China and US Vaccine Diplomacy in the Middle East and North Africa

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China and US Vaccine Diplomacy in the Middle East and North Africa

Beijing had the edge in the early stages of the pandemic, but the preference for mRNA vaccines amid the Omicron variant has helped boost U.S. vaccine diplomacy.

China and US Vaccine Diplomacy in the Middle East and North Africa

Egyptian Health Minister Hala Zayed, left, Dr. Abdel Menoim Selim, center, and Nurse Ahmed Hamdan Zayed, the first two Egyptians to receive the Sinopharm China-made COVID-19 vaccine, stand on a stage to answer questions after receiving the vaccine during a press conference, at the Abu Khalifa Hospital in Ismailia, 120 kilometers east of Cairo, Egypt, January 24, 2021.

Credit: AP Photo/Nariman El-Mofty

Since the outbreak of COVID-19, health cooperation and solidarity in fighting the pandemic has been essential in mitigating the crisis. In turn, cooperation on health issues has strengthened overall diplomatic support between nations.

After the breakout of COVID-19 in Wuhan, China faced a crucial crisis at home and also pressure abroad, in the form of accusations that it mishandled the pandemic’s early stages. Some politicians in the United States even raised a conspiracy theory over the origins of the virus. Then-U.S. President Donald Trump repeatedly accused China of being responsible for spreading the virus; he even used the expression “Chinese Virus” in public addresses, which created the impression of China as a threat to the world. This confrontational approach led to a significant deterioration in diplomatic relations between the U.S. and China.

By contrast, Beijing sought to use vaccine diplomacy to highlight its role as a responsible actor on global health issues. China has practiced health and vaccine diplomacy around the world, including in the Middle East and North Africa.

The Great Vaccine Race

In 2020, China sent doctors, nurses and researchers to hold conferences with doctors in Abu Dhabi. In August of that year, China established a laboratory in Baghdad, Iraq, with support of Chinese experts to help the country to confirm cases during the start of COVID-19 outbreak. In addition, China provided test kits, medical masks, personal protection suits, and other anti-COVID-19 supplies to Yemen. It also provided test kits and ventilators to both Palestine and Algeria. Moreover, China also localized vaccine production with Egypt, Algeria, the UAE, Bahrain, and Turkey, while Iran and Palestine both relied exclusively on Chinese vaccines in fighting the pandemic.

China’s early vaccine donations coincided with the relative withdrawal of the U.S. from the world stage under the Trump administration. This made China the sole vaccine supplier for many countries in the early stage of the pandemic. By 2021, China had already pledged to donate 1 billion COVID-19 vaccines doses to African countries. China has also provided 141 million vaccine doses have been to the Asia-Pacific region, to make Africa and the Asia-Pacific the largest two Chinese vaccine recipient regions. Most of these Chinese vaccine supplies were through sales or donations made through bilateral channels.

In Asia and Africa, most of the countries who received the vaccine were already participants in the Belt and Road Initiative (BRI). Through its vaccine diplomacy, China thus highlighted and reinforced the importance of the BRI in countries strategically important to Beijing. For instance, in Egypt, where the Suez Canal is an important strategic crossroad to Europe, in addition to vaccine donations, China also built a factory to manufacture Chinese vaccines in Egypt. This will allow Egyptian partners to gain influence and increase their exports to other African nations.

However, the effectiveness and safety of Chinese vaccines has remained a crucial concern across the MENA region. There is a perception in many countries that Chinese products are of low quality; this has affected public trust levels toward the efficacy of the vaccines from Sinopharm and Sinovac. In Egypt, the populace has been skeptical of Chinese vaccines, while showing great trust in Western vaccines such as AstraZeneca. In part this is due to the apparent transparency of scientific research in the West in contrast to more opaque methods in China.

In 2021, Saudi Arabia announced specific requirements for visitors to take at least one dose of the Pfizer, AstraZeneca, Moderna, or Johnson and Johnson vaccines in order to enter the country – or at least two booster shots of Sinovac and Sinopharm. Despite the wide use of Chinese vaccines across the region by many countries, positive opinions of the Chinese vaccines declined once alternative options were available from Western countries.

Since mid-2021, Chinese vaccines have seen a significant decline on the global stage, with countries such as Brazil and Indonesia not renewing their orders. This decline also coincided with the removal of restrictions on Indian vaccines, alongside increased production of other vaccines such as Moderna and Pfizer in the second half of 2021.

After a slow start, the United States was the world’s largest donor of vaccines globally in 2021. It has delivered more than 114 million doses of COVID-19 vaccines to around 80 developing countries across Asia, Africa, and Latin America. China is the second-largest donor with 34 million doses, according to the data provided by UNICEF.

According to U.S. State Department data, among the delivered vaccine to different regions, the western hemisphere was the largest recipient with 40 million doses, Sub-Saharan Africa has received 29 million. The Middle East and North Africa region only received 4 million doses of donated U.S. vaccines, one of the lowest vaccine recipients among all regions.

Despite the fact that the U.S. entered the vaccine diplomacy race later, Chinese vaccine diplomacy has faced a big challenge due to the spread of the highly transmissible Omicron subvariants BA.4 and BA.5. Chinese vaccines were less effective against the new subvariant, even if they were used for a booster shot. Subsequently, Sinopharm and Sinovac exported a total of 6.78 million doses in April, down 97 percent from the peak in September 2021. Western vaccines such as Pfizer and Moderna are based on newer mRNA technology, which is not yet available in China, and both are more effective against the virus than the Chinese vaccine in single doses.

U.S. and Chinese Visions of Vaccine Diplomacy

Chinese President Xi Jinping, in his speech at the opening ceremony of the 73rd World Health Assembly video conference in September, raised the idea of “community of health and shared future for humankind.” His vision highlighted the necessity of enhancing global efforts in fighting the pandemic, and promoted China as a responsible actor in the global health sector. China’s diplomacy amid the pandemic and its ambition in shaping the global health agenda favors the Chinese political system, and Chinese officials and media outlets have held up the Chinese model in tackling the health crisis as an alternative to the Western powers. China, through implementing the idea of “shared community,” is emphasizing on shared global efforts on the multilateral level.

That said, analysts have argued that China is using vaccine diplomacy to gain leverage in order to shape the geopolitical landscape to its favor. China was the largest donor of vaccine doses in many developing countries in 2020, when countries needed it most. Its vaccine diplomacy is increasing China’s soft power, including in the MENA region, in the long run. Vaccine diplomacy is shaping a new style of China’s diplomacy in the developing world, where health cooperation is used as an instrument of achieving its diplomacy goals.

In addition, the absence of the U.S. role in this field within the MENA region has given China more credibility to promote itself as a global public good provider, and therefore, enhanced its position in the global health system. Through quick action and targeted attention to countries overlooked by Washington, Beijing won this round of public diplomacy, which has given it greater confidence in making such efforts in the future.

The United States’ poor handling of the pandemic situation at home, by contrast, highlighted weaknesses in its own domestic system and undermined its image as the world’s leader, feeding disenchantment with the American model of capitalism and democracy. The U.S. efforts in vaccine donations and supply starting in 2021 show that the Biden administration is trying to strengthen its role and assert its leadership over the pandemic response, which have been challenged by China, especially during the time of Trump. Trump’s failure to take serious measures to contain the virus at home, and his decision to withdraw from the World Health Organization, claiming that it was biased in favor of China, all undermined the United States’ global leadership position.

Since assuming office, President Joe Biden’s plans for the pandemic has been markedly difference. His plans for vaccine distribution and donation to poorer countries show a willingness to engage in international cooperation to stop the spread of the pandemic and ensured the assertion of the U.S. role in tackling the virus on the global front. Biden has shown that the U.S. is willing to play an effective role in vaccine distribution, affirming that “America will be the arsenal of vaccines in the global fight against the pandemic, just as America was the arsenal of democracy in World War II.” The Biden administration’s contribution to vaccine distribution was a good step forward assuring American leadership on global public health, which served to revive its role both in the MENA region and globally.

The U.S.-led world order has witnessed a big shift in terms of the role of China as a rising power. Indeed, the COVID-19 situation accelerated the competition between two powers. The future world order will no longer be defined by a single power; therefore one single country will find it difficult to lead this order. China has emerged from the COVID-19 pandemic as an influential actor; vaccine diplomacy has been effective in upgrading China’s relations with many poorer countries. This situation puts China in a favorable position to pursue global leadership, but the degree of its involvement will matter in the long term.

At least theoretically, there should be no natural conflict between the United States and China in the Middle East. Both share an interest in stability, and both are deeply invested in the status quo. The Chinese approach in the MENA region is more focused on economic and development integration, rather than challenging the interest of other nations. China is a leading regional power in terms of infrastructure and technologies. The vast growth in the Chinese presence in many areas, such as infrastructure, technology, clean energy, and finance, has contributed to boosting its foreign direct investment and provided employment opportunities in developing countries, which the U.S. and Western powers have failed to achieve.

China enjoys a strong friendship with most of most of the countries in the MENA region. China’s position in the region of course serves its interests – to maintain a stable domestic environment by focusing on economic cooperation – but overall China’s engagement with the region has been successful due to the declining U.S. role in the region, which has happened gradually over time. While the two powers’ competition includes the race to distribute vaccines, Chinese diplomacy will maintain its focus on prioritizing its interests without becoming involving in regional issues that might lead to a conflict with the United States.

Ultimately, neither the U.S. nor China has been able to be very successful in ending the COVID-19 pandemic. Their policies at home and globally prioritize their different values and  political systems. Subsequently, the pandemic has brought their competition to a sharper point.