 4,000 Argentines had taken part in Pfizer's Stage 3 clinical trials during summer 2020. Many Argentines felt that the government's choice of Sputnik had more to do with the political ties between their government and the Kremlin than with science.

But since The Lancet gave Sputnik a solid thumbs-up, he said, Argentine doctors' reticence about the vaccine has mostly evaporated and the government is now planning to re-open schools on February 17, with teachers vaccinated.

Score a win for Russia.

Bad bet in Brazil

Authorities next door in Brazil, meanwhile, have fewer reasons to be thrilled with their bet on CoronaVac, made by China's Sinovac.

The vaccine, which was promoted by its maker as having 78 per cent efficacy, was found to have only 50.38 per cent efficacy in clinical trials in Brazil, barely meeting the minimum 50 per cent WHO threshold for use. Given that efficacy tends to drop when vaccines are confronted with some of the new COVID variants, CoronaVac may fall under the efficacy threshold in the future.

That's a headache for Joao Doria, the governor who ordered mandatory vaccination of all 46 million residents of Sao Paulo state with CoronaVac — against the advice of the World Health Organization, which says vaccination should be voluntary.

Politically, it's good news for his main rival and the man he hopes to replace — President Jair Bolsonaro, who has long questioned the Chinese vaccine and has said mandatory vaccination "should only be for dogs."

While Bolsonaro and Doria jockey for position ahead of next year's elections, the geopolitical loser in Brazil's vaccine infighting is China.

The trust deficit

China claims 79 per cent efficacy for the vaccine it's using domestically, made by state-owned Sinopharm. But Sinovac's performance in the Brazilian clinical trials now calls any Chinese efficacy claims into question, said China-watcher Lynette Ong of Toronto's Munk School of Global Affairs and Public Policy.

"I think the biggest issue is the trust deficit," she said. "When Pfizer or AstraZeneca put out a number, we have no a priori reason to question that number. But when Chinese authorities or Chinese companies give you a number, you need justification to trust that number, because of what happened in the last 12 months.

"I think that is what I see as the major implication of the pandemic — that they have to take the extra step to convince people that they could be trusted."

Sinovac's vaccine has been sent to many more countries than has Sputnik. World leaders have received the Sinovac shot, among them Turkey's Recep Tayyip Erdoğan and Indonesia's Joko Widodo. China has set aside $2 billion to fund vaccinations in Africa and has made available another $1 billion for Latin American governments to buy its vaccines on credit.

But since the Brazilian study poured cold water on China's vaccine claims, Malaysia and Singapore have put their plans to use CoronaVac on hold while they wait for more testing results.

Media outlets in the Philippines have been suggesting that President Rodrigo Duterte doesn't want to take the CoronaVac shot himself — and also doesn't want to admit that he's saddled his country with 25 million mediocre doses. Duterte has announced that he's chosen to get his shot in the buttocks, rather than the arm.

"Let's respect that," Francisco Duque, the country's health minister, told reporters recently — adding that Duterte's choice means he'll be getting his shot in private.

India the vaccine superpower

"What we see is that the countries that prefer Chinese vaccines are the ones that have supported the Belt-and-Road Initiative, meaning that as a whole, they're favourable to growing Chinese influence," said Ong, referring to Beijing's ambitious global trade infrastructure strategy.

"Quite a number of countries in the regions are quite receptive to Chinese vaccines, as they are to Chinese investment."

But some Asian countries have preferred to deal with a different giant: India.

India can't compete with China militarily or economically — but India produces more than half of the world's vaccine output.

Not only is India producing vast quantities of AstraZeneca's vaccine under license, it also has its own Covaxin — which, like Sputnik V, was rushed to market under a somewhat dubious process but still seems to work.

And India is giving its vaccine away to neighbouring countries free of charge. It gifted millions of doses in January to Bangladesh, Nepal, Myanmar, Mauritius and the Seychelles, among others — a gesture of generosity so far unique in the world.

India began this giveaway within days of starting to vaccinate its own people. India "shared even before meeting [its] own needs," said Bhutan's PM Lotay Tshering. 

Indian officials have made no secret of the fact that they hope to burnish their nation's image at China's expense. Relations between the two countries are at a low point following deadly clashes on the Himalayan border last June.

That might explain why, as January ended, India also sent two million doses to Brazil and plans on shipping more. It's a gesture calculated to highlight the contrast with CoronaVac — which is not only of doubtful efficacy but is also surprisingly expensive.

Split image

But despite its failures in vaccine diplomacy, China's Communist Party can console itself with its performance at home. 

"In spite of the early hiccups, Chinese authorities have handled the pandemic way better, domestically, than the Indian authorities," said Ong. "Domestically, they have been able to manipulate the narrative and turn the image around.

"It's like there was a war with suffering at the beginning, but then the government has fought very hard and won the war. So I think competence has boosted confidence in the government domestically."

Outside of China, she said, "it's been the opposite, especially in countries with a free press that don't rely very heavily on Chinese aid." 

Ong said that while China was the only country with a surplus of personal protective equipment (PPE) at the beginning of the pandemic, it's now in competition with other vaccine-producers that have produced better vaccines.

Not over yet

While China flounders and Russia and India gain ground, the West seems curiously absent from the field of vaccine diplomacy.

That's partly because western vaccines are produced by private corporations, rather than state-affiliated organizations like Russia's Gamaleya Research Institute.

But countries such as Canada have ordered a vast number of doses — many more than they need for their own citizens. And that suggests that they will soon find themselves in a position to play the bountiful ally with developing countries that are likely to still have billions of unvaccinated citizens when 2022 rolls around.

The great game of pandemic diplomacy is far from over.