A CIDOB, ideograma and ISGlobal report analyses the role of health in global geopolitics

 What are the geopolitics of health? Taking this question as a starting point, this CIDOB Report analyses how the outbreak of the COVID-19 pandemic has placed health at the heart of geopolitical debate and action. The pandemic and the vaccine have accelerated the rivalry between powers in a multipolar world, as Eduard Soler, Senior Research Fellow at CIDOB and editor of the publication, points out in the opening chapter. However, they also invite us to rethink international governance mechanisms and incorporate a plural, citizen-based, cooperative vision of the geopolitics of health. 

At a press conference this morning, representatives of the three institutions (Pol Morillas, Director of CIDOB, Rafael Vilasanjuan, Policy and Global Development Director at ISGlobal, a centre promoted by the “la Caixa” Foundation, and Santiago Castelo, Deputy Director of ideograma) and other contributing authors to the publication presented ”Geopolitics of health: vaccines, governance and cooperation”, which has benefitted from the support of the State Secretary for Global Spain of the Ministry of Foreign Affairs, European Union and Cooperation. 

Health multilateralism: in search of global health governance 

No longer merely a good at the service of the countries with the most advanced economies, health has become the key global security asset. In his article, Rafael Vilasanjuan examines the role of the World Health Organization (WHO) in the fight against COVID-19 and concludes that to tackle the worst pandemic in generations a better and stronger WHO was needed. He highlights the successes of the new model of health multilateralism: a vaccine administered a record333 days from the time the genetic code of the virus was deciphered; and the roll-out of international initiatives such as COVAX, the vaccine pillar of the ACT-Accelerator platform, led by multilateral organisations, which aims to distribute 2 billion free doses of vaccines to the 92 low- and middle-income countries on its list by the end of the year. Vilasanjuan calls for more inclusive governance that possesses implementation capacity “if we want to avoid similar crises with little collective response capacity”.   

Multipolar health: the geopolitical use of the vaccine 

The world’s leading powers are using the vaccine as an instrument of power and status. The chapter coordinated by Pol Morillas discussesthe range of dynamics evident in the geopolitical use of vaccines by the European Union (EU), United States (US), China, Russia, Latin America and India. The EU has become the world’s largest vaccine exporter and donor (159 million doses exported to 87 countries) and has allocated €2.2 billion to the COVAX initiative. EU diplomatic discourse highlights the bloc’s position as a power working to strengthen the multilateral system in solidarity with developing countries, but in reality most of its exports have gone to countries that could not be described as poor: the United Kingdom, Canada, Japan, Mexico, Saudi Arabia, Singapore, Chile, Hong Kong, Korea and Australia. The US, one of the world’s largest vaccine producers has exported miniscule quantities compared to other countries. Of 333 million vaccines produced to May 2021, only 3% had been shipped beyond its borders (mainly to Mexico and Canada).  

While the United States concerned itself with vaccinating its own population, Russia and particularly China have supplied vaccines in exchange for concessions that support their policies and interests. China’s official response has devoted great efforts to replacing the dominant narrative of China as culprit with its contrary – China as solution – by enhancing its role as a global manufacturer of health material and vaccines. The Asian giant has looked to fill the gap left by the world’s most developed economies, using its vaccine as a foreign policy tool despite having vaccinated only a relatively small proportion of its domestic population (it has promised to reach 40% in June 2021). According to the Chinese Foreign Ministry, it has pledged to supply (free or low-cost) vaccines to over 80 countries and it has also licensed five countries to produce its Sinovac vaccine: Turkey, Brazil, Malaysia, Egypt and Indonesia. Russia, meanwhile, has so far sold 16.3 million doses to about 45 countries and has a very long waiting list. However, its domestic population seems somewhat more reluctant to be vaccinated with Sputnik V (only about 12 million people have received the first dose). 

Russia and China have become the major suppliers to Latin America and the Caribbean. By mid-2021, 14 Latin American countries were administering Chinese vaccines and nine the Russian equivalent. This vaccine diplomacy poses a challenge to the United States’ historical influence in the region. So far, Chile and Uruguay are the only Latin American countries to have vaccinated 50% of their population, while at the other extreme Guatemala, Honduras, Nicaragua and Paraguay have below 3% coverage. 

Since the pandemic began, Indian Prime Minister Narendra Modi has focused on projecting power on a global scale through “made in India” vaccines. To do this, he has promoted the priority distribution of millions of vaccines to friendly neighbouring Asian countries, reaffirming his desire to counteract China’s influence in what India considers its natural environment. However, difficulties coping with the second wave have damaged the image Modi wanted to project of the country as “the world’s pharmacy".  

The geopolitics of biomedical research during the pandemic: patents, production and universal vaccine access 

This CIDOB Report also delves into the geopolitical dynamics of innovation and industrial production. According to Adelaida Sarukhan, PhD in Immunology and Scientific Writer for ISGlobal, the great achievement of the current fight against the pandemic has been to create a more collaborative and inclusive international R&D framework in order to better respond to future global health threats. The pandemic has shown the value of science without borders, but also that the countries with the best biomedical research infrastructure are best-placed. The article underscores the value of public investment in driving innovation and research, citing a recent publication by the Global Health Centre in Geneva, which estimates that 98.15% of the $6.1 billion identified R&D funding comes from the public sector (with the United States and Germany heading the list). When “advanced market commitment” investments for the purchase of vaccines are also included, the leading pharmaceutical companies have received about $51 billion. The author calls for the transfer of advanced technologies (messenger RNA, viral vectors, viral nanoparticles) to be encouraged and for production plants to be set up in low- and middle-income countries in order to guarantee their own vaccine production. 

The health industry’s R&D resources are aimed at societies with the capacity and willingness to pay for them, writes Joan Bigorra, Director of Innovation at ISGlobal, but the speed and ease of SARS-CoV-2 transmission makes prompt vaccination of the majority of the world's population essential. This poses huge geopolitical challenges, including industrial policy issues. The health industry, which is mostly in private hands and possesses significant financial muscle, monopolises capacity in terms of project management, production and commercialisation. A study by the prestigious magazine JAMA notes that the 35 large pharmaceutical companies listed on the New York Stock Exchange reported a net profit margin on sales of 13.8%, compared to 7.7% for the other companies. Suchexceptional performance and substantial economic returns are major incentives when it comes to pharmaceutical patents. COVID-19 vaccine manufacturers have estimated that their combined vaccine production capacity will reach 12 billion doses in 2021 and yet it remains unclear whether the volume needed to vaccinate 70% of the world's population will be reached by 2022. This is where the issue of patents comes in, as their temporary suspension could help meet production and distribution goals. 

The impact of the pandemic on the 2030 Agenda, humanitarian crises and the management of mobility and migration 

A number of the goals on the 2030 Agenda have been adversely affected by the COVID-19 pandemic, particularly those related to health, poverty and inequality. The weaknesses in the development model have been revealed, along with the current multilateral system’s vulnerability and lack of response capacity. For Anna Ayuso, Senior Research Fellow at CIDOB,  the funding gap urgently needs addressing. Poverty and inequality indicators in middle-income countries, such as those in Latin America, have been set back two decades, while fiscal deficits  have grown and debt servicing has reached the equivalent of 59% of exports. Reforms and initiatives to modify international financing structures are needed, as current tools cannot absorb the looming sovereign debt crisis. 

Pol Bargués, Research Fellow at CIDOB, and Sergio Maydeu-Olivares, Associate Researcher at CIDOB, describe how the coronavirus has ravaged war zones, aggravating three types of humanitarian crisis: health, food and mobility. During this pandemic year, vaccination programmes to fight diseases such as measles, cholera, yellow fever, polio, meningitis and the human papilloma virus have been disrupted, undoing years of work fighting these diseases and the public health endeavours that underpinned the fight. A study by the Global Network Against Food Crises (GNAFC) says that levels of hunger are at their highest for five years, with 155 million people facing food shortages in the 55 countries analysed, 20 million more than in 2019. 

On mobility, Gonzalo Fanjul, Director of Policy Analysis at ISGlobal says that as well as reducing people’s movements to historic lows, the COVID-19 crisis has strengthened the connection between migration and health. The data suggest a dramatic fall in the number of immigration permits granted (45% lower on average in G20 countries) and in asylum applications (33% lower than the same period of the previous year). Fanjul highlights the valuable contribution made by migrants during the pandemic, both to their communities of origin and to host countries. The volume of remittances sent by foreign workers is proof of this, with the World Bank estimating the total at $540 billion, only 1.6% down on the previous year’s figure. Meanwhile, migrant workers contribute greatly to healthcare workforces in host countries, comprising 11% in the EU, 12% in the United States and 17% in the UK. The percentages are higher in other essential sectors such as the care sector, fruit and vegetable picking, food services and home delivery. The article concludes by calling for the migration model to be redrawn and describes the urgent need to address some of its challenges: reactivate and rationalise mobility through more flexible mechanisms to adapt migration flows to the needs and obligations of states; stop the deterioration of the international protection system; and develop narratives to replace the anti-immigration discourse. 

Vaccines and (geo)political communication: distrust of the vaccine or distrust of the system? 

“The debate was toxic even before the pandemic” says Carme Colomina, Senior Research Fellow at CIDOB, meaning distrust of the vaccine is just another reflection of pre-coronavirus trends: information disorder, the discrediting of institutions and polarisation. At a global level, the story of the fight against the coronavirus was presented as a geopolitical face-off between the models of liberal democracies and authoritarian regimes. At the local level, the politicisation of the pandemic and the measures proposed to confront it also ended up reinforcing the arguments of the radical right: us versus them (over the right to mobility and migration) and the people versus the elites (during the imposition of lockdowns). The pandemic has worsened democratic regressions and cuts to rights and freedoms: according to the International IDEA institute in 2020 over half of the world's countries (61%) implemented measures to curb COVID-19 that challenged democratic standards or eroded human rights. Nevertheless, "the pandemic may be the prompt our governments need to give more priority to social, rights and welfare issues" argues Antoni Gutiérrez-Rubí, Director of ideograma. Health has surged up the social agenda, driving greater research investment and making scientific and technological issues fundamental pillars of the welfare state, but it has also become an asset of diplomacy and geopolitical communication between countries. 

The CIDOB Report“Geopolitics of health: vaccines, governance and cooperation” includes an infographic section that displays the main data associated with the COVID-19 pandemic and the political and scientific responses put in place to deal with it. Access this section  here. 

>>CIDOB Report Geopolitics of health: vaccines, governance and cooperation