China’s Vaccine Diplomacy, the “Health Silk Road” and a Global Pledge

15 July 2021 Purvaja Modak, FDI Associate Download PDF

Under its “Health Silk Road” programme, Beijing is supplying COVID-19 vaccines to over 80 countries, particularly in the developing world, many of which are members and supporters of the Belt and Road Initiative. While efforts to counter the virus are welcomed, the vaccines in question are largely untried and unapproved. Furthermore, while China has indeed donated vaccines to a few countries, the majority have had to purchase their supplies, in some instances using loans offered by Beijing to do so.


Key Points

  • China has used its COVID-19 vaccines to build its image as a provider of solutions to the pandemic, rather than being its source.
  • China has promised to supply the vaccines to over 80 countries, to some as outright donations and to others to be paid for at a later date.
  • China has taken advantage of the vulnerabilities of certain countries that cannot produce their own vaccines by supplying large volumes of its untried and unapproved vaccines to them as an act of goodwill.
  • China has not supplied vaccines to the US, Western Europe, India and countries like Japan, South Korea and Australia that have access to vaccines from their global allies.
  • Many of the countries to which China has pledged supplies are members and supporters of the Belt and Road Initiative, ensuring that they remain indebted to Beijing.



China has been criticised for being the likely origin of the COVID-19 pandemic and for not informing the world about the early stages of its outbreak.

Ever since vaccines to fight the pandemic were introduced in early 2021, there has been a persistent struggle to meet global demand for them. The vaccine rollouts are hampered by low production capacity and a lack of raw materials. With the objective of re-gaining its credibility, China began to supply large volumes of its unapproved and untried vaccines to the developing world in an attempt to be seen as a provider of solutions to fight the pandemic, rather than being its source.



Since late 2020, China has promised vaccines to more than 80 countries under its “Health Silk Road” initiative, an emerging diplomatic initiative to promote health co-operation. Those rollouts have faced scepticism, since the data on clinical trials have not been released for scientists to assess the efficacy of the vaccines. Critics of China’s so-called “vaccine diplomacy” do not view its efforts as an altruistic gesture. While China has indeed donated vaccines to a few countries, the majority have had to purchase their supplies, in some instances using loans offered by China to do so.

China’s “vaccine diplomacy” is underpinned by geopolitical motivations. According to an April 2021 report by Think Global Health, of the 56 countries to which China pledged doses, 55 were participants in the BRI. That is China’s way of ensuring that those countries will remain indebted to Beijing and will continue to support and allow Chinese infrastructure and connectivity projects on their territories.

That initiative has a secondary goal: China is now trying to give its pharmaceutical industry, which has been criticised for having low efficacy rates and poor credibility, a degree of legitimacy. China wishes to take its Sinovac and Sinopharm vaccines around the world to change those perceptions.

To achieve its geopolitical objectives and regain its global standing, China has sought to provide its vaccines to countries of almost every continent. As the tables below demonstrate, China has managed to penetrate many countries despite suspicion about the efficacy of the vaccines and opaque data on its clinical trials. China’s COVID-19 vaccines have been shipped to more than 60 countries for emergency use, according to an official of the Chinese Commerce Ministry. It has supplied its vaccines to five countries in India’s neighbourhood, to 27 African countries, twelve countries in Western and Central Asia, twelve more in South-East Asia and the Pacific, fifteen countries in Latin America and signed agreements to supply its vaccines to over twenty more countries. On 2 June 2021, China’s Ministry of Foreign Affairs stated that China had provided ‘more than 350 million doses’ of vaccines to the international community by that date.

China has donated funding to Brunei, Cambodia, Laos, the Philippines and Myanmar to purchase its vaccines and has sold them to Indonesia, Malaysia, Singapore and Thailand. In countries like Sri Lanka, Nepal and Bangladesh, China has had to compete with India, there being a preference for Indian vaccines. Many regional countries are turning to China, however, now that India has halted its global vaccine supply due to its own domestic shortages.

China has also concentrated its efforts in African countries. In sub-Saharan Africa, Chinese vaccines are predominantly distributed through the COVAX initiative. India, however, remains a larger vaccine supplier in the region than China. China has also donated the Sinopharm vaccine to Zimbabwe, Mozambique, and Namibia through a government-to-government initiative.

China’s Sinopharm vaccine is a popular choice in Argentina and Bolivia. In Mexico, almost all the currently distributed Chinese vaccines are available. They are being used along with the AstraZeneca, Pfizer and Russian Sputnik V vaccines. India has supplied Mexico with 870,000 doses and will deliver the full order in due course.

While Chinese vaccines are largely absent in Western Europe, some Central and Eastern European countries like Serbia, Belarus, Bosnia and Herzegovina, Montenegro, North Macedonia and Ukraine, have asked China for supplies of its vaccines.

Chinese pharmaceutical companies are keener than their western counterparts to strike licensing deals with other countries to produce the China-developed vaccines. For instance, Indonesia is producing Sinovac’s CoronaVac through its company, BioFarma. The UAE has conducted phase three clinical trials of the Sinopharm vaccine and has built in-house vaccine manufacturing capabilities, producing the vaccine under the name Hayat-Vax, a joint collaboration between Sinopharm CNBG and Abu Dhabi’s G42. It was the first country (after China) to approve Sinopharm’s vaccine. China’s “all weather” friend, Pakistan, plans to manufacture the CanSino vaccine through technology transfer. Brazil conducted clinical trials for Sinovac and began producing the vaccine. Production was halted in May 2021, however, due to a reported interruption of raw materials from China.

China has no plans, as far as is known, to domestically manufacture vaccines developed by other countries due to the state’s strong control on its pharmaceutical sector and as a matter of national pride. Its domestic production policy for pharmaceuticals was developed at a time when the state fully controlled the economy and when the country was isolated from international trade. It still follows a model of self-sufficiency for the sector, however. When China acceded to the WTO in 2001, it converted some of its state-owned enterprises (SOEs) operating in the pharmaceutical sector into privately-owned and -managed enterprises. Despite that, the largest and most important pharmaceutical companies in China remain majority state-owned. The China National Pharmaceutical Group, commonly known as Sinopharm, an SOE, is responsible for developing and manufacturing the most widely used and exported Chinese COVID-19 vaccine, as the tables below show.


China’s gains from its vaccine diplomacy can be evaluated in tangible and non-tangible ways. It provides vaccines and medical supplies in the form of commercial deals. The vaccine rollouts have led many countries in Latin America, West and South East Asia and Africa to align more closely with China, albeit they have become further indebted to Beijing. Those countries have in the past relied on China for developmental and humanitarian aid as well as for infrastructure development. The support of some countries to the BRI has been solid and their geostrategic objectives are aligned with China under the auspices of South-South Co-operation.  With its vaccine diplomacy, China has strengthened its strategic influence in those regions. It has also chosen to leave out countries like South Korea, Japan, the US, Australia and European countries, which either have their own capacity or have global allies that can provide their needs.

Although Chinese vaccine makers were among the earliest in the world to begin clinical trials for their vaccines, scepticism about their safety and effectiveness persists. That scepticism was bolstered by Gao Fu, Director of China’s Centre for Disease Control and Prevention, who said in April 2021 that the efficacy of Chinese vaccines was low and scientists were considering mixing them as an attempt to boost their effectiveness. Dr Gao’s opinion was confirmed by Brazil.

Fortunately for China, there has been some respite. In May this year, the World Health Organisation declared the vaccine made by Sinopharm ‘safe for emergency use’. That declaration came after China released some data on vaccine clinical trials and after the WHO conducted an on-site inspection of the production facility.

For China, the WHO’s approval can be seen as a step towards fulfilling Chinese President Xi Jinping’s pledge from May 2020 of making COVID-19 vaccines a “global public good”. China pledged an additional US$3 billion ($4.02 billion) in aid to developing countries and suggested setting up a global forum on vaccines to ensure equitable distribution at the Global Health Summit on May 2021.

With that declaration, Sinopharm can now be included in the COVAX, a global initiative to provide free vaccines to countries in need. Developing countries now have an alternative to Western-developed vaccines. The WHO is gauging the reliability of the Sinovac as well.

US President Joe Biden recently announced that the US will share 80 million doses of its vaccines with the world. The US and the other countries of the Quadrilateral Dialogue – Australia, India and Japan – agreed in March 2021 to provide 100 million doses of the vaccine developed by Johnson & Johnson to Asian countries by the end of 2022 to counter China’s influence in the Indo-Pacific region.

China will face a new challenge when that vaccine becomes available – to gauge what proportion of these Western vaccines will go to the regions it has already tapped and affect its capacity to be able to successfully hold its position as a dominant supplier in them. China’s vaccine diplomacy, its Health Silk Road Initiative and its global pledge are crucial to re-build its international image, especially as an intensive investigation of the labs at Wuhan, the alleged epicentre of the virus’s outbreak, gathers pace.



About the Author

Purvaja Modak is a Fellow at the Centre for Public Policy Research, a research institute in Kochi, India, where she specialises in geo-economic research. This paper is re-printed with the permission of CPPR.

Any opinions or views expressed in this paper are those of the individual author, unless stated to be those of Future Directions International.

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