A year on from when the first patient was diagnosed with Coronavirus in Wuhan, China, and two months on since the first person was vaccinated in Coventry, the growing concerns of equity, national interests, and moral obligation are becoming apparent.

The developed world has secured enough vaccines to serve their populations several times over; the least developed may not have widespread immunisation before 2023. This is while powerful global south states like China, India, and Russia made training, supply of PPE, and vaccination manufacturing and supply to the rest of the developing world a key priority as early as April 2020.

The number of vaccine doses administered in high-income states collectively stands at around 400 million. In contrast, the Director of the World Health Organisation, Tedros Ghebreyesus, said in January 2021 that ‘…not 25 million, not 25,000, just 25’ have been given the vaccine in Africa. On a proportional level this means the wealthiest states, accounting for 14% of the world’s population, have purchased 53% of the most effective vaccines, according to the Peoples Vaccine Alliance.

The pre-purchasing and hoarding of the most effective vaccines (BioNtech-Pfizer, Moderna, and Oxford AstraZeneca) has made very little available – let alone affordable – for many developing states.

These actions by the developed world are reminiscent of the inequity and even inequality perpetuated by western pharmaceuticals in the fight against HIV/AIDS from the 1980’s through to the early 2000’s. Even as the HIV/AIDS epidemic was rapidly subsiding in the developed world, the price of treatment (anti-retroviral drugs) remained astronomically high for the vast majority of Africans.

Twelve million people died of the disease in a single decade, most of whom were in the most economically productive age groups. It was only after Yusuf Hamied of India’s Cipla Pharmaceuticals created the generic version of the drug – which was permitted under the Patent Act of 1970 – that the formulae for drugs of critical public importance could be replicated for greater and more affordable access to the population. This generic version, developed in the 1990’s, reduced the cost of the drug from over $10,000 (£7,190) annually to $100 (£71) annually.

Therefore, in the wider geopolitical context, the west finds itself in another moral dilemma and risks (yet again) finding itself on the wrong side of history. With the US out of the World Health Organisation (although re-joining in January) and Europe debating vaccine short falls and export restrictions, states like China, Russia, and India have been at the forefront of providing vaccines to the least developed countries.

By the time Donald Trump decided to pull the US out of the WHO in July 2020, China had already provided large quantities of PPE to Africa and pledged a $1 billion loan to the Caribbean and South American states to purchase the Chinese Sino-Pharm vaccine. Further positioning China as a responsible global power was their participation in the Covax alliance, the global UN-led effort to equitably distribute vaccines to 2 billion people worldwide by the end of 2021.

On the bilateral level China’s Sino-Pharm vaccine is already undergoing phased rollouts in Egypt and Equatorial Guinea whilst Zimbabwe has received a 200,000-dose donation. Additionally, several South East Asian states like the Philippines and Myanmar have also been promised priority access and donations by China.

On the other hand, Russia’s Sputnik V vaccine is also in the race with an effectiveness rate of 92% – a figure that was subsequently raised to 95% after the Massachusetts-based Moderna vaccine was introduced with a 94.1% effectiveness rate. The Sputnik V vaccine has already been dispatched to Algeria, Argentina, Belarus, Egypt, Guinea, and Hungary – Hungary being the first (and so far, the only) EU member state to receive Sputnik V, with additional plans to receive the Chinese Sino-Pharm vaccine. This noticeably contradicts with the EU’s purchase of Pfizer-Biontech, Moderna and AstraZeneca.

This effort by Moscow is reminiscent of the Soviet-era vaccine donations to eastern bloc countries but modernised into a government and private industry diplomatic charm offensive, with examples of Russian mineral conglomerates like Alrosa pledging to buy and donate ‘dozens of thousands’ of Sputnik V vaccines to Angola (Africa’s largest oil producer) and Zimbabwe (the world’s third largest platinum producer) in the coming months.

India, with a much more established pharmaceutical industry, is already manufacturing the vaccine in an agreement between the Serum Institute of India (SII) and AstraZeneca; they are already suppling orders to South Africa and Morocco, among others. On a regional level New Delhi donated 3.2 million vaccines to Bangladesh, Bhutan, the Maldives, and Nepal – all of whom are SAARC (South Asian Association for Regional Cooperation) members.

In addition, India’s SII – already one of the world’s largest vaccine producers – claims to produce 100 million vaccines per month and is anticipating more orders from across the world, despite concerns that a recent fire at a SII plant will impact their progress.

While the Covax scheme has the potential to vaccinate at least 20% of each country’s population, with a population as large as Africa and the Centre for Disease Control’s immunisation target of 60%, it will need 1.28 billion more doses (assuming two doses per person) at an estimated cost of $13.54 billion to meet that target. This means that alternative arrangements will be explored on a bilateral level.

With the west making pre-purchases in a bid to secure their populations several times over and emerging global south powers like China trying to compensate for being the origin of the virus, a COVID-19 diplomacy game of high risks and potentially high rewards is evidently being played.