Also read Part I, II, III , IV , V and VI of our series 'Global vaccination'.

China

China has contained the pandemic since 23 January 2020 by only using the traditional means of disease control. Its success has boosted trust in politicians and the state. The mood is good because two things have been achieved at the same time: both containing the epidemic and bringing public life and economic performance back close to normal. But this also means: a change in strategy would force people to leave the stability of the current comfort zone and temporarily take higher risks.

With the virus under control domestically, new infections can only come from abroad – which is why international travel has become rare, while domestic air travel has returned to pre-crisis levels. In this situation, an opening up of China only seems likely when herd immunity is achieved – but the country is far from that. Vaccination has already been taking place since July 2020 on the basis of emergency approvals, which currently exist for a total of four vaccines. All the vaccines developed in China are classical vaccines, i.e. killed or modified pathogens or vector vaccines. All current approvals are only valid for people under 60 years of age. This means that the particularly vulnerable age groups cannot be protected.

Phase 3 tests weren’t made publicly available for any vaccine and all the tests had to be done in other countries, as the environment in China suitable wasn’t suitable for testing efficacy because of the low number of infections. In exchange for testing opportunities, partner countries were promised priority in the supply of vaccines. The mRNA vaccines used in the US and Europe have not yet received approval in China – despite well-documented phase 3 tests – although there is even a cooperation between the German licence holder BioNTech and the Chinese pharmaceutical producer FOSUN. The latter has even already started production. Whether this is for reasons of health policy isn’t clear.

On the one hand, surveys have shown that about 80 per cent of the population are willing to get vaccinated. On the other hand, there have been spectacular vaccination scandals in the past, and the Chinese public has an elephant’s memory when it comes to health issues. Moreover, the personal risk of infection is actually very low – which suggests that people are in principle ready to get vaccinated, but they are not in a rush. Overall, the percentage of people vaccinated is still lower than in most European countries. However, if China really wants to accelerate its vaccination campaign, then it will certainly succeed.

Scientific literature assumes that mRNA vaccines can be modified more easily for use against mutant strains. If that’s the case, the Chinese products will require a comparatively long time to adjust when new virus variants threaten to emerge from foreign circulation. All of this suggest that China will take a more leisurely approach to vaccination than countries with a high incidence – and that the isolation from the outside world will take even longer.

Alexander Kallweit, FES Beijing

Kazakhstan

Kazakhstan, the largest country in Central Asia, is not immune to the coronavirus. With almost 265,000 cases – according to official figures –, two lockdowns and enormous economic consequences, the successful implementation of a vaccination strategy for the country couldn’t be overstated. At least, that’s what one would think.

But the vaccination campaign got off to a slow start: on 1 February 2021, Kazakhstan began with vaccinating only a few population groups in the public sector – mainly medical staff, police, firefighters and some teachers.

Kazakhstan used Russia’s Sputnik V vaccine. So far, about 20,000 doses have been administered. According to the plan of the Kazakh Ministry of Health, about six million people – one third of the population – are to be vaccinated by the end of 2021. In addition to the Russian vaccine, which was procured in small quantities and is now being produced under licence in the north of the country, the authorities also plan to use the QazCovid-in vaccine, which was developed in Kazakhstan. It’s currently in the third phase of clinical trials and will be available from autumn 2021 at the latest.

Moreover, the Kazakh Ministry of Health is negotiating with various manufacturers, including Sinovac, Sinopharm and BioNTech/Pfizer. Whether, when and how these vaccines will be used in Kazakhstan, or when the general population will be vaccinated and in what order, is not really clear. Surveys on the willingness of the Kazakh population to be vaccinated is also un available, although various conspiracy theories are circulating on social media, suggesting a general uncertainty or lack of confidence.

Generally speaking, however, Kazakhstan seems to be going its own way, relying only in part on a quick vaccination campaign. Another building block may be an already high level of infestation. Unofficial estimates assume that larger parts of the population (up to one third) were already infected last year. The demographics of the Central Asian country – the median age is 29 years – and the resulting low mortality rate probably prevented the worst. The fact that the number of cases has remained at a low level – with only a few spikes after two hard lockdowns last year – supports this assumption.

Currently, large parts of the country are in the so-called ‘green zone’ and restrictions on life are almost non-existent. In the preliminary peak of the pandemic in the summer of 2020, the Kazakhstan looked very different: full hospitals, an overburdened health system and a harsh lockdown that exhausted the full repertoire – from road and curfew closures to requirements to wear a mask in public . Whether Kazakhstan has approached herd immunity with great strides, as it is currently discussed on social media, nevertheless remains a speculation, albeit a plausible one.

It’s certain, however, renewed restrictions on the economy would be hard to bear, after the lockdowns sent economic shockwaves through the country in 2020, especially in the service sector, small and medium-sized enterprises and for the self-employed. A lack of diversification and volatility in the economy because of its resource dependency ensure that Kazakhstan's ‘bazooka’ is less powerful: after social benefits of just under €95 were paid to those most in need, who may have made up as much as 50 per cent of the working population, the state budget is exhausted.

Another lockdown would not only jeopardise Kazakhstan's growth, but even set it back by years. Such a path would also have negative effects on social peace and cohesion. The current minimalist course of pandemic-related restrictions comes from an economic-political and – currently valid –epidemiological assessment. By ramping up the vaccination rate and implementing a coherent strategy, the Central Asian republic could ensure that two crises are solved with one injection.

Christoph Mohr, FES Almaty

Kyrgyzstan

For all those longing for a return to normality, Kyrgyzstan is currently something of a dream destination. Right after leaving the airport and entering the country, one will find oneself in a crowd of people without distance or masks. All public life seems to be largely free of pandemic-related restrictions. Is Kyrgyzstan back to the status quo ante? Not quite.

After several weeks of lockdown, including curfews, in the spring of 2020, the government back then had decided to lift most of the restrictions before the summer. The economic crisis – in view of empty state coffers and insufficient social safety net – apparently ruled out any other solution, especially as the parliamentary elections in autumn 2020 were imminent. As a result, the pandemic hit Kyrgyzstan with great force in the summer months of last year: Many people fell victim to the disease, and the high number of fatalities revealed the miserable situation of the health system, which is working at the limit of its capacity even under normal conditions.

The cautious behaviour of a large part of the population after the summer seemed to have evaporated following the political protests after the elections, which were overshadowed by allegations of fraud. A political crisis ensued. Today, new decision-makers are concerned with consolidating power and political stability. Measures to contain the pandemic would result in a further deterioration of the economic situation and increase political fragility shortly before the important local elections, which are coupled with the vote on a new constitution.

Considering the low incidence rates – currently below 50 new cases per day nationwide – Kyrgyz politicians hope that there won’t be another wave of the pandemic and that the population has been largely immunised by the high infection rates last summer. It’s not possible to validate the data, but there are currently no alarming reports from hospitals that would call the low numbers into question. At the same time, the focus is on the start of the vaccination campaign.

The Kyrgyz government presented a vaccination strategy against the virus at the beginning of February. In a first phase, it’s supposed to cover about 200,000 people (about 3 per cent of the total population) – mostly health sector workers and people who are particularly exposed to a risk of infection through their work. In a second phase, the authorities plan to vaccinate other risk groups. At best, vaccines should then be available for the entire population from June onwards. The first phase is scheduled to begin in March and will presumably be carried out with the Russian vaccine Sputnik V.

President Sadyr Japarov, in office since the end of January, asked for 500,000 doses of Sputnik V during his inaugural visit to Russia at the end of February. The Russian vaccine is so far the only one approved by the Kyrgyz medical authority. Another 504,000 vaccine doses from the manufacturer AstraZeneca are expected to arrive as part of the COVAX initiative. Meanwhile, neighbouring China has also agreed to supply vaccines, which points to the political dimension of vaccine procurement and use.

In the context of vaccine diplomacy, we see familiar patterns of external influence on the small Central Asian country: China tries to further expand its influence in its neighbouring state, but once again fails because of a lack of soft power. Sinophobia, mistrust and scepticism towards China are too widespread among the Kyrgyz population. It’s little wonder, then, that a survey by the Central Asia Barometer polling institute in February found that a majority of respondents (75.5 per cent) consider Russia ‘best suited’ to help the country overcome the Covid-19 crisis. Just 7.5 per cent of respondents said that the People's Republic of China was the best partner for Kyrgyzstan.

We can therefore assume that there will be far more reservations about the Chinese vaccine than about the Russian brand. Taking the population's willingness to be vaccinated into consideration, this could be a decisive factor for the authorities. But before this debate can unfold in public, vaccines must first become available in the country. Until then, we should wait and see and stay healthy.   

Alexander Rosenplänter, FES Bishkek