In the mid-1960s, the Soviet Union provided 450 million doses of a smallpox vaccine to developing countries, helped by an innovative freeze-drying technique well suited to regions with underdeveloped heath infrastructures. By 1980, largely as a result of a World Health Organisation programme coordinated between the US and the USSR, smallpox had been eradicated. The deadly pox went from millions of confirmed global cases a year to zero in less than two decades.
The Soviets’ health diplomacy won them plaudits around the world. Representatives of developing countries lined up to praise the USSR at a WHO meeting in 1965. Indian, Malian and Afghan representatives all expressed gratitude.
Today, Russia is attempting to echo some of the Soviet Union’s past success in this arena with renewed vaccine diplomacy. It named its first coronavirus vaccine Sputnik-V, a nod to the geopolitical importance of Moscow’s epidemiological effort. It hopes to sell hundreds of millions of doses of its vaccine around the world, including to developing countries, which could find it difficult to secure jabs from Western manufacturers for months to come, according to groups such as the People’s Vaccine Alliance.
Figures from the Russian Direct Investment Fund, a Russian state-owned sovereign wealth fund that is leading negotiations to sell the vaccine abroad, show more than a dozen deals totalling hundreds of millions of doses of the Sputnik-V vaccine have been signed. Russian scientists are even working on a freeze-dried variant of Sputnik-V, which they claim will be easier to distribute to developing countries in Africa and Asia.
Some countries which have already signed up to receive Sputnik-V are traditional allies of Russia, such as the former Soviet republics of Belarus and Uzbekistan. Others, such as Mexico and Nepal, are less obvious partners of the Kremlin, but may have been motivated out of fear that a nationalistic Trump administration would make it more difficult for them to obtain US-produced vaccines. “At this point, lower- and middle-income countries desperately want a vaccine and will take it from wherever they can get it,” said Judy Twigg, a professor at Virginia Commonwealth University. “You take what you can get, wherever you can get it from.”
Russia claims its vaccine has several advantages over its Western-manufactured competitors. It is competitively priced, at around $20 per patient, more expensive than the as yet unapproved Oxford/AstraZeneca jab but significantly cheaper than Moderna’s candidate, expected to cost around $50 for two doses. Crucially, the freeze-dried variant is expected to be able to be stored at fridge temperatures, which should make its distribution much simpler than some of the other varieties, which require refrigeration in specialised freezers at temperatures as low as -70°C.
[See also: The UN’s Mark Lowcock on vaccine nationalism]
Whether Russia’s vaccine diplomacy succeeds will depend on several factors. First is the effectiveness of Sputnik-V, which was billed by President Vladimir Putin as the first coronavirus vaccine in the world, although it had only passed phase two trials before Russian regulators approved it in August. Phase three trials, a crucial step in determining a vaccine’s safety and effectiveness required by most regulators, have not yet been completed, even as the Russian government this week began a mass vaccination campaign.
There is little evidence to doubt the effectiveness of Sputnik-V, but the rushed process may dissuade some governments from putting in orders until full phase three results are known. More importantly, the perception that corners were cut in the approval process could result in hesitancy in taking the vaccine, both in Russia and in the countries buying the vaccine from Russia.
The price at which doses are offered to developing countries will also matter. Even at $10 a dose ($20 in total, as the vaccine requires a booster shot), the governments of some developing countries will find buying and administering enough doses to immunise their entire populations a significant expense. If Russia offers the shots at a discount or for free, it could generate goodwill. But it is up against fierce competition: AstraZeneca has already pledged to offer its vaccine, already cheaper than Sputnik-V, at cost price to low and middle-income countries for the duration of the pandemic.
Finally, the speed at which Russia can produce enough doses will be a key factor. The country has signed several international production deals, including in India and Brazil, which should help supplement domestic manufacturing capacity.
As more vaccines receive regulatory approval in the months ahead, governments’ priorities will likely shift toward receiving as many doses as possible, irrespective of the source, Twigg said. In most cases, Sputnik-V is likely to be just one of a broad portfolio of vaccines, which could include doses from Western companies, China, and domestic production. Low- and middle-income countries are “unlikely to receive enough doses to immunise their entire populations through [the WHO’s] Covax initiative, so they will be looking to ink bilateral deals to secure more doses”, said Kalipso Chalkidou, a senior fellow at the Centre for Global Development think tank, referring to a WHO scheme intended to distribute vaccines equitably across countries.
The aims of Russia’s vaccine diplomacy are threefold: commercial, political and humanitarian.
The commercial imperative is the most straightforward. A coronavirus vaccine is the most in-demand medicine on Earth and securing doses will be a priority for every government for the foreseeable future. There is a huge amount of money to be made selling a proven vaccine. Global demand is likely to outstrip supply for most of the next year at least.
But Russia’s vaccine diplomacy also seeks to further Moscow’s status in the international arena. After a decade during which the Kremlin’s foreign policy has made it few friends – attracting Western sanctions for the 2014 annexation of Crimea and anger over its alliance with Bashar al-Assad’s regime in Syria – the vaccine provides an opportunity for Moscow to present itself as a humanitarian-minded global citizen and its medical industry as world-leading. “The Russian pharmaceutical industry is not at the point where it is actively competitive on international markets. But Sputnik is an opportunity to put Russian pharma on the map,” Twigg said.
Finally, providing vaccine doses to low-income countries which might otherwise be at the back of the queue will undoubtedly save lives, a laudable humanitarian imperative.
Yet a state’s humanitarianism can rarely be separated from its foreign policy objectives. “Even if institutionally separated, in practice humanitarian aid was and is still driven by foreign policy objectives in one way or another,” said Sherine El Taraboulsi-McCarthy, a research fellow at the Overseas Development Institute. Russian policymakers will be aware of the history of health diplomacy advancing the USSR’s prestige in the developing world. They will be hoping that Sputnik-V can replicate the successful smallpox elimination campaign spearheaded by the Soviet Union nearly six decades ago.