An Evolution of Vaccine Diplomacy

“Thanks, Uncle Sam,” a friend of mine in Asunción remarked – perhaps sarcastically – when declaring that she had received the first dose of her vaccination regimen in July.

This vaccine, one of a million Pfizer doses donated by the United States to Paraguay a few weeks earlier, was a welcome development for a country that had until recently held the position as the state with the highest per-capita death rate globally. Its vaccination campaign now underway, the number of Paraguayan citizens who had received their first dose nearly tripled over the month of July.

The State Department’s decision to send so many vaccines to such a small country could seem strange. For one, Paraguay isn’t the staunchest U.S. ally in the region, especially when considering Colombia or Chile. Furthermore, the Biden administration spent much of early 2021 pursuing a nationalist vaccine procurement plan that prioritized US citizens. This came even to the extent of ignoring pleas for assistance from the president of Mexico.

China’s early lead

By nature, Latin America is a region ripe for great power competition, given the vast natural resources present that make it critical to the global economy. Compounding the situation currently is the fact that many of Latin America’s developing countries lack the domestic production capabilities to produce their own COVID-19 vaccines (with Cuba emerging as a notable exception).

In fact, China, and to a lesser degree Russia, has led in Latin American medical diplomacy since the start of the pandemic. Beijing has been particularly assertive, exporting millions of its homegrown vaccines – such as Sinopharm, CoronaVac, and CanSino.

Chile can attribute much of its immunization successes, in which it emerged as a regional leader, to shipments of CoronaVac. Brazil’s deployed the same vaccine, following a production agreement between Sinovac and the São Paulo state government. Mexico utilizes the CanSino vaccine in much of its national immunization campaign. Meanwhile, though it has since diversified, Peru’s earliest vaccine imports came from Sinopharm.

Paraguay in the margins

Given its position as the sole country in South America – and only of only fifteen worldwide – to recognize Taiwan rather than China, Paraguay has been an unsurprising exception to this trend. It has not been recipient to the same Chinese generosity that many of its neighbors have. The effect is clear; while today the country maintains its relationship with Taipei, there’s a growing debate to switch relations.

This debate, which has included votes in the Senate and deliberations among members of the leading Colorado Party, has had global implications. Taiwan ramped up its own medical diplomacy in an effort to keep its ally; given that it couldn’t hope to compete with Beijing’s production apparatus, it asked its allies in the democratic world, namely India and Japan, to boost their medical exports to Paraguay, in an attempt to fill the gap.

The Washington reversal

Through all of this, the United States remained conspicuously silent, watching from the sidelines as China and Russia have filled the great power void. The narrative has changed, however, beginning in the late spring and progressing over the course of the summer and early fall. As the US has ramped up its efforts – as what US President Biden has deemed the ‘arsenal of vaccines’ – to expand access to immunization worldwide, Latin American countries have been the recipients of roughly a third of US-exported vaccines.

As of the end of September, Mexico has received over seven and a half million US-provided doses, composed of an assortment of AstraZeneca, Johnson & Johnson, and Moderna. Colombia has seen roughly six million vaccines delivered by its ally, namely Moderna and J&J, while Brazil, Argentina and the countries of the Northern Triangle have each received at least three million doses (J&J for Brazil, and Moderna for the remainder).

And in the case of Paraguay, there have been two million Pfizer doses delivered thus far, both over the summer. While there remains much work to be done, the country has seen its number of COVID cases drop to a point last seen in the spring of 2020.

Great power competition

With this dramatic, if belated, uptick in vaccine diplomacy, the United States is sending a clear message to its rivals, particularly China and Russia: it intends to ensure its diplomatic standing in Latin America.

This message is perhaps spurned in action by testimony to the U.S—China Economic and Security Review Commission by regional experts such as Dr. Francisco Urdinez, who in May 2021 spoke to how certain governments – from Brazil to Chile to – have been balancing relations with the two superpowers in times of COVID-19. The pro-Taiwan status of countries like Paraguay and Honduras has likely contributed to their acquirement of vaccine donations (in contrast to most Chinese ones, which are purchased from state firms). Maybe the US is just hoping to secure its borders, by vaccinating the people of Mexico and Central America. Or perhaps it’s the Biden administration’s return to multilateral and international leadership in the region, following an era, particularly since 2017, in which many countries in the area felt neglected by Washington.

Regardless, in a world in which medical diplomacy plays into heightening Sino-American competition, the United States has finally woken up regarding how its early nationalist policy regarding vaccine exports was a mistake. There’s still room for strong inter-American ties in the region, if the U.S. prioritizes competent, equitable, and ethical policy.

Just ask Paraguay.