From Asia to Africa, China promotes its vaccines to win friends

“People are very willing to take a Chinese vaccine,” said Ghazala Parveen, a senior official at the National Institute of Health in Pakistan, where two Chinese vaccine-makers are conducting trials. “In fact, we are being asked by people to have the vaccine ready as soon as possible.”

By some measures, China is leading the global race for a COVID-19 vaccine. It has four candidates in the last phase of clinical trials, more than any other country.

The United States has three vaccine candidates in late-stage trials, with Pfizer saying it could apply for emergency approval as early as October and Moderna saying it hopes to have a vaccine by the end of the year. AstraZeneca, a British-Swedish company that received U.S. government funding to develop its vaccine, paused its late-stage global trials this week because of a serious suspected adverse reaction in a participant.

China has approved at least two experimental vaccines under an emergency use program that started in July with soldiers and employees of state-owned companies and has quietly expanded to include health care and aviation workers. Its vaccine-makers have built factories that can produce hundreds of thousands of doses.

Xi has declared that China would make domestically developed vaccines a global public good, though his government has provided few details.

China has long viewed contributing to global health as an opportunity to build its soft power.

“The government definitely would like to see that China is successful in producing a good vaccine and that many countries want it,” said Jennifer Huang Bouey, an epidemiologist and China expert at the RAND Corp. “It’s beneficial for its diplomacy and changing the narrative on COVID.”

But Chinese vaccine companies that have gone abroad to conduct clinical trials have generated controversy amid fears that local residents are being treated like guinea pigs. And with so much still unknown about the coronavirus, the vaccines could make it to the last stage of trials only to stumble.

Despite the uncertainty, Beijing has pushed its prospective vaccines with confidence and has used them to help smooth over frictions.

Last month, Premier Li Keqiang met with officials from Thailand, Laos, Cambodia and Vietnam to damp criticism that China had contributed to a devastating drought in the Southeast Asian nations. He also offered Chinese vaccines — a proposal that was well received.

In a speech during the same summit, Prime Minister Hun Sen of Cambodia, a staunch supporter of China, singled out Beijing for praise, saying he “would like to give a high appreciation of efforts of our friend China in producing a vaccine.”

In the Philippines, where China is competing with the United States for influence, President Rodrigo Duterte told lawmakers in July that he had “made a plea” to Xi for help with vaccines. He also said he would not confront China over its claims to the South China Sea.

A day later, Wang Wenbin, a spokesman for China’s Foreign Ministry, said China was willing to give the Philippines priority access to a vaccine.

Chinese leaders have made similar offers to countries in Africa, Latin America, the Caribbean, the Middle East and South Asia — regions where Beijing has sought to expand its influence.

“We pledge that once the development and deployment of the COVID-19 vaccine is completed in China, African countries will be among the first to benefit,” Xi told a meeting of African leaders in June. The Chinese foreign minister, Wang Yi, promised in July that China would extend $1 billion in loans for vaccines to Latin American and Caribbean countries, according to the government of Mexico.

For all its talk of providing vaccines as a public good, China seems determined to do so only on its own terms. It has been reticent on whether it plans to join Covax, a World Health Organization-backed mechanism that aims to help countries distribute a coronavirus vaccine equitably. (The Trump administration has flat-out rejected the initiative.)

“In fact, we have already cooperated with some countries,” Hua Chunying, a spokeswoman for China’s Foreign Ministry, told reporters last week. “China always keeps its word.”

If China wins the race for a vaccine, it will owe its success to some of these countries, which have played an indispensable role by providing Chinese vaccine-makers with human test subjects.

Chinese drugmakers have taken their research abroad because the outbreak at home has been under control for months.

In Bangladesh, Sinovac Biotech, a vaccine-maker based in Beijing, is testing its vaccine on 4,200 health care workers in Dhaka, the capital. The Chinese company has agreed to provide more than 110,000 free vaccine doses to the country, according to Dr. John Clemens, executive director of Bangladesh’s International Center for Diarrhoeal Disease Research, which is helping conduct the trials.

That is a tiny fraction of the 170 million residents of Bangladesh, one of Asia’s poorest countries. And despite their participation in the Chinese clinical trials, Bangladeshis fear that the vaccines that result may be priced out of the reach of most of the country’s citizens.

“If any person in the world gets deprived of their right to a COVID-19 vaccine because of patent rights and profitability, this would be the biggest injustice in this century,” said Md. Sayedur Rahman, a professor of pharmacology at Bangabandhu Sheikh Mujib Medical University in Dhaka.

The Foreign Ministry in Beijing has emphasized that China will not seek to establish a monopoly on vaccine supply. State news media reports have also rejected accusations that China is using vaccines as a diplomatic tool, while government-backed academics assert that the provision of vaccines is altruistic.

“There will certainly be no strings attached,” said Ruan Zongze, executive vice president of the China Institute of International Studies. “Since it is going to be a global public good, adding any conditions would arouse suspicion from the other party.”

But China is already drawing concern in countries on the receiving end of its overtures as well as from regional powers that view Beijing as encroaching on their spheres of influence.

In Nepal, where China would like to conduct clinical trials on 500 workers in a cement company, politicians have raised questions about the safety of the vaccines and the lack of transparency.

“Shouldn’t we be assured about its side effects?” Prakash Sharan Mahat, a former foreign minister of Nepal and a leader of the country’s main opposition party, Nepali Congress, said in an interview.

India, which is wary of Beijing’s intentions in South Asia, has responded to China’s offers of vaccines for Bangladesh and Nepal with its own pledges to provide its allies with vaccines.

Some countries may have few alternatives to China.

Indonesia has started a last-stage clinical trial for Sinovac on 1,620 volunteers and has signed an agreement with the Chinese company for 50 million doses of COVID-19 vaccine concentrate that would allow an Indonesian state-owned vaccine-maker, PT Bio Farma, to produce doses locally.

Some political experts in Indonesia worry about the leverage that China would wield over the country, but they acknowledge that Indonesia has little choice.

“Should we be suspicious, or should we be grateful?” asked Muhammad Zulfikar Rakhmat, an academic at Universitas Islam Indonesia, who researches China’s foreign policy in Indonesia. “I think both.”