Welcome to the era of vaccine diplomacy

WHEN it comes to vaccines, the best decision for any single nation will depend on the decisions and actions of other nations. So vaccine policies cannot, and should not, be made in isolation - which means, as the Internet likes to say, that it's time for some game theory.

Consider the United Arab Emirates' (UAE) recent approval of the new China-based Sinopharm vaccine. The vaccine was tested in the UAE for six weeks, and now there is an emergency-use authorisation. By approving a vaccine early, the UAE government appears hands-on and efficient to its citizens. It might also improve its standing in the region, holding some bartering chips in the form of vaccine doses.

These benefits of fast approval apply more generally as well. Russia approved a vaccine in August and claims it is on track for wider distribution this autumn. China has gone the furthest, and has been injecting select groups with a vaccine for several months, with uncertain results. (Of course, speed can also be risky, as reflected by the recent debate over whether to resume the AstraZeneca trials of the Oxford vaccine in the United States.)

Fewer scientific controls

Ideally, a government will wish to publicise the announcement of a vaccine while slow-walking the actual distribution. That way, if there is something wrong with the brew, it can stop distribution before too many of its citizens experience adverse side effects. In essence, the approving countries are doing a version of their Phase III trials with fewer scientific controls and more out in the open. For Russia in particular, it is not obvious how much it is really ahead of other countries.

One possible American strategy would be to encourage the early approvers to distribute and test their vaccines on a broader scale, and then make their data freely available. Given close working relations, this may be easier to accomplish with the UAE than with China or Russia. If one of those vaccines turned out to be good enough, the US has the resources either to buy doses or to reverse-engineer it.

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US decisions on approval speed, meanwhile, will depend on what other nations do.

For instance, if the early approvers are gathering useful data through their experiments, US officials might decide not to hurry so much, instead preferring to let foreigners take the risks. That sounds good, but it could be counterproductive for the world as a whole. America is the country most likely to come up with the highest-quality vaccine. Slowing down the US will mean that more of the world gets the (possibly) lower-quality but more readily available Chinese product.

One tension in "vaccine relations" is that richer countries and poorer countries do not want exactly the same thing. Typically, the wealthier the country, the more risk-averse its citizens, and the less need to hurry. Switzerland can wait to get the vaccine just right, for example, while in India economic conditions are so dire that it needs a vaccine as soon as possible.

It is the rich countries that are calling most of the shots when it comes to vaccines. In this respect, China may be unique: It has some properties of a rich country (a big, advanced scientific establishment), but it has a poor country's willingness to take risks. That's one reason China might end up leading on vaccines. The US is ahead of China technologically, but Chinese priorities are more in sync with those of many other countries in the world.

At the same time, China is trying to internalise the benefits of supplying vaccines as an international public good - by asking for foreign-policy concessions from receiving nations, such as recognition of China's contested territorial claims in the South China Sea. It remains to be seen if these deals will stick.

The best thing for the world as a whole might be for the US to take more risks and experiment more with vaccines. Mexico, Brazil and South Africa would benefit from what would be learned, although those benefits don't count for much in American politics.

Humanitarian benefits

Might it be good if America, like China, were more transactional in its foreign policy ambitions? Imagine the US going to Mexico and promising the best vaccine as quickly as possible, geared to Mexican rather than American risk-tolerance levels. In return, Mexico might pledge to pay for a wall on the southern border and end the flow of drugs to the US. Whether or not Mexico would or could deliver, the humanitarian benefits would be immense.

Is such a scenario likely? Probably not. But the closer a viable vaccine gets to reality, the more these kinds of international questions will come to the fore. BLOOMBERG