By Natalie Craig
For fourteen months, world leaders have altered their foreign policy plans to handle the COVID-19 pandemic leading to a new form of diplomacy – Covid diplomacy. Countries influential in Southeast Asia such as the United States, China and Japan have engaged in various diplomatic efforts in the region throughout the pandemic with the intent of strengthening their soft power advantages with these nations. China leads COVID diplomacy efforts in Indonesia, Malaysia and the Philippines. Japan and the United States are behind in engagement in health diplomacy in the region due to their need to first address the pandemic domestically. Japan, the United States, and China are engaging these countries economically and assisting by donating medical supplies, but only China has been able to meet the dire need for vaccines. This emphasis on vaccine diplomacy increases China’s presence in the region and elevates the importance of cooperation with China among these three Southeast Asian countries.
Pandemic Responses in Indonesia, Malaysia and the Philippines
In Southeast Asia, Indonesia and the Philippines have been hit the hardest by the pandemic, and have the highest mortality rates in the region by far. As of March 22nd, Indonesia leads in infections for the region with 1.46 million cases and 39,711 deaths. The Philippines follows with 671,792 cases and 12,972 deaths. After that comes Myanmar with 142,393 cases and 3,206 deaths, followed by Malaysia with 334,156 cases and 1,238 deaths. In Malaysia and Indonesia, the largest uptick in the infection rates since the beginning of the pandemic was at the end of January, while the Philippines is currently facing its largest spike this March. The rising case counts increase the critical need for vaccines. An Yusof Ishak Institute (ISEAS) 2021 survey on the state of Southeast Asia found that Indonesians and Filipinos disapprove of their governments’ response to COVID-19 thus far. In terms of COVID-19 related assistance, 44.2 percent of respondents believe China has “provided the most help to the region for COVID-19,” followed by 18.2 percent for Japan and 10.3 percent for the EU. The U.S.’ absence from the survey demonstrates its lack of a global pandemic response.
Although the United States government has failed to engage in vaccine diplomacy efforts, Western pharmaceutical companies such as Pfizer-BioNTech have sold doses in Southeast Asia. Indonesia has only approved the Sinovac vaccine and is working closely with China to receive 125 million doses. In Malaysia, the Pfizer vaccine received initial approval, with inoculation beginning the last week of February 2021. Since then, Malaysia approved the Sinovac and AstraZeneca vaccines. The Philippines has approved the Pfizer, AstraZeneca and Sinovac vaccines; however, it did not give its first jab until March 1, which is a notably slower rollout than other Southeast Asian countries. These countries, like all others in Southeast Asia, are entirely dependent on imported vaccines. While approved vaccines are currently scarce, each country’s government is engaging in an effort to continue to approve and acquire more vaccines to meet the high demand. Reliance on imported vaccines creates a necessity for enhanced diplomatic ties and willingness to cooperate with exporting countries in order to secure supplies to end the pandemic.
China has successfully developed five vaccines to fight the virus. Among these, the Sinovac, Sinopharm and CanSino Biologics vaccines are used widely. The Chinese government has already begun distributing doses to the developing world, with nine out of ten ASEAN countries accepting Chinese vaccines. This aligns with China’s soft power ambitions to appear altruistic and lead the world in global health initiatives. China’s bilateral vaccine distribution efforts strongly outweigh multilateral initiatives, providing vaccine assistance to fifty-three developing countries and exporting vaccines to twenty-two countries. China emphasizes control over vaccine distribution, essentially becoming not only a regional, but potentially a global supplier. For countries looking to acquire vaccines, there are various advantages to choosing Chinese vaccines over Western alternatives. First, China has an established manufacturing system to fill orders and meet the demand for vaccines. Second, Chinese companies are state-owned, so the Chinese government can regulate the distribution of vaccines, unlike private-owned companies in the West that do not fall under government purview. Third, due to China’s success in controlling the virus, there is less domestic need for vaccines. Therefore, Beijing is willing to agree to export more doses. These factors give Chinese-made vaccines a competitive edge and elevates China’s influence in the region. The Chinese government is operating in a space yet to be countered by the U.S. or Japan, making it a regional provider of vaccines for Southeast Asia.
China is priming itself to be the regional supplier of vaccines for Southeast Asia. Indonesia served as a testing ground for the Sinovac vaccine, and after 3 million ready-to-use doses were distributed last December, the Indonesian government ordered 125.5 million additional doses with a licensing plan in place for local manufacturing. Additionally, the Philippines and Malaysia were promised priority access to Chinese vaccines. While Malaysia has only approved the Pfizer vaccine, it is working to secure 23.9 million Sinovac, CanSino Biologics and Russia’s Sputnik V vaccines. That number is almost double the amount of what it is currently set to receive from Pfizer. Beijing donated 500,000 doses of the Sinovac vaccine to the Philippines and locked in a deal with Manila for 25 million doses of the vaccine. Filipinos criticized this deal on account of distrust in Chinese vaccines, but President Rodrigo Duterte responded by stating “the Chinese are not lacking in brains. The Chinese are bright. They would not venture [into producing vaccines] if it is not safe, sure and secure.” Similar rhetoric can be heard in Indonesia and Malaysia, whose leaders are turning to China for the vaccine and attempting to build trust in it among their populations. Due to the mass quantity of doses China can provide, many countries see it as the primary option for vaccine supply.
China’s Vaccine Diplomacy
At the outbreak of the pandemic, China spearheaded an effort that became known as “mask diplomacy,” donating medical supplies and personal protective equipment (PPE) across the world. These efforts focused on helping its neighboring Southeast Asian countries combat the spread of COVID-19. In March 2020, the delivery of Chinese medical equipment to Malaysia was accompanied by a ceremony to thank the Chinese for their generosity. Malaysian Foreign Minister Hishammuddin Hussein saying “the blessing of COVID-19 as far as bilaterals with Malaysia and China, it has bonded us and made us closer together.” Mask diplomacy has now transformed into vaccine diplomacy, and is growing China’s influence rapidly in the region. Originally, China did not join any multilateral vaccine initiatives, preferring to engage in unilateral efforts to grow its soft power. Xi Jinping believes that China’s vaccine is a “global public good” and something that will bring the world out of this pandemic. Therefore, the rhetoric surrounding “vaccine diplomacy” is not welcome in China due to its negative connotation. It contradicts the notion that China would be giving other countries the vaccine out of mere goodwill.
In October 2020, China joined the COVAX initiative, a global World Health Organization (WHO) initiative for equitable access to COVID-19 vaccines. Japan joined this effort in September 2020, showing its support primarily economically, pledging $130 million USD to support global access to vaccines. Along with COVAX, a $9 billion Southeast Asia-specific initiative known as APVAX, led by the Asian Development Bank, will support the equitable vaccine distribution in developing Asian countries. APVAX will complement COVAX by helping to speed-up the vaccination efforts across developing countries in the Asia Pacific region.
The Chinese foreign minister embarked on a medical diplomacy tour in 2020. Since October 2020, Chinese Foreign Minister Wang Yi has visited every Southeast Asian country except for Vietnam, offering medical aid and securing agreements for priority access to vaccine distribution. China is working with ASEAN member states like Malaysia to elevate China-ASEAN relations through COVID-19 related aid. China’s growing role and ASEAN’s response will have lasting implications on power dynamics in the region and the future of health diplomacy in Southeast Asia. By promising access to vaccines, Beijing is bolstering its soft power in the region, gaining preeminence and filling a leadership void left by the U.S.
The U.S. Health Profile in the Region
Before the COVID-19 health crisis, the United States had a strong presence in the region and commitment to global health through the Center for Disease Control (CDC). The CDC played a crucial role in responding to past health crises throughout Asia. CDC-assigned staff work with the ministry of health in both the Philippines and Indonesia, with Malaysia as one of the few exceptions of CDC presence across Asia. However, due to its own problems in responding to the pandemic, the U.S. has been more or less absent in its health diplomacy efforts surrounding COVID-19. While American economic contributions are significant, $22.6 million to the Philippines, $11 million to Indonesia and $1.2 million to Malaysia, it pales in comparison to what China is willing to offer. Additionally, the U.S.’ withdrawal from the W.H.O. in July 2020 further damaged its global response to the pandemic and its ability to engage in health diplomacy. Vaccine nationalism is rampant among Western countries, as they push to get first access to the vaccine or hoard doses to vaccinate their population first. The United States is guilty of this, and it waited until January 2021 to join the COVAX initiative. This has stymied American vaccine diplomacy efforts and the U.S. has yet to indicate divergence from its “America First” vaccine strategy. However, to show commitment to the international effort to combat the virus, the U.S. has committed $4 billion to COVAX to account for the delayed global response.
Japan’s Medical Diplomacy
Although Japan has engaged in medical diplomacy efforts and supported Southeast Asian countries economically throughout the pandemic, it has struggled to contain the virus domestically. Japan is highly dependent on imported vaccines, and attempts to develop a home-grown vaccine have been feeble. Japan is a powerful actor in Southeast Asia; however, health diplomacy was neglected by the Japanese government until 2016. This has limited Japan’s capacity to counterbalance China in the fight for soft power in Southeast Asia during the COVID-19 pandemic. Throughout this crisis, both the U.S. and Japan have economically supported Southeast Asia, but they are missing the mark in the health diplomacy sphere.
Similar to Chinese government efforts, Japanese Foreign Minister Toshimitsu Motegi visited six countries across Southeast Asia in August 2020 including Papua New Guinea, Cambodia, Laos, Myanmar, Malaysia and Singapore. Throughout his visits, Motegi offered medical supplies and health care resources to help fight the coronavirus and counter Chinese influence in the region. However, China has a competitive edge in health diplomacy because Japan is unable to provide vaccine aid to the region.
The Role of ASEAN
ASEAN has yet to establish a regional vaccination policy. At the 37th ASEAN Summit in November 2020, state leaders developed an action plan for ASEAN Vaccine Security and Self Reliance (AVSSR) with a focus on timely and equitable access to affordable and quality-assured COVID-19 vaccines. This plan is idealistic and fails to give specific guidance on vaccine distribution. Although there is public distrust against Chinese-made vaccines, the bloc neglected to address Chinese influence in the region through vaccine diplomacy. Many believe it is critical to maintain U.S. and Japanese influence in ASEAN amidst China’s vaccine diplomacy, with high expectations for the Biden administration to engage with the bloc.
American and Japanese analysts fear that China’s vaccine diplomacy will further increase its influence in the region. Filipino President Duterte chose not to confront China over its claims in the South China Sea to plea for help with vaccines. When60 Chinese fishermen were detained last fall for trespassing into Malaysian waters, Chinese Foreign Minister Wang Yi negotiated the release of the fishermen in return for priority vaccine access. If diplomatic reciprocity for vaccines is expected to resolve maritime disputes, this has the potential to enhance China’s territorial/geopolitical assertiveness in the region, beyond ambitions in global public health leadership or soft power accumulation. With the U.S. absent from the region over the past year, Japan has been an alternative to China, but it is unable to provide vaccines to these countries, which diminishes its importance. This furthers the importance of China as a regional supplier of vaccines.
Additionally, several Southeast Asian countries perceive China as willing to work with them on vaccine efforts, whereas Western countries are largely seen as desiring profit. The dichotomy between these views is only amplified through China’s liberality in vaccine deals. Indonesia is the only country in Southeast Asia that has begun widespread inoculation efforts, giving credibility to the Chinese vaccines. The success of Indonesian vaccination efforts may be a barometer for the effectiveness of China’s vaccines. If Indonesia’s mortality rates decline sharply and case numbers drop, this example will amplify China’s importance and encourage cooperation between other Southeast Asian countries and the PRC. This could position China to achieve a form of “vaccine supremacy” in Southeast Asia, growing its relevance, soft power and role as a regional hegemon.
In the vaccine contest in Southeast Asia, China is winning the race while the U.S. and Japan remain absent. After the U.S. departed the W.H.O. during the pandemic, China filled a leadership void in Southeast Asia, gaining soft power from goodwill and showing their technological superiority. Japan and the U.S. have either refused to or been incapable of supplying the necessary vaccines to the region. This has left China as the only viable solution to the pandemic. While Western vaccines have a higher efficacy than those developed in China, China can supply the quantity desired by these Southeast Asian countries and at a faster rate. This will undoubtedly impact the world order after COVID-19, with China transitioning to a role with greater diplomatic ties and prominence in Southeast Asia. The Biden administration must decide whether or not it will donate excess vaccines, engaging in the vaccine diplomacy battle and reasserting American prominence in the region.
Natalie Craig is a second-year M.A. student at Johns Hopkins SAIS concentrating in China Studies. Last year, she received a graduate certificate in Chinese and American studies from the Hopkins-Nanjing Center. Prior to attending SAIS, Natalie attended the University of Kansas, majoring in Journalism and Chinese Language and Culture. She has spent almost two years in China, living in Beihai, Beijing, Tianjin and Nanjing.