China and India's COVID-19 Vaccine Diplomacy and Health Security Partnerships in Southeast Asia.

• Author: Chen, Ian Tsung-Yen

By the end of 2022, Southeast Asia had reported more than 35 million confirmed cases of COVID-19 and 360,000 related deaths. (1) Stringent lockdowns resulted in severe economic downturns, affecting entire sectors of the economy. National governments struggled to balance public safety and economic stability. As a result, public health became a matter of national security. (2) At the same time, they faced a global shortage of vaccines. Western nations, which were also severely affected by the pandemic, could not supply enough pharmaceuticals to cater to the demands of the rest of the world, thus creating an opportunity for China and India to address the global shortage through vaccine diplomacy. Through greater cooperation in public health, both countries tried to expand their diplomatic ties with developing countries and to improve their international reputation. (3)

This article examines how Southeast Asian countries responded to those initiatives. It argues that China and India's vaccine diplomacy had different economic and strategic features, which were mainly shaped by how each Southeast Asian country thought about these strategic partnerships and their own capacity to effectively control the spread of COVID-19. In addition, they also considered the credibility of a potential foreign partner and their pre-existing geopolitical relationships with that country. Ultimately, a combination of four dimensions--credibility, capacity, complexity and cost--resulted in different forms of partnership with China or India.

To test the argument, this article investigates the responses of three Southeast Asian countries: Singapore, Cambodia and Myanmar. Singapore did not perceive China and India as important or reliable health partners but formed a partnership with China mainly because of diplomatic considerations. In contrast, Cambodia valued its cooperation with China highly in all the above-mentioned dimensions. Also because of their already close alignment, Beijing became the primary provider of support to Cambodia during the pandemic. Meanwhile, Myanmar showed a more inconsistent approach due to its domestic political instability and growing anti-China sentiments.

The article is structured as follows. The first section provides a review of the relevant literature and establishes an analytical framework. This is followed by an empirical examination of the responses of the three Southeast Asian countries. The final section summarizes the findings and discusses some implications for other countries.

The Politics of Health Security Partnership

To examine China and India's health security partnerships with Southeast Asian countries, it is essential to understand how they engaged in different forms of vaccine diplomacy. This article primarily focuses on vaccine donations and sales, excluding vaccine research or joint production. Donations, as opposed to sales, were more often politically motivated and tended to be given to countries that were already on friendlier terms with New Delhi or Beijing before the pandemic. Vaccines were also donated to achieve specific international political goals. (4)

Beijing began donating personal protective equipment such as surgical face masks--hence "mask diplomacy"--during the early stage of the pandemic and was among the first countries to develop and produce a vaccine. This helped to elevate China's international status and allowed it to recover from the negative publicity it received for being the country where the SARS-CoV-2 virus originated. China also had an extensive global distribution network for pharmaceuticals before the pandemic, giving it an advantage in bilateral vaccine diplomacy. Even if it meant sacrificing some commercial interests, vaccine donations were seen as a way for Beijing to influence other countries' foreign policies. China also only approved the use of domestically produced vaccines within its own borders, suggesting that its vaccine policy was a matter of politics and legitimacy for the Chinese government. (5) Chinese state media and officials engaged in criticism of Western vaccines while asserting that China's own vaccine would emerge victorious in the global development race. (6) Unlike China, India produced large quantities of Western-branded vaccines and became one of the most important and reliable vaccine suppliers globally. (7) Its focus was therefore on bilateral commercial sales and donations through multilateral efforts, such as the COVID-19 Vaccines Global Access (COVAX) scheme. (8) Overall, China and India both sought to improve their international status by producing and exporting advanced pharmaceuticals in order to meet the growing demand for vaccines amid the global shortage.

Drawing Southeast Asian countries closer into its orbit has been a significant part of Beijing's wider geopolitical ambitions, particularly as it engages in strategic competition with the United States, which also strengthened regional partnerships during the pandemic. (9) Similarly, India's Neighbourhood First Policy meant it prioritized vaccine diplomacy in neighbouring South Asian countries, as well as in Myanmar, the only Southeast Asian country that borders India. In particular, New Delhi has a strategic interest in counteracting China's Belt and Road Initiative (BRI) and increasing its influence over Myanmar's military junta to safeguard its national interests in the Indo-Pacific region. (10) However, India's abrupt decision to halt vaccine exports in mid-2021 in response to a domestic surge of infections adversely affected its standing as a leading global supplier and may have longer-term ramifications for its credibility as a health security partner. (11)

Unlike traditional security alliances, which prioritize power distribution calculations, health security partnerships between Southeast Asian nations and their preferred collaborators prioritize the effective resolution of domestic health crises while de-emphasizing containment of emerging threats. To address the COVID-19 pandemic, Southeast Asian countries responded differently to China and India's vaccine diplomacy. Countries that had more robust public health infrastructure and access to first-tier vaccines had fewer incentives to engage in health security partnerships with China and India. In contrast, those with limited capacity were more inclined to establish deeper health security collaborations. Financial costs, such as the expense of the required pharmaceuticals and government funding, as well as the potential damage to a government's reputation, also factored into a country's decision. Additionally, there was the cost of adopting a less effective vaccine, which could increase health risks and exert additional strain on local healthcare systems. Taken together, the choice of partnership depended on which generated lower costs in these aspects.

The third factor to consider is the complexity of geopolitical considerations, meaning the impact of a partnership on a Southeast Asian country's relationships with other powers. Despite much of the region adopting a balanced, hedging approach, the quality and extent of this strategy varies according to the rapidly evolving geostrategic and domestic political landscape of the region. (12) This geopolitical factor is particularly relevant to the rivalries between the United States and China as well as between China and India in the Indo-Pacific region. (13) Unlike other factors which are more prescriptive in nature, this element is contextually determined and subject to change over time.

The fourth factor pertains to the perceived credibility of the vaccine, which is influenced by the speed of its research and development, its approval by the World Health Organisation (WHO) and the reputation of the country producing the vaccines. It also involves the transparency of vaccine development and contracts, and the efficacy of the vaccines, as well as public trust in the national government and the partnership with the donor country. A higher level of trust in these areas leads to a greater perception of credibility.

In summary, as shown in Table 1, Southeast Asian countries were more likely to establish stronger health security partnerships with China or India if they had a lower capacity to contain the pandemic, the partnership generated lower costs, the credibility of the partnership was higher and geopolitical circumstances more favourable.

To evaluate these factors more accurately, it is necessary to identify the sequences that guide the next empirical section. This article posits that at the beginning of the COVID-19 crisis, the first considerations of Southeast Asian countries in pursuing health security partnerships with China or India were the capacity of their domestic public health infrastructure and the economic and geopolitical situation in the region. However, as the crisis developed, resulting in an increasingly uncertain situation, domestically and globally, the options available for Southeast Asian countries became limited. All this affected how Southeast Asian governments pursued health security partnerships. The empirical cases of Singapore, Cambodia and Myanmar will demonstrate how this analytical framework can help explain their experiences.

Singapore: Diplomatic Partnership

Based on the framework outlined above, Singapore did not need a substantial public health security partnership with either China or India. Because of its advanced economy and public health system, as well as its efficient government operations, Singapore had the means and capacity to effectively manage a health crisis without relying on excessive external support. However, Singapore maintains a moderately stable diplomatic partnership with China and acknowledges Beijing's efforts to achieve a higher international status and improve its reputation.

Capacity and Geopolitics before the Crisis

According to the Global Health Security (GHS) index, which evaluates the...