Russian And Chinese Bilateral Vaccine Deals & Donations Outmaneuver Europe & United States
Minister of State for Masvingo Provincial Affairs and Devolution Ezra Chadzamira has today received his first dose of SinoPharm Covid-19 vaccine.

CAPE TOWN & KAMPALA – From Asia to the Americas, vaccines are fast becoming the new currency by which nations and geopolitical blocs wield influence and buy political favours – with more value than oil or bitcoin. 

But nowhere is this more apparent, perhaps, than in Africa, Latin America and south Asia, where both Russia and China are using bilateral SARS-CoV2 vaccine donations and deals to cement alliances with low- and middle income countries stung by the vaccine gold rush – in which high income countries have charged far ahead buying up limited supplies. 

Vast Trade in Vaccines 
The first consignment of AstraZeneca’s vaccine arrived in South Africa on 1 February

While global COVID-19 vaccine procurement and donations developments are very fluid, Health Policy Watch has tracked a vast trade in vaccines across Africa and other continents.  And it is clear that Chinese and Russian vaccines are deeply penetrating markets in many low- and middle-income countries (LMICs) – declarations of global solidarity by G-20 countries notwithstanding.

China reports that it has offered vaccine assistance to 53 developing countries, and that it has exported or is exporting vaccines to 22 nations, according to Foreign Minister Wang Yi. Meanwhile, by 25 February, Sputnik V had been registered in 37 countries.

In contrast, Western companies such as Pfizer/ BioNtech, Moderna, AstraZeneca/Oxford, and Johnson & Johnson, whose vaccine was the latest to be approved by the US Food and Drug Administration, are focused on a select group of high income countries in North America, Europe, the Middle East – peppered by only a few middle- or upper-middle income African or Latin American nations that teamed up with big pharma in clinical trials or swung heavily leveraged deals.  

Although the AstraZeneca vaccine is also being marketed to LMICs through the WHO co-sponsored COVAX global vaccine initiative, those sales are taking place through a separate license with the Serum Institute of India (SII). And there, too, SII has made a series of parallel, bilateral  deals, charging South Africa and Uganda 2-3 times the fee per dose, paid by Europe for the same vaccine.  

“As some high-income nations have already immunized more than 20% of their population with at least one dose, only a few African countries have reached even 1 in 1,000 people. It is frankly impossible to defeat the virus if these disparities persist,” says Solomon Zewdu, the Bill & Melinda Gates Foundation’s deputy director told Health Policy Watch, in explaning the desperate rush of others.

China’s Vaccine Outreach To Africa Began Months Ago

It is on the African continent where the Chinese vaccines are being marketed the most intensively – and perhaps embraced the most extensively. 

Beijing has confirmed that it is assisting 21 African countries to get vaccines, according to Foreign Ministry spokesperson Wang WenbinSignificantly, Egypt, Africa’s fourth largest country, has signed an agreement with China’s Sinovac to produce its COVID vaccine, as well as distribute it to other African countries. 

That represents the fruits of a Chinese vaccine outreach initiative that began months ago.


Sinopharm hosted an in-person delegation of some 50 ambassadors and diplomats on its factory premises.

Already in October of 2020, Sinopharm hosted an in-person delegation of some 50 African ambassadors and diplomats on its factory premises – in a period when Beijing was stonewalling over WHO requests to permit entry of just 14 scientists into Wuhan to investigate the origins of the SARS-CoV2 virus.  

“Sinopharm stands ready to work with the African people to deepen cooperation in the fight against and pandemic, consolidate China-Africa friendship and make an important contribution to the joint development of the China-Africa health community,” Company chairperson Liu Jingzhen told the visiting delegation at the time.  

“President Xi Jinping pointed out that after the COVID-19 vaccine is developed and put into use, it will take the lead in benefiting African countries.” 

Using a ‘Common Interest’ Approach to Cement Superpower Status

China had become an expert in public diplomacy on the continent using a “common interest approach” in its quest to cement its superpower status,  Dr Yazini April, co-ordinator of the BRICS (Brazil, Russia, India, China and South Africa) Research Centre at the Human Sciences Research Council in Pretoria, told Health Policy Watch in an interview. 

Its “vaccine diplomacy” involved three things, according to April: the country’s desire to be viewed as a “trusted friend, business and political control”.

While much of Africa is not yet part of China’s massive global transport “Belt and Road” infrastructure plan, often referred to as the Silk Road, “each country has something they can trade with, such as water in Lesotho etcetera”, she added, referring to the country’s abundant resources that provide water to parched South Africa and hydroelectricity domestically. 

On New Year’s Eve, Gabonese President Ali Bongo Ondimba promised his people that they would be among the first on the continent to get the COVID-19 vaccine. But by mid-February, when there were no signs of COVAX deliveries, Gabon turned to China and will soon get 100,000 doses of the Sinopharm vaccine. 

Many other African countries are receiving China’s Sinopharm vaccine. Equatorial Guinea has received a donation of 100,000 doses, Zimbabwe received 200,000 doses as did Sierra Leone. Algeria is set to receive 200,000 doses and Senegal has purchased 200,000 China’s Sinopharm doses, with rollout anticipated soon. 

Uganda has also been offered a donation of 300,000 Sinopharm doses. However, the modalities of receipt of vaccine have not been concluded, said Ugandan Health Minister Jane Ruth Acheng during a press briefing in Kampala last week.

China’s Foreign Ministry spokesperson Wang Wenbin said that the vaccine aid “is a clear manifestation of the China-Africa traditional friendship”,  adding that China will continue to provide support and assistance within its capacity and in accordance with the needs of Africa.

Russia – Also Present in Africa

While less active, Russia is also present too. South Africa’s regulatory authority confirmed to Health Policy Watch that it had received an application for licensing from Sputnik V’s manufacturer on 24 February and was in the process of considering the “safety, quality and efficacy of the vaccine”. The South African government has also confirmed that it is in talks with Sinopharm but has a non-disclosure agreement with the company.

In late December, Guinea, one of the world’s poorest countries – but also a Russian source of the mineral bauxite – started to vaccinate people “on an experimental basis” with Sputnik V. Most vaccinations so far have been of government officials. 

On 1 March, Ghana started its COVID-19 vaccine campaign with vaccines received from the WHO co-sponsored COVAX initiative – but still more are needed.

Ghana’s government also has said that it is considering securing some doses of Sputnik V under bilateral arrangements. Franklin Asiedu-Bekoe, Ghana’s Director of Public Health, confirmed that the country has “opened our doors outside the COVAX facility to ensure that more than 20 million Ghanaians are vaccinated. We have registered the Russian Sputnik V vaccine which will provide a backup of doses”.

Africa Centres for Diseases Control and Prevention (CDC) also is in contact with the producers of Chinese and Russia vaccines – which have no special requirements for transportation and can be stored at normal refrigeration temperatures.  John Nkengasong, the director of Africa CDC, said Russia has already submitted its dossier for the Sputnik V vaccine directly to Africa CDC – and an expert committee was reviewing their data and would come up with guidance. 

Whether or not Africa CDC will act on its own or wait for WHO remains to be seen. WHO officials have urged countries to procure only those vaccines that have received an “Emergency Use Listing” from WHO, or are approved by another strict national regulatory agency, usually understood to mean the US, UK or European Medicines Agency. In the case of both Sputnik as well as the Sinopharm and Sinovac vaccines, those WHO reviews are still pending, said Matshidiso Moeti, WHO’s  Regional Director for Africa. 

The WHO also has repeatedly urged both pharma manufacturers and countries to refrain from bilateral deals and procure their COVID-19 vaccines through the COVAX facility – although those pleas have largely been to no avail. 

“To maximimize the chance of getting fair price for COVID-19 vaccines, we are advising countries to use as much as they can the pooled procurement platforms that are in existence for the moment: COVAX or AVATT,” said Dr. Richard Muhigo the head of immunisation and vaccine development at the WHO Africa office. 

“If the countries decide to go for bilateral deals with vaccine manufacturing, our recommendation is to procure as much as they can vaccines that have been listed by WHO for emergency use,” said Muhigo. 

China and Asia
Thailand’s first shipment of vaccines arrives from China.

Between October and January, Chinese Foreign Minister Wang Yi visited every country in Southeast Asia except Vietnam, according to the Center for Strategic and International Studies

“At each of his stops, Wang coupled promises of Chinese vaccine access with other foreign policy priorities, including advancing major projects under China’s Belt and Road Initiative (BRI), which have been stalled amid the pandemic,” according to the CSIS.

In the Philippines, Wang promised half a million doses of Covid-19 vaccines along with $1.3 billion in loans and $77 million in grants for infrastructure projects. In Indonesia, the delivery of 3 million Sinovac vaccines has come with China’s commitment to “help Indonesia become a manufacturing hub for Chinese vaccines” and speed up a high-speed railway link, according to the center. 

In Myanmar, a promise of 300,000 vaccine doses was accompanied by talks to develop a  China-Myanmar Economic Corridor, which would also ensure that China’s Yunnan Province just over the border would gain better access to the Indian Ocean.

All in all, China says that it is providing vaccines to 14  Asian countries including Pakistan, Brunei, Nepal, the Philippines, Myanmar, Cambodia, Laos, Sri Lanka, Mongolia and the Palestinian Authority: “China has decided to donate COVID-19 vaccines to Palestine,” China’s UN Ambassador Geng Shuang told the Security Council in late February, during its monthly meeting on the Israeli-Palestinian conflict.  

The Palestinian Authority (PA), however, has so far spoken publicly only about its procurement of Russia’s Sputnik vaccine – after a high-level PA official visited Moscow last month and signed a contract. The PA is also receiving a dispatch of vaccines from the Global COVAX facility. On 22 February, Hamas-controlled Gaza, received a shipment of some 20,000 Sputnik vaccines, donated by the United Arab Emirates.  Israel, criticized for failing to share more of its supply of Pfizer vaccines, has given the PA a few thousand doses directly, and is now beginning to vaccinate some 140,000 Palestinian workers – along with Arab residents of East Jerusalem which both Israel and the PA claim.  

China has also been active elsewhere in the Middle East region, supplying the UAE, Iran, Bahrain, Jordan, Iran, Egypt and Morocco. However, the UAE, Bahrain, Kuwait, Oman, Qatar and Saudi Arabia have also bought the Pfizer vaccine.

Russia Makes Inroads in Europe & Latin America 

Meanwhile, Russia has mostly sewn up vaccine markets in Euroasia and is also making inroads in the European Union, according to official news agency Tass

“Hungary became the first EU country to receive samples of the Sputnik V vaccine for research. Austria, Germany, Greece, Italy, Slovenia, the Czech Republic and Finland have already expressed interest in the possible use of the Russian preparation or its local production in case of its approval,” reported Tass on 19 February.

Sputnik Favoured in Latin America

At least 10 Latin American countries have received Sputnik V, beginning with starting with Argentina on 30 December. Since then Belize, Brazil, Bolivia, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay and Venezuala have all received doses – some as small donations and others as paid orders. 

In Bolivia, vaccine talks were accompanied by discussions of Russian assistance to develop gas reserves, restart a nuclear plant project and co-operate on lithium mining, according to Reuters.

Russia has also licensed manufacturing companies to produce its vaccine in India, Brazil, China, South Korea, and Argentina.

Argentina, Brazil, Bolivia and Mexico are getting both the Sputnik and Sinopharm vaccines, while Colombia, the Dominican Republic, Ecuador, Peru, Chile and Uruguay have only secured the Sinopharm vaccine so far.

Political Power or Donations to the Global Public Good ? 
China’s Xi Jinping in 18 May 2020 address before the World Health Assembly

Although China has been accused of donating its Coronavirus vaccines for political power, Chinese President Xi Jinping has stressed at recent meetings of the World Health Assembly that it viewed its COVID vaccines as a global “public good’. 

China has also joined the global vaccine access platform, COVAX, and promised it 10 million doses.  However neither of the two leading vaccine candidates, by Sinpharm and Sinovac, have been approved by an external regulatory agency – and discussions are still continuing, according to WHO officials.

Nor have the Chinese vaccine developers published peer-reviewed studies on their vaccines. Company reports show Sinopharm’s multi-country trials yielding efficacy results  of 79%, while Sinovac trials from four different countries showed results ranging from 91.3% in a Turkish trial to 50.3% in an independently managed  Brazilian trial among health care workers. 

In the case of Russia’s Sputnik V vaccine, the Gamaleya Institute developers together with the Russian Direct Investment Fund (RDIF) say they have submitted the vaccine portfolio to the  European Medicines Agency for review.  And a Lancet report on Phase 3 trial results, found the vaccine to be 90% efficacious against the SARS-CoV2 virus.  But the CEO of the  RDIF has also stated that it prefers to deal directly with countries rather than via the global COVAX facility.

Meanwhile, in the absence of other approvals, individual countries ranging from upper middle income Chile to impoverished Zimbabwe have taken matters into their own hands – registering Chinese or Russian vaccines for emergency use – regardless of the capacity of their regulatory authorities. 

And regardless of regulatory status, China and Russia have taken advantage of the three-month interval between the start of vaccine drives in wealthy countries and the launch of the COVAX facility’s global vaccine distribution effort in lower and middle-income countries, beginning just this past week in Ghana, Cote D’Ivoire and Nigeria.

COVAX Enters The Picture 

Now that COVAX has finally started the first allocations, with the aim to deliver some 2 bllion vaccines in 2021, it may soon eclipse the individual bilateral efforts of China and Russia. Or will it? 

In fact,  COVAX is only likely to reach about 20% of the populations of countries that have joined the facility by the end of the year.  So given the global vaccine thirst, Russian and Chinese vaccines will likely continue to find willing markets, at least in the near-term.

If the Russian Sputnik is finally approved by the EMA – the doors to much wider distribution in Europe and elsewhere will open much wider – particularly in light of the vaccine’s affordable US$ 10 price tag per dose. 

However, China appears unlikely to submit its Sinopharm and Sinovac vaccines to the EMA – or to any other strict western regulatory agency for review and approval.  

So what remains to be seen, against the landscape of unmet demands as well as enormous political pressures, is how WHO will handle the delicate balance of science and politics that could surround the review of the Chinese vaccines’ efficacy for a WHO Emergency Use Listing.

Image Credits: TellZimbabwe/Twitter, GovernmentZA/Flickr, CGTN, Flickr: Francis Kokoroko/UNICEF, the foreign photographer/Flickr.

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