Vaccine Diplomacy: How China and the USA Sought to Expand Their Influence in East and Southeast Asia

Guanqing Chen, University of Warwick

Reece Peter Jerome, Monash University, Australia

Vaccine diplomacy

Before returning to the UK in 2022, Guanqing was faced with a dilemma of whether to take her COVID vaccine in China or the UK. Due to different policies, China only offered domestic vaccines – from China – while the UK provided only US vaccines. Therefore, she needed to make sure that her vaccinations were recognised by both governments so that she could travel freely. After a long period of lockdowns and decline in international travel, vaccines had been instrumental in providing the bridge that reconnected the world. However, she realised that they had also assumed another usage that perhaps went beyond what their creators had intended.

When examining the actions of governments in 2021, the USA and China have utilised vaccines as diplomatic leverage in East Asia – and Southeast Asia in particular due to it being the site of many emerging economies and markets, making it an area of strategic significance for both powers. Through ‘vaccine diplomacy’, vaccines were – and still are – used to counter each other’s attempts to expand their influence and pursue their interests in the area (Srinvas, 2021). Southeast and East Asian countries are often receptible due to their inability to produce vaccines, which is restricted to a select few countries. This article examines how influential the vaccine policies of the USA and China have been in East Asia and Southeast Asia, and how their respective governments have reacted towards it. Based on statistics provided by governments and intergovernmental organisations (IGOs), it is observed that although some states remained solely aligned with either the USA or China, there have been some instances of ‘hedging’, where governments will try to play both sides – as Singapore and Cambodia both do – due to national interests.

Photo showing a person waering a clinial protective suit injecting something with a syringe into a globe with the words COVID-19

Chinese Asian policies

The fact that China managed to achieve significant economic success in the twenty-first century was seen as a threat to other powerful states, especially the USA (Nguyen Thi, 2017: 47). Over the past several decades, the USA and China have been engaged in a strategic competition to expand their influence in Southeast Asia (Xinbo, 2000). This rivalry further grew during the COVID-19 pandemic since both nations leveraged vaccine diplomacy to spread their national influence within this area.

China started its first Sinovac trial in April 2020 (Sinovac, 2020) and, with the help of the Chinese government, major vaccine makers such as Sinopharm and Sinovac increased their annual capacity of 300 million doses by the end of 2020, which enabled China the ability to fulfil the demands abroad. Since the USA prioritised distributing its vaccines to its citizens, China took advantage of the absence of US vaccines in Southeast Asia. Consequently, by August 2021, China secured 126 million doses of Sinovac and 75 million doses from Sinopharm (UNICEF, 2021).

Additionally, Southeast Asia countries of Myanmar and Cambodia became the first recipients of military aid support from China (Suzuki and Yang, 2023), which indicated China’s tactical diplomatic strategies of spreading its influence in Southeast Asia through COVID vaccines in the early stage. Countries such as Thailand and Myanmar also used Sinovac as their primary vaccine in combating COVID-19 (Buchholz, 2021), demonstrating China’s success in building a closer relationship between some areas of Southeast Asia through vaccine diplomacy. However, China had failed to utilise their vaccine influence in major East Asian countries such as Japan and South Korea, which the USA was able to secure in its place.

Photo showing two glass containers of COVID-19 vaccine with the Chinese flag in the background

United States Asian policies

The United States had entered the field of vaccine diplomacy at a disadvantage. Initially, it had been slower to distribute vaccines to other countries, due to its focus on domestic demands (Brown, 2021). This vaccine nationalism hampered its relations with low-income countries, especially in Southeast Asia, which, as we have seen, had been further undermined by the Chinese, who freely distributed its vaccines (Kumar, 2021). However, due to the qualitative issues faced by the Chinese regarding their vaccines, the United States was granted an opportunity to catch up, and it presented its vaccines as a superior alternative (Wee and Myers, 2021). This can be observed as a counterbalancing action, where the USA sought to regain its influence – especially in East Asia.

Japan and South Korea are often seen as the traditional allies of the USA in East Asia. Consequently, both states hold cold relations with China, which had worsened due to the ongoing US–China rivalry in Asia. Although Japan still maintains diplomatic connections with China, they have, in recent years, strengthened their ties to the USA due to security and economic reasons (Sahashi, 2020). Similarly, South Korea has also pivoted and has made provocations against China by purchasing US military equipment, among other actions (Maduz, 2023: 248). This alignment towards the USA is reflected in both countries’ vaccine policies, where both Japan (COVID19 Vaccine Tracker, 2023a) and South Korea (COVID19 Vaccine Tracker, 2023b) only utilise US-made vaccines like Pfizer and Moderna, while not utilising Chinese vaccines. It is reasonable to assume that vaccines have helped reinforce US influence in both countries, especially in regards to these countries’ desire to further cement their ties to the US.

Taiwan also received vaccine support from the USA during its COVID-19 outbreak, where the USA sent 1.5 million COVID-19 vaccines (Martina, 2021). Since China claims Taiwan as a province, the Chinese government announced that ‘it welcomed Taiwanese to come and get vaccinated against COVID-19’ with its own vaccines. However, Taiwan did not accept vaccine support from China because it was concerned about the safety of Chinese vaccines (Wang, 2021). China tried to counter by offering Taiwan free Chinese vaccines, suggesting that the Chinese felt threatened by the United States’ gesture. Nevertheless, as in Japan and South Korea, China failed to spread its diplomatic influence in Taiwan by using COVID vaccines, which can be attributed to geopolitical interests that favours the USA. Additionally, the USA also likely saw this as an opportunity to reassert its position in the region, which it has at the expense of its rival.

Photo showing two glass containers of COVID-19 vaccine

Hedging policies

The concept of hedging is normally understood as the strategy when a state undertakes a mix of cooperative and confrontational strategies towards another (Ciorciari and Haacke, 2019). Presently, the USA and China are rivals to each other’s long-term goals, with both trying to undermine each other throughout the world. This has forced most countries to either choose or to try and play both sides.

Foreign policy in Singapore is driven by the need to maintain neutrality in the face of conflict – so hedging is a significant tactic. As a major trade centre, Singapore appears to be one of the key areas where both the USA and China maintain a significant economic and cultural presence (Friedberg, 2022). With the onset of the COVID-19 pandemic, both states offered their vaccines to Singapore in order to further cement their ties to the country (Ministry of Health Singapore, 2023). Despite this, it can be observed that the USA is still trying to undermine China, since it sent 23 million vaccines, which Singapore happily received (Wee and Myers, 2021). However, it should be noted that since Chinese vaccines are still offered, it can be interpreted as a sign of goodwill on Singapore’s part to China. Therefore, Singapore’s stance of allowing both vaccines, despite implicit US influence in deciding vaccine usage in other countries, genuinely reflects the Singaporean government’s attempts to appease both China and the USA.

This can be further demonstrated in other Southeast Asian countries, where many were willing recipients of US vaccines. One of the most notable examples is Cambodia – a traditional Chinese ally – which was demonstrated when they approved the emergency use of Sinovac from China in early 2021 (Tao et al., 2022). However, despite being a close ally of China, Cambodia openly received vaccine support from the USA. In fact, it accepted 3,057,930 Pfizer and JandJ doses for the people of Cambodia (U.S. Department of State, 2023). This reveals the United States interference with the Chinese influence in Cambodia through vaccine diplomacy since the USA likely wanted to reassert itself against China.

Future vaccine diplomacy

It has already been demonstrated that vaccines have uses that go beyond their original purpose. In the US–China rivalry, vaccines took centre stage in Asia, where their high demand and the lack of local supply for states that needed them opened a new avenue for diplomatic manoeuvres. The Chinese were the first to take advantage of the vaccine nationalism that the USA was committed to, which garnered it acclaim at the start. However, it would not be too long before the USA decided to enter the stage, and directly compete with China by providing its own vaccines in Asia. Although COVID-19 has largely faded from the public mind, who is to say that in the advent of a new pandemic, vaccines will not once again become a tool for power politics in other regions?


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