This book unpacks the political economy of China’s COVID-19 vaccine supplies to the Global South. Examining the political and economic forces at play, the book demonstrates how China’s vaccine provisions have been determined by a complex set of commercial interests, domestic politics, and geopolitical relationships.
The book sheds light on how domestic interests shape China’s role in global governance and its international economic engagement. Its analysis contributes to broader academic debates on the politics and economics of crises, as well as offering new insights on how pre-existing political and market forces shape aid and trade in the context of crisis.
This concluding chapter summarizes the book’s core arguments and findings, namely that China’s overseas vaccine supplies are driven principally by commercial imperatives, as well as by the party-state’s need to maintain its performance-based legitimacy domestically. It then discusses some broader implications of this analysis. With respect to China’s foreign relations, the findings of this book point to the importance of domestic factors and state-corporate linkages in shaping China’s external interactions. With respect to international political economy, they offer insights into how crises are shaped by existing institutions and patterns, but also provide new opportunities for actors able and willing to seize them. The chapter finishes by looking ahead to the future of Chinese vaccine supplies overseas as production and exchange of COVID-19 vaccines becomes a routine transaction. It outlines both the challenges of increasing competition from other players (in particular, those further ahead in the use of mRNA technologies) and successive variants of the virus, as well as promising opportunities for further development, in particular in vaccine manufacturing collaborations in the Global South.
This chapter lays out the pre-pandemic initial conditions that shaped China’s overseas COVID-19 vaccine supplies by contextualizing China’s position in global health in recent history. First, it describes China’s domestic health governance and its increasing importance to the party-state’s performance-based legitimacy, in particular following the outbreak of the COVID-19 pandemic. Next, it charts China’s role in health sector foreign aid and international health governance institutions, highlighting Beijing’s longstanding preference for bilateral cooperation over multilateral engagement through institutions such as the WHO. Finally, it describes China’s position in the global pharmaceutical industry and vaccine markets, which has expanded rapidly in recent years – facilitated in part by state support for technological innovation – but nonetheless pre-pandemic was relatively weak compared to other major industrialized economies.
This chapter sets the scene for the analysis in the remainder of the book. It describes the developmental and health impacts of the COVID-19 pandemic in the Global South, as well as the inequities in global vaccine supplies, in particular during the first wave of the vaccine rollout in which vaccine nationalism in the West created a space for China to step in to. It then situates the book in context by reviewing existing understandings of China’s relationship with the Global South, and of the political economy of crises. Next, the chapter summarizes the analytical framework and main argument: that the distribution of Chinese COVID-19 vaccines was shaped by the ‘opportunity management’ of state and corporate actors, with the former seeking to consolidate their performance-based legitimacy and the latter to expand internationally into new products and markets. Finally, the chapter describes the data sources and provides a roadmap of the book.
This chapter examines commercial vaccine exports from Chinese manufacturers, which were the majority of Chinese vaccine doses administered abroad during the first half of 2021. It first reviews the histories of the companies involved, including Sinopharm (officially known as China National Pharmaceutical Group Corporation), which is an established central state owned enterprise under the State Owned Assets Supervision and Administration Commission (SASAC), and Sinovac and CanSino, which are both relatively young private firms started by entrepreneurial scientists, and were little known before the pandemic. It then describes how these companies each leveraged state support to quickly develop and bring to market their vaccine candidates. Finally, it maps patterns in Chinese vaccine sales during the initial mass vaccination rollout, which were driven both by standard market forces of supply and demand, and by clinical trial partnerships between manufacturers and host states.
This chapter examines China’s official donations of COVID-19 vaccines. It first briefly reviews competing narratives on Chinese vaccine supplies outside China (grand strategy of ‘vaccine diplomacy’) and inside the country (‘global public good’), and explains why neither is particularly helpful in explaining patterns in the actual distribution of China’s vaccine donations during the first half of 2021. It then empirically charts those patterns, showing that – in line with the state’s performance-based legitimacy goals – Asian neighbours were prioritized over traditional aid recipients in Africa. The evidence suggests Beijing’s vaccine donations were motivated mainly by a pandemic-induced desire of Chinese officials to avoid ‘imported infections’ at home (and their potentially significant consequences for domestic legitimacy) and maintain regional stability, and relatedly by pre-existing strategic partnerships with the country’s neighbours.
To date there have been six PHEIC declarations, as well as several other health emergencies that have been considered as potential PHEICs. These non-PHEIC events fall into two distinct categories: those considered by an EC, but not declared a PHEIC; and those for which an EC was never convened, but which objectively met the criteria for declaration. In this chapter we examine each of the health emergencies declared a PHEIC in turn, followed by the non-PHEIC events. In doing so we explore how the criteria to declare a PHEIC have been understood and applied by the DG and the EC, as well as the wider considerations that each of these actors might have taken into consideration when fulfilling their functions in respect of a PHEIC under the IHR. In doing so, we demonstrate the overarching findings of this book: that the criteria to declare a PHEIC have been subject to broad interpretation by the EC beyond the legal text, which have been subsequently improperly validated by the DG in accepting the advice of EC. We structure each section first with a background to the context of the health emergency, second with detailed analysis of the apparent PHEIC decision making, third with consideration of the TRs recommended, and finally with analysis of the additional lessons learned about the broader PHEIC, IHR process and global health security. In the analysis we centre on the initial declaration of the PHEIC, and only consider later EC meetings for each disease outbreak if they are a noteworthy change in advice provided or justification.
The PHEIC mechanism has been fraught with tension since it was first introduced in 2005, with the revisions to the IHR. As this book has shown, the declaration process and decision making underpinning a declaration are the source of many of the inconsistencies regarding the PHEIC.
In the wake of COVID-19, and the widespread failures of the global health architecture to manage disease transmission, many elements of the system will come under review, and likely reform. While it is too early to know the outcomes of such processes, it is likely that the IHR will be revised in some format in the coming years, or be replaced by, or replicate, a similar mechanism through the proposed ‘pandemic treaty’. We write this book to inform such discussions and demonstrate the need to ensure that any power bestowed upon the DG is exercised in a reasonable and proportional manner. In doing so we highlight the following arguments.
First, the PHEIC criteria, as laid out in the IHR, have been inconsistently applied by the DG and the EC throughout the history of PHEIC declarations and non-declarations. To this end, there have been PHEICs declared that do not appear to meet the objective criteria found at Article 1 (and nor did the EC describe these as such). Equally, there have been other events whereby the criteria appear to have been met, but no EC was convened by the DG, or an EC was called, and a PHEIC was not declared.
Amid a global health crisis, the process for declaring a Public Health Emergency of International Concern (PHEIC) is at a crossroads.
As a formal declaration by the World Health Organization, a PHEIC is governed by clear legislation as to what is, and what is not, deemed a global health security threat. However, it has become increasingly politicized, and the legal criteria now appear to be secondary to the political motivation or outcome of the announcement. Addressing multiple empirical case studies, including COVID-19, this multidisciplinary book explores the relationship between international law and international relations to interrogate how a PHEIC is declared and its role in how we collectively respond to outbreaks.
Further to the case studies in the previous chapter, we also sought to understand whether the same inconsistencies were present in outbreaks that were not declared a PHEIC. Within this chapter we consider events for which the DG convened an EC, but which did not result in a PHEIC declaration and second, we also consider events the DG did not convene an EC for, despite the criteria appearing to be met. Considering these events enables us to have a clearer understanding of the use of executive discretion by the DG in regard to the PHEIC, particularly in respect of when an EC is convened, and the relationship between the DG and the EC. We find that multiple DGs failed to convene ECs to consider an event a potential PHEIC, despite the criteria to do so appearing to be met. We further show that the DG is unwilling to go against the advice provided by the EC, even when, as was the case with MERS-CoV, it was apparent that the criteria to declare a PHEIC had been met. This is unusual, given the advice of an EC is one of multiple considerations the DG needs to consider when determining whether a PHEIC declaration is warranted, and goes some way towards demonstrating the extent to which certain aspects of the DG role have been fettered away to the EC.
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus, which is transferred to humans from camels.