Michael B. Greenwald, Michael A. Margolis
The coronavirus has catalyzed many global shifts and exposed growing rifts in society. Along with increasing unrest and separation amongst its domestic population, the role of the United States as the leader in the international community has been called into question. Coinciding with more American threats for unilateral withdrawal from global partnerships is the rise of China as a viable option for geostrategic leadership. Over the past several years, China has dedicated resources to supporting emerging markets, and now competes with the United States as an alternative and often preferred geoeconomic partner for many emerging market countries. Traditionally, in the case of natural disasters and shared threats around the world, American leadership has played a central role in rebuilding communities, economies, and multilateral support initiatives. However, in the most recent iterations of its foreign policy, retrenchment and a dialing back of international goodwill have defined its administrative priorities.
Throughout history, there have been very few moments that incorporated such a vast number and variety of the world’s state actors. In the age of coronavirus and the search for a vaccine solution that could revitalize the global economy, leadership in the international community is needed more than ever. While countries compete to launch their own medical solutions and become the hero that finally stems the flow of negative effects from the pandemic, a central question arises: When a vaccine is accepted for widespread use, how will it be distributed? With newly announced positive vaccine results from Moderna and Pfizer trials, it is clear that a solution is coming. Domestically, healthcare workers, vulnerable populations, and non-healthcare essential services workers will largely be the first to receive vaccinations. What should be the distribution priorities to the rest of the world?
If the United States wishes to sustain the past eighty years of its global leadership and set the stage for the next phase of American diplomatic negotiations with the international community, the extent to which it chooses to participate in rebuilding the shattered post-coronavirus global economy will be the most visible signal of its intentions to return to the global community and remain connected to issues of mutual interest in coming years. Further, how it participates will also signal the relative balance of its economic, strategic, and ethical priorities, with the potential to positively influence its future opportunities.
Historical Case Studies (Polio, SARS, HIV/AIDS)
In the past, when the world was faced with lasting crises linked to natural disasters or infectious disease, the United States took the initiative to stem the negative effects and lead the recovery. In the case of mitigating threats from past pandemics, the United States has a lengthy resume of taking action. American policymakers have signed on to the “Polio Endgame Strategy” 2019-2023, spent more than $50 billion on AIDS relief in Africa, saved more than 43 million lives from Tuberculosis related death through USAID funding, and led the response to the Ebola outbreak that originated in 2014. For every major pandemic response throughout the past century, the United States has fought to be at the forefront of the charge, rallying support and resources to aid the most affected countries.
However, at the beginning of 2020, the United States was hardly prepared to combat COVID-19, let alone come to the aid of other nations in their battle against the disease. Instead, the world was introduced to a new leader in the charge, who had plenty of equipment and resources to lend a hand to their neighbors. Countries from all over the world that rely on China as a global production and distribution hub for all types of products, quickly sought support from their troves of personal protective equipment (PPE), ventilators, and other medical devices. Having already dealt with the virus for several months before the more substantial outbreak rocked the international community, China was more than willing to engage in some variation of “mask diplomacy” to improve their global standing. While China and the United States dealt blows back and forth, attempting to pin the other for their role in irresponsibly spreading the virus, the east Asian country“…exported more than $1.4 billion of pandemic supplies from March 1 to April 4.” Regardless of whether or not anyone thinks that China should hold the primary responsibility for the outbreak of COVID-19, it has certainly stepped up to the plate and provided leadership for the world in its response plan. Its deployment of face masks, PPE, and ventilators to scores of countries has outshined American efforts, which have been very limited in their approach. In fact, the meager international response that the United States has embarked upon is highlighted by the $2 trillion stimulus package that was released earlier in 2020, of which only $1 billion was earmarked for spending outside the US.
Meanwhile, the United States has signaled its desire to withdraw from the World Health Organization (WHO) during a time when many other countries are signing on to a global vaccine initiative (COVAX), and Chinese President Xi Jinping has stated that he expects China to “…take an active part in leading the reform of the global governance system.” China has also stated its plans to be carbon neutral by 2060, leading the charge of yet another shared global challenge for the coming years. According to Eyck Freymann and Justin Stebbing in an essay in Foreign Affairs, “If Washington keeps refusing to compete, it won’t just risk losing the vaccine race. It will allow China to win the prestige of a first-rate technological power, the goodwill of a slew of new potential allies, and a legitimate claim to global leadership.”
Vaccine Diplomacy
Global health and global diplomacy were informally linked until the late twentieth, early twenty-first century. There were many loose historical collaborations; in the 1950s and 1960s, international collaboration efforts led to the development of an oral polio vaccine and a smallpox vaccine. A conference in Almaty, Kazakhstan in 1978 led with the Declaration of Alma-Ata associating economic and social development with health and, in this context, further linking health care and politics. Ultimately, in 2000, The United Nations’ Millennium Declaration, in conjunction with the seminal report of the World Health Organization’s “Commission on Macroeconomics and Health” published in 2001, firmly linked global health and global diplomacy.
As the international community has continued to struggle through 2020, it has reached a new inflection point – and reason for hope – as potential vaccine solutions reach the final stages of testing. With over 90% efficacy, both the Moderna and Pfizer vaccines seem to have great potential in providing the first steps back to a “new normal”. While the United States has made critical breakthroughs in approving some of the first vaccines for widespread use, China, Russia, and England have all also been strong competitors in the race for a solution.
As citizens of the world await the availability of such a vaccine and the ability to move freely about the globe once again, new questions of diplomacy, multilateral approaches, and strategic deployment once again come to the fore. It has been widely accepted that the first to receive any vaccine will be healthcare workers, vulnerable populations, and non-healthcare essential services workers. However, once the domestic populations are assured safety from the virus, how will countries with surplus address global distribution?
China and the United States will face each other with competing offerings, and their handling of the situation will have tremendous impact on the shaping of a post-COVID-19 world. Both countries should wisely make surplus vaccines accessible to the world at an affordable price. However, which countries specifically get the vaccine, when they get it, and the diplomatic package attached to it, are all still to be understood.
China combines a public relations campaign with medical teams, scientific research assistance, hospital equipment, PPE, loans, and financial aid. In its narrative, the U.S. is characterized as nationalist and increasingly disengaged; Europe is slow and bureaucratic, and China is stepping up to do its part. In truth, China is running with this leadership opportunity and its intentions are not purely altruistic. Indo-Asian News Service reports that “China deliberately delayed divulging details of the genetic material of the coronavirus, that originated in Wuhan at the end of 2019, which had handicapped efforts of other countries to develop a vaccine to fight the pandemic.” China has targeted specific parts of Europe, Turkey, Indonesia, Philippines, Brazil, Africa, and areas of the world that are open to confronting Western democracies, especially those that have benefitted less from capitalism or feel left behind by government assistance measures.
China’s assistance is designed to repair its image, increase its prominence within global multinational institutions such as the G20, World Bank and IMF; gain recognition as a global public health provider; gain leverage in political disputes (e.g., South China Sea); further integrate its economy with regional countries, and give a boost to its domestic industries. China’s Sinovac Biotech, for example, will provide vaccines to Indonesia. Indonesia will test the vaccine and Indonesia’s Bio Farma will gain the right to manufacture the doses locally. According to Aleksius Jemadu, professor of international politics at Indonesia’s Pelita Harapan University, "China is very enthusiastic about this vaccine partnership with Indonesia because, unlike partnerships in other [sectors], it is uncommonly binding.” China’s assistance is aligned with its Belt and Road Initiative (BRI) to realign trade and trade governing systems with an Eastern point of view. In this instance, China will further the development of its “Health Silk Road” which will leverage its BRI logistical infrastructure to deliver medical support and potentially health surveillance technologies as well.
Historically, the United States also provided assistance with strategic intent. In the 1930s, the Roosevelt administration used the Export-Import Bank to blunt the rise of Japan. U.S. post-World War II European assistance was designed to contain Russia and its communist philosophy. More recently, the United States’ health distribution priorities were driven by human well-being and gave priority to methods that save lives and restore economies. The United States pursued an epidemiology-based approach. Today, ethical considerations feature even more prominently in American assistance decisions. The discussion surrounding giving greater aid to lower-income countries to avoid reinforcing disparities provides an example. Nobel Prize recipient in Medicine Dr. William G. Kaelin Jr. of Dana Farber Cancer Institute said that “vaccine distribution should be based on science and not politicized. The distribution should be a data driven approach where the United States and other countries should behave ethically,” and Kaelin hopes the United States will take the high road in this vaccine distribution area. Kaelin believes that this moment is an “opportunity for the United States to lead and it would be a fool’s errand to map who paid for what as the sole basis for how to distribute the vaccine.” A vaccine solution Kaelin said “was made possible because of the knowledge generated by decades of research from many countries around the world.” In its global response to COVID, the incoming administration will have to decide where it stands in the balance between economic, strategic, ethical and other driving considerations when determining its vaccine policy. Its stance should be transparent. A strong proposal to the world will compete with China’s offering and serve as an alternate pole for the many countries determining where on the spectrum they lie on critical societal issues: democratic versus autocratic; capitalist versus socialist; nationalist versus humanitarian. This will help them chart their future path as a responsible – or irresponsible – member of the international community.
A Strategy for Managing Global Leadership
If American leadership displays another unilateral attempt to exit the international community and China steps up to the plate, supplying the world with life (and economy) saving vaccines, the historical role of the United States as a global force for good may be further undermined. In an optimal scenario, American policymakers will begin to position themselves as the favorable alternative to China, understanding that it is a rising influence that cannot go unchecked. While competition between the two in areas such as vaccine diplomacy – if handled properly – could be a substantial force for good in the world, leaving shared areas of international interest to an authoritarian regime is destabilizing in the long run. Though in the age of a pandemic this is not a zero-sum game, where a “loss” for China equals a “win” for the United States, longer-term effects of changed global leadership now could have resounding influence on the future of international partnerships. Multilateralism, competition, and cooperative initiatives have solved global problems in the past and have the potential to do the same in the future. If China takes on the role of global leader and partner, do debt traps, a lack of international standard operating procedures, and authoritarian governments become the norm? The traditional role of the United States as a consistent, reliable partner that takes the moral high ground and strategically plans alongside allies in times of crisis, is being challenged.
Policy Recommendations
The American COVID-19 vaccine distribution strategy, as part of a more comprehensive policy, affords an immediate opportunity for reengagement. From an economic perspective, seeing to the well-being of the U.S. economy and its most important supply chain partners should be a priority; these countries include Mexico, China, Canada, Japan, Germany, United Kingdom, India, South Korea, among others. Ongoing shifts in the U.S. supply chain away from China further favor Mexico and southeast Asian low-cost countries, which have improved their supplier bases and manufacturing labor forces. Many industries and some critical have been impacted; they include health care, construction machinery, automation /robotics, semiconductors, electrical equipment, software, consumer durables, apparel, and food and staples retailing among others. The U.S. should aim to expand the number of countries participating in its trade agreements and the scope of these agreements as well. For example, a COVID-19 vaccine trade and investment agreement could alleviate inefficiencies in the global distribution system -- such as fears that elements of the supply chain like adjuvants, hospital-grade pulp or ventilator motors, could be held up for leverage in obtaining more of the vaccine. In lower-income countries, the U.S. could facilitate investment in local manufacturing and distribution capacity for promising vaccine candidates.
From a strategic perspective, vaccine access opens the door to developing long-term health security arrangements. Accordingly, the U.S. might consider expanding the five eyes (Australia, Canada, New Zealand, The U.K. and the U.S.) to include Japan. It may also consider expanding the intelligence arrangement to include the pooling of key strategic reserves such as critical minerals, technologies, pharmaceuticals and medical supplies. Other strategic matters for consideration include promoting investment in medical research and development, and strengthening the protection of intellectual property and export of critical technologies.
Ethical considerations should be fully embraced as well. The United States could begin by recommitting to the World Health Organization and supporting the COVAX Facility. It should assist low-income countries and remote populations in receiving immediate assistance because it’s the right thing to do. And if this is not adequate incentive, the U.S should recognize an outbreak anywhere, can readily translate into an outbreak everywhere. Africa should not be forgotten; without a U.S. vaccine offering for Africa, the continent will have little choice but to capitulate to Beijing’s vaccine and concomitant offerings, meaningfully displacing the U.S. opportunity in this part of the world. Mitty Professor of Bioethics at NYU Grossman School of Medicine Arthur Caplan has said that “When thinking about how to distribute vaccines America needs to prioritize taking care of its own who are most in need. Once that is done, we need to shift to helping our friends and allies since the very notion of an ally is a nation that has legitimate expectations of assistance. Then, we need to push vaccine toward nations that can make a difference in restoring the economy—all boats will rise if certain nations can return to economic normality. Ethics and pragmatism can overlap in allocating vaccines beyond the U.S.—helping our friends is both prudent and right.”
Certainly, the relative balance of economic, strategic and ethical considerations merits deep consideration. The totality of the American offering should produce a more compelling route forward for the world than the Chinese alternative. The American COVID-19 vaccine response in 2021 is a long-term investment for the United States. This moment holds the opportunity to emphasize its position as the preferred alternative to China when it comes to economic, strategic and ethical decisions – it would be remiss to ignore the diplomatic significance of its vaccine deployment strategy in 2021.
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