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Why China’s Vaccine Internationalism Matters

Qiao Collective

United Nations Secretary-General António Guterres called it “the biggest moral test” facing the world today. World Health Organization Director General Tedros Adhanom warned of a “catastrophic moral failure” whose price would be paid with the lives of those in the world’s poorest countries.

Such cautionings of inequitable global vaccine distribution have been shunted to the margins; instead, optimistic chatter of “returning to normal” is circulating once again as Global North citizens line up for their long-awaited COVID-19 vaccine. But normal, as ever, is relative: public health advocates warn that some countries may not be able to even begin their vaccination campaigns until 2024.

Vaccine apartheid is here, and it is revealing once more the ways our world continues to be structured by the geopolitical binaries of colonialism, capitalism, and racism. The People’s Vaccine Alliance reports that rich countries have bought enough doses to vaccinate their populations three times over. Canada alone has ordered enough vaccines to cover each Canadian five times over. Until March, the United States was hoarding tens of millions of AstraZeneca vaccines—not yet approved for domestic use—and refusing to share them with other countries (only under immense pressure did the Biden administration announce it would send doses to Mexico and Canada). Israeli officials, lauded for delivering a first dose to more than half of its citizens, have likened their responsibility to vaccinate Palestinians living under apartheid to Palestinians’ obligation to “take care of dolphins in the Mediterranean.” The European Union has extended controversial “ban options” which allow member states to block vaccine exports to non-EU nations. Meanwhile, countries like South Africa and Uganda are paying two to three times more for vaccines than the EU.

While the Global North hoards global vaccine stockpiles, China—alongside other much-maligned states such as Russia and Cuba—is modeling a very different practice of vaccine internationalism. As of April 5th, the Foreign Ministry reported that China had donated vaccines to more than 80 countries and exported vaccines to more than 40 countries. Science analytics firm Airfinity reported that as of March 2021, China had shared 48% of domestically-manufactured vaccines with other countries through donations and exports. By contrast, the United States and United Kingdom had shared zero. China has also partnered with more than 10 countries on vaccine research, development, and production, including a joint vaccine in collaboration with Cuba.

Crucially, China’s vaccine sharing has provided a lifeline to low-income Global South nations who have been out-bidded by rich nations racing to stockpile Western-made vaccines. Donations to African nations including Zimbabwe and Republic of Guinea, which both received 200,000 Sinopharm doses in February, have allowed those countries to begin vaccine rollouts for medical workers and the elderly rather than wait months or even years for access to vaccines through other channels. Just a week after Joe Biden ruled out sharing vaccines with Mexico in the short term, the country finalized an order for 22 million doses of China’s Sinovac vaccine to fill critical shortages.

Even more, Chinese vaccine aid has reached countries isolated from global markets by sanctions and embargoes enforced by the United States and its allies. In March, China donated 100,000 vaccines to Palestine, a move praised by the Palestinian health ministry for enabling the inoculation of 50,000 health workers and eldery in Gaza and the West Bank who have been cut off from accessing Israeli vaccine rollouts. Venezuela, with many of its overseas assets frozen by U.S. sanctions, received 500,000 vaccines donated by China in a gesture praised by Nicolás Maduro as a sign of the Chinese people’s “spirit of cooperation and solidarity.” China’s international vaccine policy follows the broad pattern of China’s early pandemic aid, which similarly equipped low-income and sanctions-starved nations with the tools to combat the pandemic at home.

In the face of a global pandemic that the U.S. alliance has used as a political cudgel against China, China’s vaccine internationalism has been a natural outgrowth of its philosophy of mutual cooperation and solidarity. From rapidly sequencing the viral genome and making it immediately publicly accessible to world researchers, to sending medical delegations to dozens of nations around the world, China’s pandemic response has been guided by a simple axiom of global solidarity. Xi Jinping made China the first nation to commit to making a COVID-19 vaccine a global public good in May 2020, meaning any Chinese vaccine would be produced and distributed on a non-rivalrous, non-excludable basis. In a telling contrast, that commitment came just as President Donald Trump threatened to permanently freeze U.S. funding to the World Health Organization in an attempt to punish the organization for daring to work cooperatively with Chinese health officials. Chinese Foreign Minister Wang Yi has similarly emphasized vaccine solidarity, urging his colleagues at the United Nations Human Rights Council in February that “solidarity and cooperation is our only option.” Wang chastised countries that he noted are “obsessed with politicizing the virus and stigmatizing other nations” and implored that global vaccine distribution be made “accessible and affordable to developing countries.” China’s record to date shows it is working to follow through on the lofty rhetoric its officials have used to implore global solidarity to defeat the pandemic.

Because China’s vaccine internationalism models a form of multilateral cooperation beyond the scope of U.S. hegemony, it has been met with relentless media propaganda designed to cast China’s vaccination efforts as shady, manipulative, and unsafe. In November 2020, the Wall Street Journal gleefully announced that Brazil had suspended trials of the Sinovac vaccine following an “severe adverse event.” Jair Bolsonaro, the right-wing Brazilian president and Trump ally, declared it a “victory.” Casual observers would reasonably assume that there were serious safety issues with the Chinese vaccine; only closer reading would fill in the crucial context, that the cause of death of the participant was in fact suicide. A similar ruse was exploited in January, as headlines blasted that a Peruvian volunteer had died in the midst of a Sinopharm vaccine trial. Again, behind the salacious headlines was a crucial detail: the volunteer, who died of COVID-19 complications, had received the placebo rather than the vaccine.

As study after study shows the efficacy of Chinese and Russian vaccines, the media has turned to painting vaccine aid and exports as a dangerous form of “vaccine diplomacy.” Human Rights Watch nonsensically described China’s vaccine aid as a “dangerous game,” citing conspiracies about the research development of Chinese-made vaccines. The New York Times wondered if China had “done too well” against COVID-19, claiming that the government was “over-exporting vaccines made in China in a bid to expand its influence internationally.” Headline after headline bemoaned that China was “winning” at vaccine diplomacy, making clear that Western pundits view the lives of Global South peoples as pawns in a zero-sum game valued only insofar as they further the interests of Western hegemony.

Some advocates say the bias against Chinese vaccines is based both on geopolitics and racist notions of scientific expertise. Achal Prabhala, coordinator of the AccessIBSA project, which coordinates medical access in India, Brazil and South Africa, said “the entire world—not just the West—is incredulous at the idea that you could have useful science in this pandemic come out of places not in the West.” Yet he emphasized the importance of Chinese and Indian vaccines as a “lifeline” to low and middle-income countries, both in addressing vaccine gaps in the developing world and as a “useful cudgel” for negotiations with Western pharmaceuticals.

Despite mainstream media tropes of Chinese “vaccine diplomacy,” it is the United States—not China—whose pharmaceutical companies are employing exploitative tactics to profit from vaccine sales. Pfizer, for instance, has been accused of “intimidating” Latin American governments in their vaccine sale negotiations, asking countries to put up embassy buildings and military bases as collateral to reimburse any future litigation costs—leading countries like Argentina and Brazil to reject the vaccine outright. One can only imagine the media hysteria which would ensue were Sinopharm to be caught demanding overseas military bases as collateral for its vaccine exports. But because it is a U.S. company, Pfizer’s medical neocolonialism has been absolved and flown under the radar.

Despite allegations of Chinese vaccine opportunism, it is the United States which has politicized its recent foray into vaccine exports. During his first meeting with leaders of the “Quad,” an anti-China alliance likened to NATO and consisting of the United States, Australia, India, and Japan, Joe Biden announced his intention to use the alliance to produce one billion vaccines for distribution in Asia in an explicit bid to “counter” China. It is telling that while China stresses global cooperation through channels such as COVAX (to which it has donated 10 million doses) the WHO, and the UN peacekeeper’s vaccination program, the United States is pursuing vaccine diplomacy through a highly-politicized military alliance designed to contain China. Likewise, despite the Biden administration’s lofty rhetoric about its leadership over a global “rules-based order,” it is the United States which has violated a UN Security Council resolution demanding a global military ceasefire to facilitate pandemic cooperation with recent airstrikes in Syria.

Perhaps most egregiously, the United States and other rich nations have blocked a proposed World Trade Organization waiver on intellectual property restrictions which would enable Global South countries to manufacture generic versions of COVID-19 vaccines. Proposed by South Africa and India with the backing of China, Russia, and the majority of Global South nations, Global North obstruction of vaccine IP waivers in the WTO makes clear that the status quo of vaccine apartheid is not an accident, but a product of deliberate policy by Western nations to put the profits of their pharmaceutical companies above the lives of the world’s poor.

With Global North nations stockpiling vaccines and experts warning that new rounds of vaccinations may be necessary to combat COVID-19 variants, critical vaccine shortages are here to stay. China’s manufacturing power and macroeconomic policy puts it in a position to continue to be the world leader in vaccine production. As of April, China’s Sinovac announced it had reached the capacity to produce a whopping 2 billion doses of CoronaVac per year, thanks in part to Beijing district government efforts to secure the company additional land for vaccine production. China’s vaccine production builds on the successful model of state intervention and coordination through which state-owned enterprises and private companies rallied to construct hospitals, manufacture PPE, and coordinate food supplies during China’s February 2020 outbreak.

The vaccine policies forwarded by China versus the U.S. and its allies serves as a microcosm for two very different worldviews: where China has insisted on global solidarity to defeat the pandemic, the Western world has refused to ease the pressures of its neocolonial regime. While China supports bids for vaccine equity in the WTO and UN, the Global North is bolstering vaccine apartheid for the sake of corporate profits. These differences alone ought to be enough to put to rest vacuous assertions that render U.S.-China conflict as a matter of “competing imperialisms.”

Xi Jinping stressed at the beginning of the COVID-19 pandemic a commitment to “protect people’s lives and health at all costs.” Not when it is profitable, not when it is geopolitically expedient—at all costs. Western obstruction of efforts towards vaccine equity forwarded by China, Cuba, South Africa, and other Global South nations only reveals the very different calculus which governs the West’s continuing neocolonial regime.

(Qiao Collective is a diaspora Chinese media collective challenging U.S. aggression on China.)

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Cuba Libre to be COVID-Libre: Five Vaccines and Counting

Helen Yaffe

On March 23, 2021, British Prime Minister Boris Johnson told a group of Conservative Party backbenchers: ‘The reason we have the vaccine success is because of capitalism, because of greed, my friends.’ Johnson was articulating the dogma that the pursuit of private profit through capitalist free markets leads to efficient outcomes. In reality, however, Britain’s accomplishments in developing the Oxford AstraZeneca vaccine and in the national vaccination rollout have more to do with state investments than the market mechanism. Government money subsidized the vaccine development at the University of Oxford, and it is the state-funded National Health Service that has carried out the vaccination program. Johnson did not admit that it is due to capitalism and greed that Britain now has the fifth worst COVID-19 mortality rate in the world with over 126,500 deaths (almost 1,857 per million people in the population) and counting.

The British government, like most neoliberal regimes, refused to take the measures necessary to slow and halt community transmission, it failed early on to provide health care and social care workers with adequate PPE and other resources which could have saved the lives of hundreds of frontline staff who died as a result. It contracted private businesses to carry out essential activities, most with little or no relevant experience, for example, instead of equipping the community-based GP system of the National Health Service to take charge of ‘track and trace,’ the government dished out £37 billion to Serco to manage part of the system. In public health terms it has been disastrous; but measured by Boris Johnson’s celebrated standards of capitalism and greed it is has indeed excelled. The greatest beneficiaries of Britain’s response to the pandemic have been the private corporations making huge profits. Around 2,500 Accenture, Deloitte and McKinsey consultants are on an average daily rate of £1,000, with some paid £6,624 a day.

Johnson has now laid out a road map for reopening the economy. As a result, even the most optimistic scenario predicts a third wave between September 2021 and January 2022 resulting in at least 30,000 additional deaths in Britain. These deaths are preventable. But it precisely because the British government is driven by the capitalism and greed that it insists that we have to learn to ‘live with the virus’ so that the business of business can continue.

Contrary to Johnson’s claims, this pandemic has affirmed that public healthcare needs cannot be adequately met under a profit-based system. Indeed, it is the absence of the capitalist profit motive which underlies the outstanding domestic and international response to COVID-19 by socialist Cuba, which now has five vaccines in clinical trials and is set to be among the first nations to vaccinate its entire population.

By reacting quickly and decisively, by mobilizing its public healthcare system and world-leading biotech sector, Cuba has kept contagion and fatalities low. In 2020 Cuba confirmed a total of 12,225 coronavirus cases and 146 deaths in a population of 11.2 million, among the lowest rates in the Western Hemisphere. In November 2020, the airports were opened, leading to a surge with more infections in January 2021 than the whole of the previous year. By March 24, 2021, Cuba had registered fewer than 70,000 cases and 408 deaths. The death rate was 35 per million and the fatality rate was just 0.59 percent (2.2 percent worldwide; 2.9 percent in Britain). Within one year, 57 brigades of medical specialists from Cuba’s Henry Reeve International Contingent had treated 1.26 million COVID-19 patients in 40 countries; they joined 28,000 Cuban healthcare professionals already working in 66 countries. Cuba’s accomplishments are more extraordinary given that from 2017 onwards, the Trump administration punitively unleashed 240 new sanctions, actions and measures to tighten the 60-year blockade of Cuba, including nearly 50 additional measures during the pandemic which cost the health sector alone over $200 million.

Cuba has gone on the offensive against COVID-19, mobilizing the prevention-focused, community based public healthcare system to carry out daily house visits to actively detect and treat cases and channeling the medical science sector to adapt and produce new treatments for patients and COVID-19 specific vaccines. These advances bring hope not just for Cuba, but for the world.

What is special about Cuba’s vaccines?

Some 200 COVID vaccines are being developed worldwide; by March 25, 2021, 23 candidates had advanced to phase III clinical trials. Two of those were Cuban (Soberana 2 and Abdala). No other Latin American country has developed its own vaccine at this stage. Cuba has three more vaccine candidates in earlier stage trials (Soberana 1, Soberana Plus and an intranasal, needle-free vaccine called Mambisa). How do we explain this accomplishment? Cuba’s biotech sector is unique; entirely state-funded and owned, free from private interests, profits are not sought domestically, and innovation is channeled to meet public health needs. Dozens of research and development institutions collaborate, sharing resources and knowledge, instead of competing, which facilitates a fast track from research and innovation to trials and application. Cuba has the capacity to produce 60-70 percent of the medicines it consumes domestically, an imperative due to the US blockade and the cost of medicines in the international market. There is also fluidity between universities, research centers, and the public health system. These elements have proven vital in the development of Cuba’s COVID-19 vaccines.

There are five types of COVID-19 vaccines being developed globally:

• Viral vector vaccines, which inject an unrelated harmless virus modified to deliver SARS-CoV-2 genetic material (Oxford AstraZeneca, Gamaleya and SputnikV)
• Genetic vaccines containing a segment of SARS-CoV-2 virus genetic material (Pfizer, Moderna)
• Inactivated vaccines containing disactivated SARS-CoV-2 virus (Sinovac,/Butantan, SinoPharm, Bharat Biotec)
• Attenuated vaccines containing weakened SARS-CoV-2 virus (Codagenix)
• Protein vaccines containing proteins from the virus which trigger an immune response (Novavax, Sanofi/GSK)

The five Cuban vaccines under clinical trials are all protein vaccines; they carry the portion of the virus spike protein which binds to human cells; it generates neutralizing antibodies to block the binding process. Dr Marlene Ramirez Gonzalez explains that they are, ‘subunit vaccines, one of the most economical approaches and the type for which Cuba has the greatest know-how and infrastructure. From protein S — the antigen or part of the SARS-CoV2 virus that all COVID vaccines target because it induces the strongest immune response in humans — Cuban candidates are based only on the part that is involved in contact with the cell’s receptor: the RBD (receptor-binding domain) which is also the one that induces the greatest amount of neutralizing antibodies. This strategy is not exclusive to Cuban vaccines. But Soberana 2 does distinguish itself from the rest of the world’s candidates as the only “conjugate vaccine.” Currently in phase III clinical trials, it combines RBD with tetanus toxoid, which enhances the immune response…Cuba had already developed another vaccine with this principle. It is Quimi-Hib, “the first of its kind to be approved in Latin America and the second in the world,” against Haemophilus influenzae type b, coccobacilli responsible for diseases such as meningitis, pneumonia and epiglottitis.’

Idania Caballero, a pharmaceutical scientist at BioCubaFarma points out that the vaccines build on decades of medical science and work on infectious diseases. “The mortality rate in Cuba due to infectious diseases, even in times of COVID, is less than one percent. Cuba today vaccinates against 13 diseases with 11 vaccines, eight of which are produced in Cuba. Six diseases have been eliminated as a result of vaccination schedules. The vaccines produced with these technologies have been administered even to children in the first months of life.”

The Soberana vaccines are produced by the Finlay Institute in partnership with the Centre for Molecular Immunology (CIM) and the Centre of Biopreparados. Soberana means ‘sovereign,’ reflecting its economic and political importance; without a domestic product, Cuba would struggle to access foreign vaccines either due to the US blockade or to the cost. Soberana vaccines insert genetic information into superior mammalian cells. Soberana Plus is a the world’s first vaccine for COVID-19 convalescent patients to reach clinical trials.

The other vaccines, Abdala and Mambisa, names which also pay tribute to Cuba’s struggle for independence, are produced by the Centre of Genetic Engineering and Biotechnology (CIGB). These vaccines insert genetic information in a less evolved organism, a unicellular microorganism (the yeast Pichia Pastoris). They build on the CIGB’s extraordinary record, including its Hepatitis B vaccines, used in Cuba for 25 years.

By developing different vaccine platforms, those institutions avoid competing for resources. Caballero explains that, “Cuba has the capacity to produce two independent vaccine chains, with over 90 million vaccines annually, while maintaining the required production of other products for the domestic market and for export.” The Cuban vaccines require three doses and, because they are stable at temperatures of between two and eight degrees, do not require costly special refrigeration equipment.

Phase III trials and ‘interventional studies’

By late March, phase III trials were underway for Soberana 2 and Abdala, each incorporating over 44,000 volunteers over 19 years old in regions with high incidence of COVID-19. Soberana 2 is being administered in Havana and Abdala in Santiago de Cuba and Guantanamo. Analysis and follow-up for phase III trial patients will continue until January 2022 to investigate whether they prevent transmission, how long immunity lasts, and other questions that no vaccine producers can yet answer. However, an additional 150,000 healthcare workers in Havana are receiving Soberana 2 shots, as part of an ‘interventional study,’ a form of clinical trial that can be authorized after drug safety has been demonstrated in phase II. Intervention studies do not involve double blind testing or placebos. Another 120,000 healthcare workers in western Cuba will receive Abdala in the next few weeks. Other interventional studies in the capital will see 1.7 million people in Havana, most of the adult population, vaccinated by the end of May 2021, meaning that two million Cubans will have been fully vaccinated.

Assuming satisfactory results, in June the real national vaccination campaign will begin, prioritizing groups according to risk factors and starting with over 60-year-olds. By the end of August 2021, six million Cubans, over half the population, will have been covered and by the end of the year, Cuba will be among the world’s first countries to fully vaccinate its entire population.

Cuban medical scientists are confident that they have the capacity and experience to adapt their vaccine formulations, technologies and action protocols to tackle new variants. The next steps are for Soberana 1 and Soberana Plus to enter phase II trials and a new study involving five to 18-year-olds will be launched.

Cuba and China team up on Pan-Corona

Cuba’s CIGB have teamed up with colleagues in China to work on a new vaccine called Pan-Corona, designed to be effective on different strains of the coronavirus. It will use parts of the virus that are conserved, not exposed to variation, to generate antibodies, combined with parts directed at cellular responses. The Cubans contribute the experience and personnel, while the Chinese provide equipment and resources. The research will take place at the Yongzhou Joint Biotechnology Innovation Center, in China’s Hunan Province, which was established last year with equipment and laboratories designed by Cuban specialists. Gerardo Guillen, director of biomedical science at CIGB said the approach “could protect against epidemiological emergencies of new strains of coronavirus that may exist in the future.” The project builds on nearly two decades of medical science collaboration between Cuba and China, including five joint ventures in the biotech sector.

A vaccine for the Global South

Cuban professionals have received ten gold medals from the World Intellectual Property Organization (WIPO) over 26 years; their biotech products were exported to 49 countries prior to the pandemic, including vaccines used in childhood immunization programs in Latin America. Cuba has stated that its COVID-19 vaccines will be exported to other countries. This brings hope to low- and middle-income nations that simply cannot afford to vaccinate their populations at high prices (between $10 and $30 per dose) demanded by big pharma. In February 2021, the Bureau of Investigative Journalism reported that US company Pfizer has been ‘bullying’ Latin American countries into putting up sovereign assets, such as embassy buildings and military bases, as guarantees against the cost of any future legal cases in relation to their COVID-19 vaccines.

Through an agreement with Iran’s Pasteur Institute, 100,000 Iranians will take part in the phase III clinical trials for Soberana 2 and another 60,000 people will participate in Venezuela. Other countries including Mexico, Jamaica, Vietnam, Pakistan, and India, have stated their interest in receiving the Cuban vaccines, as has the African Union, which represents all 55 nations in Africa. It is likely that Cuba will apply a sliding scale to its COVID-19 vaccine exports, as it does with the export of medical professionals, so what it charges reflects the countries’ ability to pay.

What Cuba has achieved is remarkable, but as Caballero states, “without the unjust US blockade, Cuba could have more and better results.” Cuba has become a world leader in biotechnology because it has a socialist state with a centrally planned economy, that has invested in science and technology and puts human welfare before profit; that is, with the absence of capitalism and greed that British Prime Minister Johnson celebrates.

(Helen Yaffe is a lecturer in Economic and Social History at the University of Glasgow, specializing in Cuban and Latin American development. Article courtesy: Canadian Dimension, a forum for debate on important issues facing the Canadian Left today.)