Will we ever know the origins of COVID-19 ? China’s transparency during its initial emergence – and its aggressive attempts to manage a World Health Organization (WHO) investigation and subsequent report into the outbreak – have been fiercely criticized. The U.S. was among 13 nations to protest what the White House deemed a “partial and incomplete picture.” The report did downplay theories of a lab leak in Wuhan as a potential cause, and a Georgetown researcher deemed its overall inconclusiveness as a “grand slam home run” for China.
China’s success in controlling COVID-19 within its borders is undisputed. It’s also unleashed a soft power diplomacy campaign with its Sinovac and Sinopharm vaccines, exporting over 100 million doses worldwide. Yet the jury remains out on these vaccines’ efficacy, and hesitancy and confusion have emerged around the world – as far away as Chile and closer to home in the Philippines and Hong Kong. As the U.S. ramps up production of highly effective vaccines, a global battle for hearts and minds and arms may have only begun.
After rolling out the world’s largest COVID-19 vaccination program in January, India announced it was going global. By the end of March, it had dispatched 60 million shots overseas. This humanitarian gesture also had strategic dimensions: Showcase soft power, secure goodwill, and push back against China’s vaccine diplomacy. It was also a big gamble. In March, India experienced a surge in new cases. New Delhi insisted it wouldn’t ban exports. But with less than 1 percent of the population fully vaccinated, the government incurs considerable domestic political risks by continuing to ship vaccines abroad.
Afghanistan and Bhutan exemplify the stark contrasts in pandemic experiences. Convulsed by terrorism and wracked by insurgency, Afghanistan’s military is overwhelmed and its government overstretched. With violence often killing dozens daily, COVID-19 is just one of many complex, deadly challenges. Kabul has struggled to muster the bandwidth, much less the capacity, to mount an effective response. But in peaceful and sparsely populated Bhutan, state and society quickly mobilized to fight the virus. Bhutan now boasts the world’s fastest vaccination program, and one week after its launch in March, 62 percent of eligible Bhutanese were vaccinated.
As COVID-19 emerged, South Korea swiftly rolled out a national pandemic emergency plan that promoted “testing, treating and tracing” and leaned on technology, science and public messaging. The response paid off in a year without major shutdowns or economic fallout, yet repeated surges and slow vaccine deployment remain issues. North Korea shut its borders in late January 2020— and they remain tightly shut. Its report of zero positive COVID cases is broadly disputed, but what’s certain is that its strict border measures have severely impacted the economy and essential trade with China.
Japan will host the summer Olympics in July, exactly one year after postponing the Games because of the pandemic. The world’s biggest post-COVID-19 sporting event will be scaled back, with no foreign spectators allowed into the country, and domestic audience attendance is expected to be limited. Japan’s infection rate has remained relatively low compared to the United States, but like the rest of East Asia, the vaccination rate too remains low at around 1 percent. The recent spike in infections has led to a decline in support for Prime Minister Suga, who will face an election by September of this year.
How badly does Russia undercount its COVID-19 deaths? Global coefficients vary between .5 and 2.5, but in Russia, that figure is 6.5—a number likely 6.5 times greater than official reports. A toll of 400,000 excess deaths is dramatic, so why has it not filtered down to the average Russian? Government control over the media plays a part, but years of meager economic growth have led individual Russians to feel the economic impact of widespread closures more keenly than the disease itself.
Russia’s inexpensive Sputnik V vaccine has been proven effective – and supply exceeds demand. A rare feat. So why is there domestic hesitancy? Polls say only 30 percent of Russians will take one—and 74 percent of young people mistrust it. A rapid development that skipped large-scale clinical trials may be one reason; disinformation is another factor. Nearly 2 out of 3 Russians believes COVID-19 is an artificial bioweapon. Fear of contracting it has also fallen. There is powerful irony in a damaging “infodemic” spreading in a nation proud to have developed a remarkable vaccine.
The V” in Sputnik V stands for victory, not 5. And even as Russians shun the vaccine, nations in Central and South America, Africa, and East Europe have lined up to secure supplies. Russia sees vaccine diplomacy as a demonstration of scientific prowess and a much-needed boost to its soft power, preferring to select partners and set terms via bilateral deals. While Russia enjoyed initial successes in vaccine diplomacy, it is now seeking to join more globally-focused efforts as they expand their reach.
One expert dubbed Sputnik V “as reliable and effective as a Kalashnikov rifle.” This apt comparison works in Russia’s neighborhood. Close ally Belarus uses the vaccine and will soon produce it. In Central Asia, Sputnik V generally beats out its Chinese competitors on the basis of Russia’s popularity there. Ukraine’s government has banned the vaccine on its territory, but Russia distributes it very publicly where separatists are in control. Moldova recently received a supply of AstraZeneca from neighboring Romania, while pro-Russia elements there clamor for Sputnik V.
Africa has defied pessimism about the impact of COVID-19. But how? Early robust and agile collective action. The African Union (AU) activated its Emergency Operations Center and established the Africa Task Force for Coronavirus before the first reported case on February 19, 2020, By March, the AU and the Africa Center for Disease Control launched a COVID-19 response strategy and a response fund. African nations embraced lockdowns, started public education campaigns, and banded together to battle supply chain disruptions with startling results: Africa has experienced only 3.6 percent of global cases and deaths.
Africa has fallen short in the global vaccine race, receiving less than 2 percent of the global doses thus far. Vaccinating at least 60 percent of the population to reach herd immunity remains far off. Claims of vaccine hoarding have vied with some countries’ need to boost their supply chain and storage capacities and improve distribution in rural areas. The good news? Efforts are underway to move more of the vaccine supply chain—including dosage manufacturing—to the continent, which will increase supply.
The success of the United Arab Emirates (UAE) in vaccination has made it a global leader, with most of its population covered by the spring. The UAE’s decision to become a trial site for China’s Sinopharm vaccine paid off, and it was the first country to approve its general use. Now, the UAE is becoming a major player in global vaccination efforts, manufacturing Sinopharm, and offering Jordan and Egypt vaccine supplies. A Hope Consortium established in the UAE will also be a major hub for vaccine storage and distribution, with capacity for six billion vials.
Jordan’s early nationwide lockdown successfully stemmed a first wave of COVID-19. But subsequent waves driven by new variants have unleashed a daily average of 8,000 cases and one of the world’s highest fatality rates. The pressure on hospitals has been immense, and tragedy occurred in early March at Al Salt Government Hospital where seven COVID-19 patients were admitted to the ICU when oxygen supplies depleted. Protests born out of the frustration with the nation’s response are numerous, yet amidst the challenges, Jordan is the first country in the world to vaccinate UNHCR registered refugees.
Challenges with Australia’s rollout of the Astra Zeneca vaccine put a dent in that nation’s momentum on COVID-19 – and left it scrambling to secure alternative supplies. (AstraZeneca is the only vaccine also manufactured in Australia.) Researchers and science policy experts argue that Australia would not have been caught napping if calls for that nation to become a manufacturer of high-efficacy mRNA vaccines had been heeded. As one Australian researcher observed: “The technology, the equipment — it exists, we can buy it, we just need, essentially, the will.”
New Zealand’s surge of non-pharmaceutical interventions, (including testing and contact tracing) has kept case rates and COVID-19 deaths startlingly low. So the announcement of a “travel bubble” between New Zealand and Australia starting on April 18, 2021 (the first such arrangement between nations) underscores the payoffs to effective constraint on the spread of the virus. The new arrangement opens New Zealand to Australian travelers for the first time since March 2020, and aims to boost tourism,— trade—and even family reunions.
Mexico’s COVID-19 crisis is well-documented. But can past U.S-Mexico successes and better use of shared structures point a way forward? This key relationship has achieved positive public health outcomes, as demonstrated in the bilateral cooperation in facing challenges posed by 2009’s H1N1 crisis. Better coordination between the FDA and Mexico’s COFEPRIS could yield numerous benefits, including improved cross-border safety in food and medicine. Relaunching a shared U.S.-Mexico public health agenda could aid preparations for future pandemics – and alleviate broader shared challenges as well.
The Canada-U.S. border has been restricted to essential traffic since March 2020 – a measure taken to slow the spread of COVID-19 and renewed every 30 days since. Over a year later, businesses, citizen groups, and members of Congress are clamoring to re-open it. The Biden administration is reviewing all U.S. travel restrictions (including Canada), but the Trudeau government is preoccupied with COVID-19 variant outbreaks and securing vaccine imports. The sooner Washington and Ottawa can agree on a border plan, the better the prospects for economic recovery.
The EU Commission was heralded for taking the lead on vaccine negotiations, and single market bargaining power secured one of the lowest price-rates for vaccines. But a lack of quantity and the pace of COVID-19 spread have sparked frustration and anger – and caused national leaders to battle a slow rollout. Italy stopped the export of 250,000 AstraZeneca doses to Australia. Austria and Denmark joined forces with Israel in vaccine production. Hungary obtained Russian and Chinese vaccines. And Austria, Latvia, the Czech Republic, Bulgaria, Croatia and Slovenia complained formally about unequal vaccine distribution.
Freedom of movement binds EU citizens together, and the pandemic has severely hindered cross-border travel and caused major rifts between governments. The EU Commission’s solution? A “green digital pass” that will allow vaccinated Europeans (and others who qualify) to travel more freely again. (Member states will set the rules on entry.) While the proposal still needs approval by both the European parliament and member nations, NGOs have raised concerns whether vaccine passports will violate privacy or discriminate against vulnerable groups unable to get a vaccine.
The vexed mess of Brexit was finalized mere weeks before COVID-19 surged into Great Britain, and the timing could not have been worse for UK businesses. The Lloyd’s Banking Group Centre for Business Prosperity reports that the confluence of Brexit and pandemic has cost the UK market share in the US, EU and in China. Retailers estimate the cost of lockdowns in Britain to amount to £22 billion in lost sales. And relations with the EU continue to be frosty, highlighted by a row over AstraZeneca vaccine delivery.
Deep political polarization in the UK, rooted in Brexit, has made the politics of battling COVID-19 in the UK extraordinarily fraught. Early in the pandemic, controversy over missteps and hypocrisy swirled around Prime Minister Boris Johnson’s government. British citizens’ confusion and frustration over public health policy was bubbling over even before a more contagious and more deadly COVID-19 variant swept the nation. Even one of the signal peacemaking initiatives of modern times in Northern Ireland is coming apart in a toxic mix of pandemic and politics.
COVID-19 quickly overwhelmed Latin America, which has 8 percent of the world’s population, but accounts for 19 percent of global cases and 28 percent of deaths. Poor leadership has played a role; Venezuela’s dictatorship arrested health workers who highlighted threats. But the region’s large, densely populated cities and informal workforces (with no option to telecommute) also undermined aggressive measures—and even led to hunger. (Needy residents of Colombia’s capital, Bogotá, at one point draped red rags on their balconies to plead for food.) Meanwhile, the region’s underfunded medical systems have struggled to test and vaccinate populations, and monitor variants.
As Latin America’s hospitals buckled under the crush of COVID-19 patients, governments pleaded for help. China visibly—and quickly—answered their call, and its “medical diplomacy” rapidly facilitated the sale or donation of much needed supplies. Beijing also promised the region a $1 billion loan for vaccine purchases. (Russia also speeded its Sputnik V vaccine to Venezuela, Argentina, Bolivia, and Mexico.) Aid from the U.S. was slow to arrive, meaning that China’s head start and the scale of its response has strengthened its relationships throughout the region.
A lack of coordinated federal leadership has devastated Brazil’s pandemic response. President Jair Bolsonaro publicly diminished the threat of COVID-19 (even after contracting it), preferring instead to tout unproven treatments and battle public health interventions. High government turnover – especially in the Ministry of Health – also played a role as deadly tragedies unfolded in Manaus and elsewhere. Brazil was late to the vaccine game, too, with Bolsonaro committing to vaccine purchases only in March 2020, and making a belated request for the global COVAX program to cover 10 percent of Brazil’s population.
Is greater healthcare innovation and collaboration a light at the end of the tunnel in Brazil’s tragedy? Policy conversations about equity and access are underway, as well as discussions about data privacy, telehealth and public-private healthcare integration. Brazil also boasts an excellent primary care health system, with 42,000 public health clinics—a system capable of vaccinating more than 1 million people per day (if Brazil had the requisite doses). Brazil is also developing its own vaccine, and producing China’s Sinovac vaccine domestically.