The COVID-19 pandemic not only exposed the poor state of South Asia’s healthcare infrastructure, but also reignited the rivalry between India and China as both powers engaged in competitive mask diplomacy to aid the struggling countries in the region. The two Asian giants supplied PPE kits, ventilators, masks and sanitisers to help the region tide over the first wave of COVID-19 cases. Prior to the pandemic, India was already a dominant player in the region’s healthcare sector. Its low-cost healthcare services made it a popular destination for medical tourism in the region. According to the Medical Tourism Index, India ranked 10th among 46 major destinations for Medical Value Travel (MVT) for 2020–2021, while China was 33rd. In 2019, foreign tourist arrivals in India for medical reasons were 697,453—6.4% of the total tourist inflow; and in 2018, this number was 644,036—6.1% of the total.
India was thus well-positioned to take the lead as the region’s ‘first responder’ when cases of COVID-19 began to appear in South Asia in January 2020. It reactivated the South Asian Association for Regional Cooperation (SAARC) and established the SAARC COVID-19 Fund to cater to the needs of its regional members. By December 2020, India had exported over 20 million PPE kits and 40 million N-95 masks to a number of countries.
India, which prides itself as the ‘pharmacy of the world’, started the Vaccine Maitri programme and began supplying vaccines to its South Asian neighbours free of charge. On March 30 this year, India’s External Affairs Minister, Dr. S. Jaishankar, proudly declared that India had “supplied 64 million doses of vaccines to 82 countries”. Unfortunately, when the second wave engulfed the country just a few months later, it exposed just how unprepared India was to deal with a healthcare emergency of such magnitude.
India’s vaccine diplomacy came under severe criticism by opposition political parties. In January 2021, a fire struck the Serum Institute of India (SII)’s facility in Pune, delaying plans to ramp up vaccine production. During the height of India’s second wave in May, the country’s healthcare system was overwhelmed by the sheer number of infections and high mortality rate. The domestic production of the vaccine could not cater to this sudden surge in demand—from a situation of vaccine hesitancy India was confronted by a rush to get vaccinated as the government lowered the age of vaccination to 18 years. SII prioritised “domestic needs” which had “a knock-on effect in other parts of the world that desperately need vaccines”. Until the ban on export of vaccines, SII was exporting 60 percent of its production.
India’s vaccine diplomacy suffered due to the inability of SII to step up production, compounded by a chronic shortage of raw materials due to the US export ban. Countries like Bangladesh and Nepal were forced to halt inoculation efforts with India’s Covishield after SII admitted in May that it would be unable to fulfil its international commitments for several months.
Up until that point, India’s regional vaccine diplomacy had actually been remarkably successful. Covishield was the preferred choice in the neighbourhood because of its comparatively cheaper price and World Health Organization (WHO) recognition. In addition, India had been supplying doses of Covishield as gifts to underline its ‘Neighbourhood First’ policy, reiterating its mantra, ‘sabka saath, sabka vikas’ (everyone's support, everyone's development). China’s vaccine diplomacy in contrast, had failed to take off as recipient countries were expected to share the cost of its Sinovac clinical trials. The fact that India prioritised sharing vaccines with its neighbours before it had completed inoculating its citizens further earned the gratitude of many in the region. This allowed India to emerge as an empathetic provider unlike the US that prioritised vaccination of its own citizens. SII’s failure to meet its international commitments, therefore, dealt a major blow to India’s vaccination outreach to the region, opening the door for China.
In May this year, two China-made vaccines—Sinopharm and Sinovac—were granted emergency use authorisation by the technical advisory group of the WHO, opening the possibility that they could be included into the Covax programme—a worldwide initiative aimed at distributing vaccines to poorer countries. On May 26, China announced a gift of 1 million doses of Sinopharm to Nepal, with 800,000 doses arriving in Kathmandu just days later on June 2. Notably, China’s announcement came just days after SII communicated its inability to provide vaccines to Nepal. Likewise, Sri Lanka has received just 1.3 million doses of India’s Covishield while it has received 2.2 million doses of China’s Sinopharm. By the end of 2021, China’s total vaccine contribution to the rest of the world is expected to surpass 1 billion doses.
Like India’s Vaccine Maitri programme, China considers its vaccine contributions as a “global public good”. Yet, the competition between the two to use vaccines as a part of their diplomatic outreach to exert influence has been apparent. Both giants targeted the countries of South Asia, Southeast Asia, West Asia and Africa. While China had more success in Southeast Asia, India initially had the upper hand in South Asia. India’s initiative of the SAARC COVID Fund, the SAARC Health Ministers’ Meet, the sharing of experiences through the SAARC Disaster Management portal, and allowing visa-free travel for doctors and nurses, all made India an important player in the region. China also tried to create an alternative forum in South Asia to advance its vaccine diplomacy. Beijing invited the foreign ministers of the South Asian countries to discuss how to take the cooperation on COVID-19 ahead. India did not join this meeting, but Bangladesh, Sri Lanka, Pakistan, Afghanistan and Nepal participated in the virtual meeting. This almost countered India’s SAARC COVID-19 initiative.
There were media reports that China had forced Nepal to accept the first batch of 800,000 vaccines, though Kathmandu has since decided to procure another 4 million doses of Sinopharm vaccines, due to the continued uncertainty over the SII supply. China’s request to include a non-disclosure clause in this purchase created some consternation in Kathmandu, and when the price ($10 a dose) was subsequently leaked to the press, Beijing was none too pleased. Bangladesh similarly drew China’s ire when one of its high-ranking officials unwittingly disclosed the price (also at $10 a dose) for its procurement of 15 million vaccines, leading Dhaka to quickly issue an apology. China was left thoroughly embarrassed when press reports revealed that it had charged Sri Lanka $15 per dose for the Sinopharm vaccine—$5 more than what it charged Nepal and Bangladesh. Compared to this, the price of Covishield produced by SII is between $4 and $5 per dose. COVID-19 vaccination involves mass inoculation. Therefore, the pricing of the vaccine remains an extremely sensitive issue in South Asia.
The success of China and India’s vaccine diplomacy is yet to be decided as the two Asian giants scramble for influence and goodwill. India, which is known as the ‘pharmacy of the world’ is likely to gear up its vaccine supplies as its second wave subsides and mass inoculations make a third wave increasingly unlikely. SII has indicated that it hoped to resume exports by the end of the year. Yet, the failure to supply vaccines to its neighbours just as a surge in cases engulfed the region has been a major setback to India’s vaccine diplomacy and exposed India’s own vulnerability. Certainly, the porous border with Bangladesh and open border with both Nepal and Bhutan would mean India’s inoculation program has to run in tandem with theirs. For that, SII needs to fulfil its regional commitment. Closing these borders and an export ban cannot be a long term option. For example, COVID-19 cases in the Indian states bordering Bangladesh is seeing a surge along with the bordering districts in Bangladesh. Therefore, it is important to take a more regional approach under its Vaccine Maitri programme as part of its efforts to keep India safe. As India expands its vaccine production to include others like Moderna, Pfizer, and Sputnik, and more private players are permitted to produce vaccines, the fall in price of vaccines may still help India regain its position as the ‘pharmacy of the world’.
Dr. Smruti S. Pattanaik is a Research Fellow at Manohar Parrikar Institute for Defence Studies and Analyses (MP-IDSA). Her area of specialisation is South Asia. Her current research project is titled as “India’s Response to China’s Presence in South Asia: Challenges and Policy Options”.
The views expressed in the article are solely those of the author(s) and do not necessarily reflect the position or policy of the Lee Kuan Yew School of Public Policy or the National University of Singapore.
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Journal of Asian Security and International Affairs 8, no.1 (2021): 33–61
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Much has been said about how China’s rapidly growing economy has led to increasing power disparity between India and China over the last two decades. China’s economic growth in this period has been spectacular, but it is not clear whether that gives a good sense of how effective its military capabilities are against India. In the context of the escalating Sino-Indian rivalry, this article asks the question: what is the nature of India’s power disparity vis-à-vis China? And does the existing power disparity between India and China give China a clear and uncontestable advantage? We argue that while there is significant asymmetry between India and China, the asymmetry is not as overwhelming when we consider certain facets of war-making capacity such as capital intensiveness of the military, military mobilisation, extractive capacity of the state and the institutional capacities to mobilise forces on a large scale, should the occasion demand. Moreover, India, with a more defensive posture against China, is in a better position to counter it because it mitigates the effects of power disparity. Therefore, we seek to understand the variation in asymmetries across different parameters of war-making capacity and force structure to better assess where the two countries may have advantages and disadvantages in the months and years to come. This article’s main contribution is to demonstrate through publicly available data the various levels of asymmetry between India and China. It also contributes to the security studies, rising powers and conflict literature.
Compiled and sent to you by Centre on Asia and Globalisation and the Lee Kuan Yew School of Public Policy, National University of Singapore.
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