Commentary | Dakila Kim P. Yee, A Trojan Horse: China’s Vaccine Diplomacy and the internal dynamics of the COVID-19 Vaccine Rollout in the Philippines

The end of the pandemic is far from sight in the Philippines. As of May 3, 2021, the country has 1,037,460 cases with at least 17,234 confirmed deaths. In absolute numbers, the country has the second most number of confirmed cases behind Indonesia (1,668,368). The country ranks 3rd in terms of cases per million of the population (9,728), behind Malaysia (12, 872) and Singapore respectively (10,885). The Philippines never seemed to flatten the curve of infections, with a new surge in cases since March 2021 as the country reopened the economy.  The country breached the 10,000 daily cases mark in the last week of March, with a record-high 15,310 cases reported on April 2, 2021. Metro Manila and the surrounding region, which accounts for the highest contribution to the GDP as well as the highest number of COVID-19 cases, reverted to “Enhanced Community Quarantine” status, the strictest form of lockdown in the country, to stem the rise in infections as of March 29, 2021. Hospital capacities were overwhelmed, with many patients being turned back and being left to fend for themselves in their homes, or in makeshift tents.

What accounts for the failure to stop this pandemic? Simply put, President Rodrigo Duterte has pinned the entire COVID-19 recovery of the Philippines on vaccine procurement and deployment, to the detriment of implementing public health measures that worked in containing the pandemic, such as massive testing, contact tracing of COVID-19 cases, and installation of isolation and treatment facilities.  Despite the prioritization of vaccination as the pandemic exit strategy, vaccination rollout has proceeded at a glacial pace. A total of 1,676,687 doses of COVID-19 vaccines have been administered with only two brands being administered as of this writing: Sinovac’s Coronavac vaccine and Oxford’s Astrazeneca vaccine. However, only 1.4% of the population has been vaccinated and only 0.2% of the population can be considered as fully vaccinated (completed the two dozes).

Several analyses of the COVID-19 vaccine rollout in the Philippines have identified vaccine diplomacy by China as a key driver of this phenomenon. While it is true that China is the looming actor here, I want to expound on factors that resulted in China becoming the most important vaccine supplier, while highlighting the implications of China’s actions in domestic politics in the country.

Constraints to Vaccine Procurement

A majority of the countries from the Global South like the Philippines have zero vaccine manufacturing capabilities, and for those that do, such as India, these capabilities are hampered by export bans imposed by the Global North on inputs for vaccine production. Another issue raised by civil society organizations is the failure of the World Trade Organization to waive the Agreement on Trade-Related Aspects of Intellectual Property Rights, particularly waiving patent monopolies which would have enabled developing countries to adopt technology and develop their own COVID-19 vaccines.  Developing countries have also raised objections to the hoarding of vaccines by countries in the developed world. People’s Vaccine Alliance, a coalition of civil society organizations all over the world, found that rich countries, accounting for only 14% of the global population, have hoarded 53% of the global supply of the top COVID-19 vaccines. Thus, there is a massive pinch on global vaccine supply for developing countries.

A second constraint to vaccine procurement is the lack of funding prioritization for vaccine procurement and deployment. While the General Appropriations Act of 2021 (the law that enacts the budget of the government) has allotted Php 82 billion pesos for vaccine rollout, only 12.5 Billion will come from the national budget, while 70B will be funded from unprogrammed funds. This means that they are dependent on the availability of revenues. Unprogrammed funds are not readily available as they can only be financed once the government exceeds the year’s revenue targets and/or if the government secures loans. Because of this, the cash on hand is limited only to the 12.5 allotment, thereby limiting the resources available for the vaccine rollout. Why is this important? Limited resources make the country susceptible to donations, and that is what happened in February when the initial allocation of Sinovac vaccine was donated by the Chinese government.

Vaccine Diplomacy

“We are awaiting for God’s blessing na magkaroon tayo ng vaccine either from sino diyan na bright boy: China, Russia, America. I’m sure na kung meron na sila, they will share it with the rest of the world”

“We are waiting for God’s blessing that we will have vaccines, from…: China, Russia, America. I’m sure, if they have it, they will share it with the rest of the world” (President Rodrigo Duterte’s address to the nation)

To make matters worse, initial stages of the vaccine procurement process have been hampered by delays and missteps. In December 2020, foreign affairs secretary Teodoro Locsin Jr. and senator Panfilo Lacson pointed out that the Sec. Duque “dropped the ball” in the procurement process of the Pfizer vaccine by failing to sign the papers  necessary to finish the deal.  This resulted in missing out on at least 10 million doses of the Pfizer vaccine. Sec. Duque defended himself by saying that they scrutinized the deal with Pfizer as part of doing due diligence.

The clear winner from this fallout is China. First off, China is a preferred partner in the COVID-19 response.  President Rodrigo Duterte has gone on record to state his preference for vaccines made in China, and as of this writing, he was recently inoculated with the Sinopharm vaccine, which has not yet been approved for use in the Philippines. In late 2020, a controversy sparked when it was exposed that several public officials, including the President’s close-in security were inoculated with the Sinopharm vaccine, despite the lack of emergency use authorization (EUA) approval from the Food and Drug Administration (FDA) of the Philippines. In January 2020, just one month after the supposed bungled procurement of the Pfizer vaccine, the Food and Drug administration approved the application for emergency use approval of the Sinovac vaccine despite the lack of published clinical trial results. The shortfall from the potential 10 million doses from Pfizer has been filled by Chinese made vaccines. As of this writing, there are 4,040,060 doses of vaccines delivered to the Philippines of which, 3.5 million are from Sinovac while 526,000 are from AztraZeneca.

While there are concerns about the efficacy of the Sinovac vaccines due to its lower efficacy as compared to Pfizer, the government has proceeded with the inoculation of health care workers and other priority groups, mainly from this vaccine. This is a significant coup for the Chinese government, as another strategic country has subscribed to its vaccine. For the Philippine government, they have emerged relatively unscathed despite the regulatory fiascos that emerged prior to the approval of the vaccine. Despite early pundits claiming that the Chinese vaccine diplomacy was a dud, the vaccine rollout has proceeded well: There are almost no reports of vaccine refusals, with millions inoculated. The only problem so far is the glut in global vaccine supplies which has hampered the ramping up of vaccinations in the country.

A Trojan Horse?  Implications of the Vaccine Rollout

As China is the first to supply the country with vaccines, their influence in the entire vaccine rollout will be very evident and will likely not wane.  What are the implications for the vaccine rollout in the Philippines? I want to briefly discuss two issues: The West Philippine Sea dispute within the broader South China Sea complex and the build up to the 2022 elections in the Philippines.

WPS issue

While China has been amped the pace in its vaccine diplomacy towards the Philippines, this was accompanied by aggressive posturing of the former in the disputed waters of the West Philippine Sea. On March 7, 2021, 220 Chinese militia ships were spotted in Julian Reef, 175 nautical miles west of the town of Bataraza, Palawan. This sparked an ongoing diplomatic dispute between Manila and Beijing, with the Defense secretary and Foreign affairs secretary issuing strong statements condemning the incursion. However, Duterte has not been as aggressive on the issue, stating that confronting Beijing may lead to war and that there is no capacity to take back the islands. The President also claimed that the country owes China a “debt of gratitude” (utang na loob) for supplying the vaccines to the country, which is why the government is not confronting China on the incursions. The West Philippine Sea issue has remained a thorn on Duterte’s side and will most likely factor into the 2022 national and local elections which will select the successor to the Presidency.

China in the 2022 elections

The glacial pace of the vaccination drive may very well seem that the vaccination rollout will extend until 2022, which means that the vaccination rollout will coincide with the 2022 national and local elections in the Philippines. There are two implications.

First, domestic elections in the Philippines which are already marked by high prevalence of vote-buying will not be compounded by the political effects of rolling out vaccinations. In a country which has experienced a year-long lockdown, rising infections and death rates and a deflated economy, the promise of vaccines as a way out of the conundrum of the COVID-19 pandemic will certainly have political dividends on politicians who can dispense the vaccine.

Second, we will see another national election where China will play an active role, this time via the vaccination rollout. China may ramp up the production and delivery of vaccines and deploy these vaccines to the Philippines, thereby increasing its visibility and influence in a very crucial political juncture. The next elections will be crucial, as China may seek to protect its infrastructural drive in the country as well as its encroachment into sovereign territories.

Conclusion

The COVID-19 vaccination rollout in the Philippines has exposed various international and domestic issues that has hampered the ability of the country’s vaccination plan. At the international level, hoarding of vaccines, embargoes on vaccine inputs to developing countries like India and the failure to waive the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) for patent monopolies have hampered the ability of developing countries to secure and to produce COVID-19 vaccines, causing a glut in the supply chain. At the domestic level, the lack of domestic funding priorities for vaccinations coupled with dependence on China as the source of vaccines has not enabled the country to expand the pool of vaccine resources.

The dependence on China has likewise highlighted the geopolitical priorities of the Duterte administration. The latter’s focus on infrastructural investment to boost the domestic economy and to shore up its political legitimacy has made it dependent to Beijing’s promise of funding and aid. As pointed out, this comes at a cost: claims to the West Philippine Sea have been compromised, with no clear resolution in sight. As China increasingly becomes the focal player in the country’s vaccination drive, the ties between Beijing and the Duterte administration may become too difficult to unknot.

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Dakila Kim P. Yee is an Assistant Professor in the Division of Social Sciences at University of the Philippines Visayas Tacloban College.

To cite this essay, please use the suggested entry below:

Dakila Kim P. Yee, “A Trojan Horse: China’s Vaccine Diplomacy and the internal dynamics of the COVID-19 Vaccine Rollout in the Philippines,” criticalasianstudies.org Commentary Board, May 5, 2021; https://doi.org/10.52698/JJLT2807.