Beyond Charity: Who Owes Who?

During the COVID-19 pandemic, C-17's and C-130's painted with national flags took over the empty skies, carrying vials of hope. However, it was clear—these were not just medical shipments but geopolitical statements. These lifelines became loaded favours for developing nations. Nations like China, India, Russia and the United States wielded vaccines as diplomatic weapons, manipulating them to extend influence, force half-hearted alliances and deepen economic dependencies. 

Wealthier nations are not bound to global healthcare equity, though it is portrayed as an act of goodwill. It has been a means of control rather than pure humanitarianism. The so-called “vaccine diplomacy” showed the world how healthcare aid could be moulded into political leverage, where dependent countries feel pressured to align with donor ideologies out of fear that the supply tap might suddenly shut off. Vaccine diplomacy, then, is simply a modern iteration of a much older game. 

The Historical Precedent 

After World War II, Europe was in ruins — economically, politically and medically. Public health infrastructure had collapsed, and diseases like tuberculosis and polio surged due to malnutrition and poor sanitation. In response, the U.S. launched the Marshall Plan (1948-1952) - a $13 billion economic recovery program designed to rebuild Western Europe. Medical assistance played a pronounced role, as political stability and economic recovery depended on a healthy workforce (Eichengreen). 

However, it was not just about European recovery; it was a calculated effort to prevent war-ravaged nations from turning communist. The Soviet Union had already begun expanding its influence through healthcare programs in Eastern Europe. The U.S. isolated Soviet-controlled governments by providing allies with modern medical equipment, vaccines and antibiotics, improving public health systems in western Europe (Gimbel). Funding was allotted to repair healthcare facilities, especially in war-torn regions of Germany and France. Furthermore, food programs were implemented to support the famine-stricken nations of Italy and Greece.

The Marshall Plan reinforced American political influence in Western Europe, ensuring nations aligned with capitalist, democratic values rather than turning to Soviet Socialism. European pharmaceutical industries became closely tied to American medical technology (Milward). Since aid was given selectively, it deepened international divisions further.

During the Cold War, medical aid became a direct proxy battle between the U.S. and the Soviet Union. Both superpowers used health interventions to gain influence in Africa, Latin America, Asia and Ethiopia. The USSR also played a role in global smallpox eradication efforts, providing vaccines and healthcare personnel to allied nations (Bristol). It also sent thousands of doctors and nurses to Cuba, North Vietnam, Angola, Mozambique and Afghanistan to train medical professionals (Marks). Hospitals were built in newly independent nations like Ghana, Ethiopia and Angola in exchange for political loyalty and military cooperation (Hopkins). 

To counter Soviet influence, the U.S. funded public health campaigns, but recipients often had to adopt pro-Western economic policies to receive aid due to the threat of economic isolation (Landsdale). U.S. health initiatives prioritized family planning in many developing countries, sparking debate over whether this was a means of controlling non-Western population growth (Connelly). Moral limitations accompanied U.S. aid, particularly to HIV/AIDS programs, where contraception funding was denied in Catholic-majority nations like the Philippines and Latin America (Epstein).

The Cold War set the foundation for what would later evolve into vaccine diplomacy, where nations wielded public health resources for geopolitical leverage — something that became glaringly evident during the COVID-19 pandemic.

The Power Play Behind Vaccines

India’s ‘Vaccine Maitri’ supplied vaccines to over 96 countries and UN forces and was celebrated as humanitarian (Chattu). However, it also served a larger geopolitical purpose — strengthening trade and economic ties while countering the growing Chinese presence in the region, who supplied vaccines to 92 nations, securing economic and political footholds (Zhu; Banerji; Apolinário Júnior). China linked Sinopharm and Sinovac vaccines deliveries to debt restructuring agreements (Teng), securing cheap labour and guaranteeing future returns. 

Chinese spokesperson Hua Chunying framed it as being “ready to contribute to accessibility and affordability of COVID vaccines in developing countries” (Ministry Spokesperson). However, China prioritized nations that did not recognize Taiwan's independence, whereas Paraguay – a supporter of Taiwan – struggled to access Chinese-made vaccines (Londoño). Similarly, Belt and Road Initiative members like Pakistan, Hungary and Serbia had priority access (Khan; Huang; Rudolf; Apolinário Júnior). In the Philippines, Chinese vaccinations were embraced under President Rodrigo Duterte, but as tensions grew over South China Sea territorial issues, supplies slowed and became challenging to procure (Heydarian).

This pattern of selective vaccine distribution was not unique to China, and at first, Western governments hoarded vaccinations, distributing them to poorer nations only after securing domestic supply. The U.S. provided Pfizer and Moderna doses through COVAX, but only to aligned nations (Elliot). Russia, though lagging in global influence, used Sputnik V vaccines to forge ties with South America and Africa (Pozzebon). In every case, vaccine diplomacy served strategic interests rather than global health equity.

The Hidden Costs

One of the most insidious effects of vaccine diplomacy is how it perpetuates corruption and dependency. A study on Sub-Saharan Africa showed that a 1% increase in foreign health aid was associated with a 0.19% decrease in domestic healthcare investment. (Farag). 

Significant cutbacks were made to foreign assistance, particularly HIV/AIDS initiatives, under the term of President Donald Trump. About 90% of USAID's contracts were discontinued in 2025, impacting international humanitarian initiatives, such as South Africa’s HIV programs, which faced immediate repercussions (Imray). The U.S. government's move for convenience and national interests highlights how aid can be influenced by domestic political agendas and how countries dependent on such aid can immediately be left with nothing if their provider abandons them. 

Foreign medical personnel were essential in containing Ebola in Sierra Leone, Liberia and Guinea during the 2014–2016 outbreak. However, foreign support stopped once the crisis ended, leaving fragile healthcare systems behind. By 2019, Sierra Leone had less than 500 doctors for 7.5 million people (Ministry of Health and Sanitation). Similarly, Malawi’s government-run clinics struggled to retain doctors, as international aid groups offered better compensation (Mandeville).

During the COVID-19 crisis, these patterns repeated. Vaccine-receiving nations often had to accept disadvantageous economic agreements. Corruption flourished - 1,500 cases of bribery, favouritism, and inappropriate use of COVID-19 aid monies were reported worldwide (Citizens Report Corruption), accompanying tales of local elites manipulating vaccination deliveries in return for political allegiance

Breaking the Cycle

If history has taught us anything, it is that true medical security comes from self-sufficiency. Some nations have already begun charting this path. India’s Serum Institute demonstrates the power of domestic production. India vaccinated its massive population and became a major supplier to over 96 countries (Chattu). Cuba created its own COVID-19 vaccines (Abdala, Soberana 02, and Soberana Plus) independently of Western corporations and assistance, despite decades of economic sanctions. Through investments in state-run biotech research since the 1980s, an emphasis on public health infrastructure, local vaccine production through the Finlay Institute and BioCubaFarma, and international cooperation for sharing technology, Cuba was able to fully vaccinate over 90% of its population using domestic vaccines by the middle of 2022 (Gonzalez).

Africa is also making strides with the African CDC to reduce reliance on foreign organizations and push for localized vaccine production in countries like Senegal and South Africa (Dunleavy). Furthermore, in Rwanda, studies examined the relationship between foreign aid and government investment in rural health centres, and findings suggested that an increase in foreign aid at the health facility level did not crowd out government investments and was positively associated with service provision for child and maternal care and infectious diseases (Lu). This indicates that when foreign aid supplements rather than replaces government funding, it can enhance healthcare. 

Beyond just vaccine production, governments should subsidize R&D, create incentives for biotech startups and allow foreign and local businesses to invest in health infrastructure while maintaining government oversight, as seen in Thailand. Countries must invest in stockpiling of essentials, regional disease monitoring and medical research. Digitalization of healthcare supply chains, improved disease modelling and public-private partnerships in biotechnology ensure that future pandemics do not leave nations scrambling for aid as the next pandemic is not a matter of if, but when, and nations must be stronger to handle such crises independently. 

Self-Sufficiency

Vaccine diplomacy may appear benevolent on the surface, but history reveals it as a double-edged sword. Whether during the Cold War or the COVID-19 pandemic, medical aid has often served as geopolitical rather than purely humanitarian. Even though aid is rarely just altruism, nations use it to secure economic and political advantages. Wealthier nations will always prioritize their own interests. Instead of waiting for their aid, developing nations must stop relying on goodwill and take control of their own medical future through self-investment in vaccines, biotech, and regional alliances. Africa’s CDC and India’s Serum Institute prove that self-sufficiency is possible. If developing nations fail to act now, they will remain at the mercy of wealthier states—not just in the next pandemic but in every future global health crisis.

Works Cited:

Banerji, Anuttuma, “India’s Flawed Vaccine Diplomacy.” Stimson, 25 June 2021, https://www.stimson.org/2021/indias-flawed-vaccine-diplomacy/ .

Bristol, Nellie, “Smallpox Eradication: A Model for Global Cooperation.” Center for Strategic and International Studies, 13 May 2020, www.csis.org/analysis/smallpox-eradication-model-global-cooperation#:~:text=An%20initiative%20for%20global%20smallpox,that%20the%20plan%20was%20approved.

“Citizens Report Corruption in COVID-19 Humanitarian Aid.”, Transparency International, 25 Aug. 2021, www.transparency.org/en/press/citizens-report-corruption-in-covid-19-humanitarian-aid-quarantine-health-care.

Chattu, Vijay Kumar, et al., “The Rise of India’s Global Health Diplomacy Amid COVID-19 Pandemic.”, PubMed Central National Library of Medicine, https://pmc.ncbi.nlm.nih.gov/articles/PMC10790121/#:~:text=India%20distributed%20vaccines%20not%20only,Maitri%20(Vaccine%20Friendship)%20program .

Chunling Lu et al., “Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda”, PubMed Central National Library of Medicine, https://pmc.ncbi.nlm.nih.gov/articles/PMC5656131/ .

Connelly, Matthew. Fatal Misconception: The Struggle to Control World Population., Harvard University Press, 2008.

Dunleavy, Kevin, “African Union Gains $45M Package to Boost Vaccine Manufacturing in Senegal.”, Fierce Pharma, 26 Jan. 2022, www.fiercepharma.com/manufacturing/african-union-gains-45m-package-boost-vaccine-manufacturing-senegal.

Eichengreen, Barry, The European Economy Since 1945: Coordinated Capitalism and Beyond., Princeton University Press, 2007.

Elliott, Andrea., “Poor Countries Face Major Obstacles in Accessing Moderna’s COVID-19 Vaccine.”, The Washington Post, 12 Feb. 2021, www.washingtonpost.com/world/coronavirus-vaccine-access-poor-countries-moderna/2021/02/12/0586e532-6712-11eb-bf81-c618c88ed605_story.html.

Epstein, Helen, The Invisible Cure: Africa, the West, and the Fight Against AIDS., Picador, 2008.

Farag, Marwa, “Does Funding From Donors Displace Government Spending For Health In Developing Countries?”, Health Affairs, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.4.1045

“Foreign Ministry Spokesperson Hua Chunying’s Regular Press Conference on January 20, 2021.”, The Ministry of Foreign Affairs, The People’s Republic of China, 20 Jan. 2021, https://www.mfa.gov.cn/mfa_eng/xw/fyrbt/lxjzh/202405/t20240530_11346970.html .