China’s Journey to Vaccine Hegemony

Swapneel Thakur, Research Intern, ICS

Source: Wall Street Journal, 2021

Since the beginning of the COVID-19 pandemic, China has continued to control the spread of the virus, successfully and effectively. A country of 1.4 billion people, more than the combined the populations of Europe and the United States, has been reporting some clusters of cases and has been able to prevent widespread community transmission. Although much of this success could be attributed to its experience gained from the SARS Epidemic in 2002, China’s disease control strategy featured a balanced combination of both prevention and protection.

Soon after COVID-19 first emerged in December 2019, Chinese scientists were able to identify the virus and share the genome sequencing data internationally. By the end of the January 2020, Chinese doctors had already categorised the clinical symptoms of COVID-19 patients, risks of person to person transmission, genomic characteristics, and the epidemiology. This robust foundation of research was backed by political commitment from the very top to use science to tackle the outbreak decisively. For instance, China’s National Health Commission sent three groups of national infectious disease experts to Wuhan at the beginning of the outbreak to investigate the risks and transmissions of the virus, to which their recommendations for a lockdown immediately implemented. The government was also quick to respond to the advice given by academic scholars such as Cheng Wang, the President of the Chinese Academy of Medical Sciences. His idea of Fangcang shelter hospitals, or temporary hospitals built by converting existing public facilities like stadiums became a key strategy for promptly providing large number of hospital beds and appropriate health care to patients suffering from the disease. However, its prevention control strategy would not have been possible without the broad range of community engagements and solidarity that was seen at an unprecedented level during the COVID-19 outbreak. Control measures that could curb individual freedoms like mandatory wearing of mask in public areas and social distancing were readily accepted by the public, unlike in the Western countries where anti-masking and anti-lockdown protests were quite common. Thus, after achieving the primary objective of limiting the spread of the virus, China’s next strategic goal was to successfully balance these immediate challenges with preventive measures, namely, providing safe and effective vaccines for protecting the population from further infections.

While the US and most Western countries followed a market driven model based on advanced purchase agreements, China adopted a state driven model which leveraged both political mobilisation and the use of economic instruments. Responding to an outbreak of a new infectious disease by solely relying on market mechanism can be expensive, besides being fraught with risks. Furthermore, market-based solutions could increase the probability of slowing down vaccine research due to high levels of uncertainty. For instance, despite having early access to the virus’s genome, several Western pharmaceutical companies continued to dedicate greater share of resources to develop lucrative treatments for existing chronic diseases such as cancer than to counter this infectious disease which could have global ramifications. Janssen and Pfizer’s COVID-19 vaccine research began only when large scale infection was imminent in Western countries during late February.

With vaccine research starting as early as in January 2020, China’s Ministry of Science and Technology (MOST) had already launched emergency research projects by February to accelerate vaccine development. It went on to sponsor five technological roadmaps and 12 vaccine candidates that included private sector giants and nascent start-ups. In order to coordinate policy goals across agencies and to mobilise resources promptly, the government had also established a COVID-19 Task Force comprising senior officials from the National Medical Product Administration (NPMA), the MOST and other concerned departments. The Task Force was affiliated to the Joint Prevention and Control Mechanism of the State Council and reported directly to the Vice Premier of China. Under the Task Force’s direction and guidance, the vaccine research program featured multiple players collaborating to maximise their joint performance. For instance, due to the long-standing relationship that the MOST shared with domestic pharmaceutical companies, the Chinese Government was quickly able to identify enterprises that were capable of developing COVID-19 vaccines during the public health emergency. These enterprises were then supported with efficient allocation of resources required for vaccines development across the Chinese Academy of Sciences, universities, the army and the state-owned enterprises. In addition, the Task Force had also directed the NPMA to modify its procedure in accordance with China’s Vaccine Administration Law to streamline the inspection and review process for vaccines and accelerate market approval.

As of now, four vaccines have been approved in China and in at least one foreign country. Sinopharm’s BBIBP-CorV, Sinovac Biotech’s CoronaVac, CanSino BIO’s Convidecia and ZhifeiLongcom’s ZF2001 make up the most of China and its allies arsenal in the fight to defeat COVID-19. The World Health Organisation (WHO) had also given emergency approval to Sinopharm vaccine in May and the Sinovac Biotech vaccine in June 2021 With the help of government resources and institutions such as Chinese Academy of Sciences and Academy of Military and Medical Sciences, Chinese manufacturers had already started increasing production capacity when the vaccines were in early stage of development. As early as in April 2020,Sinopharm had established production lines in Beijing and Wuhan with an annual capacity of 300 million doses and with plans to eventually export 300 to 500 million doses to over twenty countries. Similarly, Sinovac and CanSinoBIO increased their production capacities to 300 million and 200 million doses respectively. This explains why Chinese companies have been very optimistic about reaching an annual production capacities of more than a billion doses in 2021. For instance, earlier this year both Sinovac and Sinopharm had declared that they were capable of producing more than a billion doses annually. This expanded capacity has allowed China to meet huge domestic demands as well as to fulfil orders from abroad. With Chinese vaccine developers conducting Phase III trials in various countries in Asia, Latin America and Africa, China has emerged as one of the leading suppliers of COVID-19 vaccines in the world.

Such vaccine developers would usually collaborate with local pharmaceutical companies or health departments which helped recruit volunteers, coordinate physical and institutional resources and conduct trials in return for preferential pricing, delivery time and technology transfer. This led to China extending support to more than 80 developing countries. The government has been actively encouraging companies to export independently to other countries in its effort to ensure sufficient supplies of COVID-19 vaccines. Some of the agreements entered into by Chinese companies included an additional clause stating that if a local pharmaceutical company has hosted the clinical trial, the country itself is designated as partner in manufacturing and distributing vaccines for domestic use and export. This explains why China has been supporting overseas production bases of its vaccines in countries like Brazil, UAE, Egypt, Indonesia, Turkey Mexico and Pakistan. While UAE would be producing Sinopharm’s vaccine under the name of Hayat Vax, Brazil, Indonesia, Turkey and Egypt have been manufacturing Sinovac Biotech’s vaccines. Mexico and Pakistan have also started producing CanSinoBIO’s vaccine via an exclusive production line in their respective countries.

As one of the major producers of COVID-19 vaccines in the market, China has reshaped its position as a supplier of affordable vaccines to several developing countries in the world. By investing in research and production capabilities right from the early days of the pandemic, Chinese companies have not only taken major steps to mitigate the severe shortages of vaccines in the developing world but has also provided a viable alternative to expensive vaccines offered by pharmaceutical giants like the Pfizer and Moderna.

The author is thankful to his mentor, Dr. BiswajitDhar, Professor, Centre for Economic Studies and Planning School of Social Sciences, Jawaharlal Nehru University.The views expressed here are those of the author(s), and not necessarily of the mentor or the Institute of Chinese Studies.

China’s Health Diplomacy in Africa during COVID-19: Discerning Prospects and Problems

Dr. Veda VaidyanathanVisiting Research Associate, ICS

LI Nan, a South Africa’s Chinese Embassy representative, left, elbow bumps with Zweli Mkhize, South African Minister of Health, during the handing over for the emergency medical equipment for COVID-19 from China, at OR Tambo Johannesburg, South Africa, Tuesday, April 14, 2020.

Source: AP Photo

At the margins of the third session of the 13th National People’s Congress, as Foreign Minister Wang Yi fielded questions from the press, China’s role helping other countries fight COVID-19 was brought up and China’s assistance to Africa, in particular, found considerable mention. As is usually the case, high doses of morality and altruism accompanied stories of China’s health cooperation in the region. In Wang Yi’s words

China is always willing and ready to help others. When our friends are in distress, we never sit by and do nothing. A case in point is our assistance to Africa during the Ebola epidemic. While some countries evacuated their personnel from the affected areas, China rushed to Africa’s aid despite risks of infection, sending in medical teams and badly needed supplies and fighting alongside our African brothers and sisters until victory was declared.”

However, this does not take away from China’s multifaceted contribution to the African region in its fight against COVID-19. Actors including the state, provincial governments, companies and entrepreneurs have been contributing to different countries in varied forms. The Chinese government sent medical expert teams to Africa’s 5 sub regions while the resident medical teams based in 45 African countries have also been very active and have held over 400 training sessions for medical workers. On the 18th of March, the first teleconference of experts was held between China and countries in Africa. Over 300 people including representatives from over 23 African countries, the African CDC, officials from the WHO posted in the region attended the meeting with experts from the Chinese Academy of Sciences, the Chinese CDC, the first hospital of Peking University. Since then over 30 video conferences have been held. China has also been upgrading health infrastructure, like a $500,000 donation to the Wilkins Infectious Diseases Hospital, the main Covid-19 centre in Harare, Zimbabwe. Provincial actors like Chongqing municipal government sent supplies along with a delegation to Algeria and a team of 12 medical experts from Hunan province brought medical supplies to Zimbabwe.

Chinese media houses have also been critical to its ‘Corona diplomacy’ in the continent. A website hosted by China Daily called “Fighting COVID-19 the Chinese Way” is used to share facts, updates and stories about managing the virus. Another platform called “COVID-19 Frontline” by CGTN is an online live show for medical workers and officials to share information. One of the shows hosted was titled “Fight as one: Exchange of COVID-19 treatment experiences between China and Zambia” where Doctors from the First Affiliated Hospital of Xi’an Jiaotong University, who served on the frontlines in Wuhan shared their experiences with their Zambian counterparts. Similarly CGTN invited experts from Jiangsu Province who worked in Wuhan to share their experiences with colleagues in Tanzania. Links to such platforms have been advertised in the websites of Chinese missions in various African countries. In addition to the Chinese State, Alibaba’s Jack Ma and the Alibaba foundation have also contributed to the African fight against the pandemic by providing thousands of detection kits, PPEs, face shields, infrared thermometers, extraction kits, surgical masks, swabs and gloves among others. Other Chinese firms active in the region have also been donating to local charities.

However, Chinese assistance during the pandemic has not always been received positively in the region. There is an increase in xenophobia and this has resulted in several unpleasant exchanges. One of first reports that came out in this regard saw several Africans in Guangzhou being discriminated against, evicted from their homes and forced into quarantine. This attracted an unprecedented and strong response from a group of African ambassadors in Beijing who “immediately demanded the cessation of forceful testing, quarantine and other inhuman treatments meted out to Africans”. A few weeks later news broke that three Chinese nationals were murdered in Lusaka. According to the Zambian police, the suspects killed the victims who were working in a Chinese clothing company and set their warehouse on fire. While many commentators have discussed how deep-rooted racism is a longstanding issue in China-Africa relations, officials like Zambia’s ambassador to China doesn’t seem to be too perturbed; stressing thatSometimes, our people or your people make mistakes out of anxiety. It is not good to amplify these small negative points. We should pursue cooperation under a bigger picture”.

Nonetheless, one of the major expectations from China, beyond knowledge sharing and supply of medical equipment, is to forgive loans and ease debt repayments. As several countries in the continent are struggling with weak health systems, rising domestic dissatisfaction due to unemployment and cessation of economic activity, they are not in a position to make repayments on debt. Considering that China has been the largest trading partner of the region ($208 billion in 2019), one of the largest investors ($110 billion stock) and holds a fifth of Africa’s sovereign debt, this takes centre stage. A case in point is Kenya: by March 2020, Kenya’s total national debt reached an all-time high of Sh6 trillion ($57 billion), very close to its 70 per cent national debt ceiling of Sh9 trillion ($90 billion), of this its debt to China stood at Sh660 billion ($6.6 million). While China has supported the call of the World Bank and IMF and will join the G20 nations to forgo repayments, officials have stated that they will also conduct bilateral meetings to discuss further debt relief. It is very likely that China will forgive significant African debt, not only because there is a precedent, but also due to the fact that in the post pandemic world, where investigations looking into the origins of the virus are underway, African support will be critical to China.

Similarly, Africa could also gain tremendously from China’s close engagement. As global supply chains are hard hit, intra Africa trade could increase, kick starting the African Continental Free Trade Area, and major economies in the region including Kenya, Nigeria and South Africa could start supplying to other countries and Chinese cooperation in this regard would be vital. There have already been several instances of states turning to domestic production to meet demand. The Ugandan President for instance, launched two production lines at a Chinese firm in Uganda, Lida packaging Products Ltd, that employs over 300 people and has the capacity to produce 560,000 masks a day. Similarly, the tech, digital and e-commerce spaces that have been growing rapidly – including coming up with home grown solutions to problems posed by the pandemic – stands to benefit from close cooperation with Chinese actors. Like many other geopolitical equations, China-Africa relations in the ‘new normal’ will also undergo a reset. A narrative is already building around Africa’s unwavering loyalty to China, especially during the pandemic. For instance, the Chinese ambassador to Zambia, Li Jie, stated that when the pandemic broke out in China, Zambia was one of the first countries to call and extend support and therefore Beijing will provide substantial support to Lusaka in this trying time. It would be prudent therefore, that other actors engaged in the region, like India, pay close attention to the myriad forms Chinese assistance to the continent is taking and how they are received, because it will not only influence Africa’s fight against the pandemic but will also help shape a narrative that projects China as a ‘voice of reason and judgement’ in a landscape that is seemingly devoid of global health leadership.