Nikita Rakhyani faces a long, uncertain wait.
Like most healthy, working-age adults across the world, she is at the back of the line for the COVID-19 vaccine. In the case of India, the massive queue is not surprising when one considers its total population of over 1.3 billion, more than four times that of the United States.
“I know that I’m not getting the vaccine for at least a year. So I’m not even thinking about it,” said Rakhyani, who lives in the capital New Delhi.
India is widely considered as the nerve center of the world’s vaccine supply chain. And it’s not alone in the race to supply the global community with direly needed vaccines as the pandemic shows little signs of abating, entering a second wave with the emergence of new strains of the dreaded virus. Meanwhile, many of its citizens including Rakhyani are facing extended wait times, with millions of doses manufactured within its borders earmarked for export to other countries.
China, too, has emerged as a major COVID-19 vaccine supplier to the developing world. Both India and China have stepped in as wealthy nations in the West face accusations of vaccine hoarding.
While tackling the monumental task of inoculating their huge populations, these two countries must also perform a delicate balancing act: meeting domestic demand while boosting their economic and political interests.
As major vaccine producers, China and India must perform a delicate balancing act: tackling the monumental task of inoculating their huge populations and supplying vaccines to other countries.
Vaccine diplomacy
India, which manufactures about 60 percent of vaccines globally, started the world’s largest COVID-19 vaccination drive in the world in mid-January. It has approved two vaccines for emergency use — the Oxford University/AstraZeneca vaccine (known locally as Covishield) and Covaxin (domestically produced by local firm Bharat Biotech) — and plans to inoculate 300 million people by August. About 90 percent of people included in the first tier are over 50 or have underlying illnesses that make them vulnerable to the coronavirus.
The first phase of the country’s vaccination drive, while dwarfing the number of doses in other COVID-19 hotspots such as the United States and the United Kingdom, will only cover less than a quarter of the total population. India aims to hit the minimum threshold of 60 percent. Yet, it has committed to export vaccines to Saudi Arabia, Brazil, Morocco, Mexico and South Africa. The largest commitment is with Saudi Arabia. In late January, the Serum Institute of India (SII), the Indian biotech firm that owns the distinction of being the world’s largest vaccine maker, announced that it would supply three million doses of the AstraZeneca vaccine to the Gulf state. SII supplies orders on behalf of AstraZeneca. However, it can agree to deals on its own.
Aside from importing doses for profit, India has also engaged in a vaccine diplomacy, donating millions of doses to friendly neighboring countries such as Nepal, Bangladesh, and Bhutan. Notably absent from its donation list is Pakistan.
The two countries, both of which are armed with nuclear weapons, have been on opposing sides of three wars since gaining independence from the British in 1947. In 2019, tensions between the two countries rose again due to the disputed territory of Kashmir.
Pakistan has, in turn, embraced India’s competition in its quest for using soft power to tame its neighbors. China has pledged to donate 500,000 doses of its Sinopharm vaccine to Pakistan. Another Chinese vaccine from CanSino Biologics has also conducted its final clinical trials in the country.
Yawning gap between rich and poor
Vaccine breakthroughs achieved in less than a year offer hope to a pandemic-weary world. But they also lay bare structural inequalities.
Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, has denounced the gap between rich and poor nations in terms of vaccine access, which has led to strained supplies of the Pfizer and Moderna vaccines.
“As the first vaccines begin to be deployed, the promise of equitable access is at serious risk,” he said in his opening remarks at the WHO’s 148th session of the Executive Board in January.
“More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25.”
As India and China are boosting the immune systems of neighbors, with varying methods of international cooperation, they are helping fill a void in poorer countries waiting on the sidelines for vaccines.
SII has partnered with AstraZeneca, the Gates Foundation, and the Gavi vaccine alliance to manufacture one billion doses for poor countries. China, on the other hand, has struck deals to conduct final-phase trials in more than a dozen countries, including Brazil, Bahrain, Pakistan, Bangladesh, Morocco, United Arab Emirates, and Indonesia. It has also combined vaccine donations with infrastructure loans.
COVID-19 vaccination drives in Asia, which are moving in different phases, are fraught with challenges, including the interplay of public health and geopolitics.
Vaccine fears
Indian and Chinese vaccines have different reputations in terms of safety and efficacy. In the competition to become Asia’s savior, India has a clear edge due to its ties to scientifically trusted corporations from the West. China, on the other hand, has reinforced fears that it has politicized and rushed the vaccine. Before even completing clinical trials, the country administered more than a million doses of the Sinopharm vaccine to its own citizens. What makes this more egregious is the fact that Sinopharm figured in a scandal involving defective vaccines in 2018.
Publicly available data shows that Chinese vaccines are much less effective than its Western counterparts. The Sinovac and Sinopharm vaccines have efficacy rates of 50.4 percent and 79.3 percent, which are much lower compared to the 95 percent and 94 percent efficacy rate for the Pfizer and Moderna vaccines.
With many countries purchasing vaccines from multiple sources, demand has become tiered in some developing nations, with Western-made vaccines at a premium. In places like the Philippines, this has caused internal friction, with the government facing questions for its preference for China’s Sinovac vaccine.
The Philippine government initially refused to reveal the vaccine’s price due to a non-disclosure agreement. This caused a backlash against the administration of President Rodrigo Duterte, with many questioning how a non-disclosure provision can take effect in a deal involving public funds. Initial estimates from the country’s Department of Health had the price at 3,629 pesos, or about $76, for the two doses of the vaccine. This was much higher than that of AstraZeneca (610 pesos or about $13), Novavax (366 pesos or about $8) and the COVAX facility vaccine (854 pesos or about $18). On January 18, the Philippine government finally revealed the “Best Friends Forever prices” that it got from the Chinese government. Officials released a ballpark figure of 650 to 700 pesos (around $14 to $15), and said that the exact price would only be revealed once the procurement agreement for 25 million doses was signed.
Lawmakers suggested that there was corruption in the procurement process, citing lower prices for the vaccine in other Southeast Asian countries. According to media reports, Sinovac’s CoronaVac vaccine was priced at around 240 pesos (about $5) in Thailand and 670 pesos (around $14) in Indonesia.
When COVID-19 vaccines arrive in the Philippines (the target delivery date for Sinovac is March), there is a possibility that it would be a tough sell to health workers, who are first in line for the shots.
“I’m not too keen on it,” said Micco Sollano, an internal medicine physician who was one of the first health workers to recover from the virus in the country.
“I’m hesitant to get the vaccine,” added Karen, an internal medicine doctor in Manila who requested not to be identified.
Nonetheless, there is a possibility that brand recognition may move the needle in terms of uptake of the vaccine for health workers.
“For personal preference, obviously you’d want the best. From what I know, Pfizer and Moderna still have the best efficacies for the vaccine, Sollano said.
“Am I going to risk a vaccine like Sinovac that has only 50 percent [efficacy]? Maybe, just because it’s still a 50 percent chance. At the end of the day, a 50 percent chance is better than no chance at all… But obviously, you always want the best for yourself.”
Indonesia, which has the worst COVID-19 outbreak in Southeast Asia with over a million infections, has likewise thrown its lot with the Chinese vaccine. It ordered 125 million doses from Sinovac, which is five times the number of doses headed to the Philippines.
The government, which initially didn’t take the pandemic seriously—it believed that tropical weather would slow down transmission—has a tougher sell with the vaccine. First, it has to convince people that the virus is real.
“There are still many people who say COVID-19 is a hoax,” said Tatat Sukarsa, the program manager of the International NGO Forum on Indonesian Development.
To sway the populace, authorities have embarked on a PR blitz. It launched its vaccination drive with President Joko Widodo getting the vaccine on live television. Next in line were Instagram influencers, who have outsized influence in a country that ranks near the top in world rankings for spending the most time on social media.
But the Indonesian government still has a lot of minds to change. An earlier poll showed that only 37 percent of the population were willing to get the COVID-19 vaccine.
This Indonesian people’s hesitancy about inoculations tracks with the prevailing attitude across most of Asia. Based on a poll conducted by global market researcher Ipsos, one of the most skeptical countries in the continent is South Korea, with only 14 percent saying they would get the shot. The numbers were similarly low in places like the Philippines (32 percent), China (23 percent), and Japan (22 percent). These figures are significantly lower compared to those outside the region such as the UK (65 percent), Germany (55 percent), and the US (53 percent).
No matter the provenance of the vaccines and the political leverage that is created in the process, to some, the long, uncertain wait may be one that’s deliberate. ●
Christian Brazil Bautista has worked in the United States and the Philippines, reporting and editing for The Real Deal, Digital Trends, Financial Times, Real Estate Weekly, Yahoo! Southeast Asia, and Rappler.
