Policy Alert #222 | January 29, 2021

As COVID-19 cases surpass 100 million globally, the successful distribution of vaccines is the only solution that allows the world to truly recover from the pandemic. According to a vaccine database managed by Duke University, governments around the world have purchased more than 7 billion vaccine doses as of January 2021, among which 4.2 billion were bought by high-income countries. Even though they only represent about 16% of global population, high-income countries are holding 60% of all COVID vaccines. Most of these countries are holding more vaccines than their populations, while some have enough to cover their populations several times over. For instance, Canada has purchased enough vaccine doses to cover more than five times their population, whereas the UK ranks second by holding enough for three times their population. In contrast, most middle and low-income countries lack the capability to develop vaccines themselves and are scrambling to secure the remaining vaccine supply. This global inequality of vaccine distribution thus offers an opportunity for China and India – two of the handful of countries that are capable of exporting COVID vaccines – to enhance their soft power and geopolitical influence through the provision of vaccines for countries in need.

In this Policy Alert, we examine the ongoing Sino-Indian competition in vaccine diplomacy and compare the success of their global distribution efforts.

China as Global Pharmaceutical Supplier, India as Global Vaccine Producer

China is the world’s largest pharmaceutical supplier, whereas India is the largest vaccine producer. It is no surprise that both countries – especially China, who has been criticized for its lack of transparency during the initial COVID outbreak – see the pandemic as an opportunity to extend their soft power and geopolitical influence. In China, there are three COVID vaccines that have been developed and ready to be exported. The first vaccine comes from private company Sinovac. At the higher end, testing in Turkey shows that the Sinovac vaccine is 91.25% effective, whereas at the lower end, a report from Brazil reveals an efficacy rate of 50.5%. The second Chinese vaccine is developed by state-owned Sinopharm, which is yielding an efficacy rate of 79%. The Chinese government plans to distribute free shots of Sinopharm vaccines for all of its citizens. Finally, the vaccine from privately-owned CanSino has also reached its final stage of testing, but the efficacy rate has yet to be published.

India has two vaccines that are ready for distribution. The first is Covishield, which is licensed from Oxford University and AstraZeneca and produced by the Serum Institute of India, the largest vaccine manufacturer in the world. The original Oxford-AstraZeneca vaccine has an efficacy rate between 60% and 90%, while the testing of the Indian model shows an efficacy rate of 70.42%. The second Indian vaccine is Covaxin, which is indigenously developed by Bharat Biotech in collaboration with the Indian Council of Medical Research and the National Institute of Virology. Covaxin is still undergoing its late stage trials and the efficacy rate is yet to be published.

The headline efficacy rates of vaccines – especially China’s Sinovac – have received a lot of media attention and require careful consideration. The official result from Sinovac’s Brazilian testing is 78%, but one report revealed that the headline rate drops to 50.4% when “very mild” infections are included in the calculation. It remains unclear how the “very mild” cases are defined, while it is also unclear if Sinovac’s 91.24% result in Turkey follows the same standard, and whether the efficacy rates of other existing vaccines include “very mild” cases. As the result, direct comparison of headline efficacy rates can be challenging, especially when Chinese data lacks transparency.

Trends in Distribution of Chinese and Indian Vaccines: China Selling, India Donating

Unlike the Moderna and Pfizer-BioNTech vaccines, which have adopted a new RNA technology and require extremely low temperatures for storage, Chinese and Indian vaccines utilize the traditional viral vector method, which is apparently less effective, but the lower cost of production and distribution makes it the best option for middle and low-income countries around the world. The following Chinese and Indian vaccine distribution data are extracted from a database run by Duke University and supplemented by media sources.

As of January 28, 2021, China has donated vaccines and/or entered agreements of vaccine purchases with the following countries:

Sinovac
Country             Doses              Donation or Sale
Azerbaijan        4 million         Sale
Brazil                100 million     Sale
Chile                 60 million       Sale
Indonesia        125 million      Sale
Malaysia          14 million        Sale
Mexico             Unknown        Sale
Philippines     25 million        Sale and 500k Donation
Thailand          2 million         Sale
Turkey             50 million       Sale
Ukraine           1.8 million      Sale

Sinopharm
Country           Doses                Donation or Sale
Morocco          10 million         Sale
Pakistan          1.7 million        Sale and 500k Donation
Peru                 38 million        Sale
Serbia              1 million           Sale
UAE                 3 million          Sale

CanSino
Country          Doses                     Donation or Sale
Indonesia       15 million              Sale
Mexico            10 to 35 million   Sale
Malaysia         10 million             Sale
Pakistan          20 million            Sale

As of January 28, 2021, India has donated vaccines or entered agreements of vaccine purchases with the following countries:

Covishield (Oxford-AstraZeneca):
Country              Doses                   Donation or Sale
Bangladesh        2 million             Donation
Bhutan                150k                     Donation
Brazil                  2 million              Sale
Caribbean          500k                     Donation
Maldives            100k                     Donation
Mauritius          150k                      Donation
Morocco            2 million              Sale
Myanmar          1.5 million           Donation
Nepal                 1 million              Donation
Nicaragua          200k                   Donation
Oman                 100k                    Donation
Pacific Islands  200k                   Donation
Seychelles          50k                     Donation

Competition in Vaccine Diplomacy: An Indian Edge

China first attempted to generate soft power by exporting PPE at the beginning of COVID pandemic, but Beijing’s initial effort blundered due to the inconsistent quality of Chinese-made equipment. As COVID vaccines are readied through expedited development, both China and India seized the opportunity to engage in vaccine diplomacy.

Comparing vaccine distribution, it is clear that there is a huge difference between the Chinese and Indian approach to vaccine diplomacy. Even though Chinese vaccines have a much wider outreach, they are almost exclusively distributed through purchase agreements instead of donations. Interestingly, the only Chinese donations are to the Philippines and Pakistan, both significantly associated with China’s ongoing disputes in the South China Sea and the Ladakh/Kashmir regions respectively. In contrast, India adopts a different strategy of vaccine diplomacy by first targeting its immediate neighbors, followed by its extended neighborhood and smaller island countries around the world. The main difference between the two countries is that Indian vaccines are almost exclusively distributed through donation – a strategy known as the Vaccine Maitri (Vaccine Friendship).

The most notable competition of vaccine diplomacy between China and India happened in Bangladesh and Myanmar. Bangladesh initially planned to purchase vaccine from China’s Sinovac, but the deal apparently fell apart when the Chinese company asked Dhaka to share the cost of clinical trials. This created an opportunity for India to step in and offer a donation of 2 million doses. Similarly, China promised a batch of donations to Myanmar during Chinese Foreign Minister Wang Yi’s visit on January 12, but has yet to fulfill the commitment as India stepped in to donate 1.5 million doses. Moreover, Chinese and Indian media have also traded accusations against each other’s vaccine diplomacy. Chinese media and netizens questioned India’s ability to manufacture high-quality COVID vaccine after a fire broke out at a plant of India’s largest vaccine maker. Meanwhile, Indian media accused China of using the vaccine agreements to put pressure on the Turkish Parliament to ratify a treaty that allows the extradition of Uyghur dissidents.

In the initial round of vaccine distribution, it seems India has gained an edge in vaccine diplomacy through its Vaccine Maitri. Although China has signed purchase agreements with a larger number of countries, Beijing’s ability to fulfill its vaccine commitment is the country’s greatest challenge, especially when outbreaks are surging within China. India has committed to less countries, and its donation of vaccine shipments are gradually being fulfilled. However, as total COVID cases continues to rise while new variants of the virus are spreading around the world, India is also facing tremendous pressure to distribute vaccines within the country. For both China and India, vaccine diplomacy may ultimately be successful only if production is able to exceed the domestic demands of their huge populations.