China-Africa Public Health Cooperation and Vaccine Diplomacy

China’s reputation game in Africa is of strategic and vital importance as Chinese engagements (investments, infrastructure, and other projects) typically receive positive ratings on the continent while generating controversy and outcry in other parts of the world.

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ACCORD COVID-19 Conflict & Resilience Monitor
Photo: Minasse Wondimu Hailu/Anadolu Agency via Getty Images

China’s COVID-19 assistance to Africa is a continuation of a long-dated tradition of public health cooperation. During the early stages of the epidemic (and later pandemic), African countries were first to show their support and assistance to China. China’s reciprocation of Africa’s assistance has filled a void in the absence of other partners but has yet to reach its full potential and has not produced vaccine distribution equity.

One could easily overlook the fact that China was not long ago (in fact a little over a year ago) a recipient of #COVID19 assistance and that African states provided much of that aid @LBenabdallah

China’s reputation game in Africa is of strategic and vital importance as Chinese engagements (investments, infrastructure, and other projects) typically receive positive ratings on the continent while generating controversy and outcry in other parts of the world. Maintaining a positive image and a solid reputation for being a responsible partner and a reliable friend, have been solid drivers of China’s pandemic diplomacy in Africa over the last year and a half. However, the lingering impacts of the pandemic both on social and economic wellbeing of African populations as well as the very slow motion roll-out of vaccines across the continent have proved to be serious challenges for China. So far, China’s PPE diplomacy has proved to be more efficient than its vaccine diplomacy but with the Forum on China Africa Cooperation (FOCAC) eighth edition around the corner, health cooperation will likely take centre stage. 

Capacity Building at the Heart of Healthy Cooperation 

Health cooperation between China and African states goes all the way back to the early years of the People’s Republic of China (PRC) as well as many African countries’ independence. The PRC, under the leadership of Mao, sent medical delegations to African countries in order to help with capacity building in newly independent African countries’ health sectors. One such team was sent from Wuhan to Algeria in 1963 to help train local doctors after the country’s independence in 1962. The spirit of these delegation visits was to ensure that Chinese doctors helped their African counterparts stand on their own feet and build public health institutions that were independent of colonial relationships. 

Therefore, placed on a continuum, China stepping up its health diplomacy in Africa in light of the COVID-19 pandemic is nothing new. Perhaps what’s interesting, or different, about this particular instance of health diplomacy is that it shows a much more diversified approach than that of the 1960s: the use of media to spread awareness and visibility around China’s efforts and the vocal criticisms of the West’s quasi-absence and greed in hoarding vaccines at the expense of Global South patients. 

COVID-19 Solidarity and Reciprocity 

One could easily overlook the fact that China was not long ago (in fact a little over a year ago) a recipient of COVID-19 assistance and that African states provided much of that aid. Indeed, in the early weeks of the epidemic, African states stood in solidarity with China at a time when several Western governments enjoyed agonising it. Several African countries (including Algeria and Egypt) sent planes filled with PPE including masks, gloves, thermometers, and other assistance. 

Besides equipment and material donations, Africans showed their solidarity with China and the Chinese people in a variety of other ways. African students in Confucius Institutes all across the continent participated in campaigns of sending positive and hopeful messages addressed to the Chinese people. As the epidemic spread inside China, African students in the country started volunteering to take temperatures outside of buildings and disinfect public spaces.

In addition, we also saw gestures of solidarity not just from individuals but from African governments and business corporates. We recall Egyptian health minister Hala Zayed’s visit to China in March 2020 to convey solidarity with the country. Similarly, Ethiopian airlines decided not to suspend its flights to China in a show of solidarity despite popular criticism at home. Several African governments were also reluctant to repatriate their nationals from China in a move to avoid embarrassing Chinese authorities. When the epidemic became a pandemic and the scale of propagation of the virus expanded, several African presidents and political elites took to making statements endorsing China’s state narrative about China’s handling of the pandemic and disputing theories that the virus originated in a Wuhan Lab. 

China’s health diplomacy during the COVID-19 pandemic 

Despite China’s experience with providing medical assistance for various outbreaks in Africa before, the COVID-19 pandemic was just different. This was a time when both lack of experience (or clear understanding of how the virus operates and how to stop it) coupled with the fact that the Chinese government had to walk a very fine line between providing all the resources possible to respond to the health crisis at home, while at the same time not retreating from the global stage and performing solidarity and responsibility. 

Much of this management was handled through public messaging and through social media presence. As we know, China’s vaccine diplomacy has been extremely well-medialised, to say the very least. This kind of messaging campaign (echoed by Chinese diplomats, missions and embassies, and other venues) was important to get the message across and raise awareness around China’s stepping in and showing up to provide assistance and vaccines to African populations. 

The optics did not always match the reality on the ground, however, as several challenges stood in the way of unlocking China’s vaccine diplomacy potential in Africa. 

Data collected and updated by Bridge Beijing, which is a vaccine tracker, indicates that the number of doses donated by China (as of August 22, 2021) was 40 million doses. The number of doses sold is over a billion with over 620 million doses delivered. This suggests that vaccine donations by China are less than 4% of the total number of vaccines, which is a very small amount, and much smaller than media narratives suggest. In addition, the Bridge Beijing tracker shows that of the 620 million doses delivered by China so far, only 52 million doses (which is a little over 8%) are finding their way to Africa. Without a surprise, China’s closest neighbours are getting a far bigger share (over half of the total amount goes to the Asia Pacific), and then Latin America has received close to a third of that amount (191 million doses). If we isolate donations from sales, Africa comes second (after Asia Pacific) with 8 out of 40 million donated doses. 

That said, Chinese vaccines (Sinopharm and Sinovac) have made their way into 37 African countries providing, in many cases, the only vaccination option for tens of thousands of frontline workers, first responders, and vulnerable populations. In addition to these vaccine deliveries, at least three African countries (Egypt, Morocco, and Algeria) are in the process of acquiring local production capacities that will enable them to produce the Chinese vaccine locally (with Egypt already entering the production phase promising to make 5 million more doses available in September 2021). 

With FOCAC 8 coming on the heel of a deadly wave of the Delta Variant in Africa, the conditions are open for African government elites to negotiate better delivery deadlines of the Chinese vaccines, more efficient capacity building programmes in public health, including the possibility of actually producing the vaccine locally instead of just “mounting” the parts. 

Lina Benabdallah is Assistant Professor at Wake Forest University.

This piece was first published by the London School of Economics on 20 October, 2021 and is available here. It was part of a report titled FOCAC at 21: Future Trajectories of China-Africa Relations.

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