Perspective | The tricky power politics of vaccine promotion

Perspective | The tricky power politics of vaccine promotion

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People arrive at a mobile vaccination site in Los Angeles on Tuesday. The Johnson & Johnson vaccine was due to be administered, but it was replaced with the Pfizer vaccine following a recommendation from federal health officials. (Frederic J. Brown/AFP/Getty Images)

April 14, 2021 at 8:00 p.m. GMT+9

Last year I wrote that the covid-19 pandemic was unlikely to have lasting effects on the distribution of power in the world. Being a canny academic, however, I gave my argument a caveat: “The one wild card is whether one of the great powers develops an easily reproducible vaccine or therapeutic drug far earlier than any other actor. Whichever country or coalition is first in that race will have demonstrated its ‘protean power.’ ”

How have the great powers been doing since that article was published? Russia, China and the United States rolled out vaccines within a month or two of each other, thereby negating the hypothesized edge discussed in the paper (the less said about the European Union, the better).

The past few months have also revealed a wide variation in approaches to vaccine distribution and effectiveness. Russia distributed its vaccines before full testing. China conducted trials in the developing world. Both countries have exported far more of their vaccines as a means of promoting its soft power. Russia has also been not-so-subtly attempting to cast doubt on vaccines produced in the West. Meanwhile, the United States has prioritized domestic distribution of the three vaccines it has approved.

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From an international relations perspective, it would be easy to see how this might disadvantage the United States. This is why the hard-working staff here at Spoiler Alerts has advocated for more foreign distribution of vaccine doses just sitting around in the United States.

Recent developments, however, suggest a future more favorable to the United States. For one thing, The head of China’s Centers for Disease Control and Prevention has publicly admitted that his country’s vaccines are not terribly effective compared with the mRNA vaccine technology that Pfizer and Moderna developed.

Meanwhile, the United States is getting really good at distributing vaccines to the domestic population. Over the weekend, more than 4 million people received vaccine doses; at this rate, everyone who wants to be vaccinated should get jabbed before the end of spring. As the Atlantic’s Anne Applebaum sardonically notes, “if the United States is very, very bad at social trust and public-health systems, it is very, very good at large-scale logistics. And skill at large-scale logistics, far more than social trust, has turned out to be a big advantage in this new stage of the pandemic.”

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Applebaum further argues that there is a strategic opportunity here as well. As U.S. vaccine supply begins to outstrip demand, there is a ripe opportunity for the United States to start flooding the rest of the world with safe vaccines: “The best answer to Russian and Chinese strongmen who offer thousands of vaccines to countries that say nice things about them is to flood the market with millions of American doses, helping everyone regardless of what they say about the U.S. or anyone else.”

This suggestion seems sensible enough. But there are two cautionary notes that are worth stressing before getting into the export promotion game. The first is that the speed with which these vaccines have been developed has prompted suspicions that need to be allayed. If nearly 40 percent of U.S. Marines have declined a vaccine, that is a problem.

In a country with low levels of social trust, the federal government must practice “radical transparency” in acknowledging any adverse effects caused by its vaccines. Such admissions might temporarily increase vaccine hesitancy, but they also increases trust in health authorities. As Dan Carpenter told Ezra Klein a few weeks ago, a mass vaccination campaign is “a deeply social technology, and so the credibility is everything.”

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This is why despite a lot of misgivings (including my own), I understand why the Food and Drug Administration decided to pause administering the Johnson & Johnson vaccine. HuffPost’s Catherine Pearson has an excellent explainer of what is going on. So far, the J&J vaccine is linked to six cases of rare blood clotting out of 6.8 million doses. In other words, the risks from contracting covid-19 are still much greater than any risk from the J&J vaccine.

It might seem as though this pause is an overreaction, especially when the United States remains well short of herd immunity. Pearson points out, however, that such an announcement helps “educate health care providers around the country on signs of these rare blood clots, as well as provide them with information about how to treat and report them.” And as my Post colleagues reported, publicizing these cases was useful because it might shine a light on additional cases of brain blood clots that had gone unreported.

This decision comes with costs. Even if the pause is for only a few days, uptake of the J&J vaccine might still be lower at first. That would be much better than accusations of a coverup, however, if these rare blood clot cases were not publicized and investigated. It would also reassure other countries using or considering the J&J vaccine.

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Finally, the best way for the United States to promote its soft power abroad is to develop herd immunity at home. The sight of the country returning to pre-pandemic life because of vaccines (as opposed to the superior testing-and-tracing regimes in East Asia) would be the strongest advertisement for the resilient power of the United States in 2021. That means continuing to do as much as possible to reduce vaccine hesitancy in the United States.

In the end, Applebaum is right, and beginning this summer the U.S. should be showering vaccines on the world, starting with the Western hemisphere. But this is not a foreign policy slam dunk. It’s more like a contested layup.

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