The effect of Chinese vaccine diplomacy during COVID-19 in the Philippines and Vietnam: a multiple case study from a soft power perspective

Global health diplomacy encompasses international policy-making to address health issues and the strategic use of health concepts to achieve non-medical goals, including soft power. Vaccine diplomacy, a subset of this, involves using vaccine delivery to achieve foreign policy objectives. China, a rising world power, significantly engaged in vaccine diplomacy during the COVID-19 pandemic, distributing billions of doses globally. This study focuses on two key South China Sea (SCS) claimants—the Philippines and Vietnam—to assess the effectiveness of China's vaccine diplomacy as a soft power tool. The research question is: How effective was Chinese COVID-19 vaccine diplomacy in the Philippines and Vietnam from a soft power perspective? Understanding this is crucial because the SCS territorial disputes represent a potential regional conflict flashpoint, and China's 'peripheral diplomacy' strategy prioritizes winning over its neighbors. Therefore, evaluating the success of Chinese vaccine diplomacy in winning hearts and minds in these key countries is essential.

Existing literature offers a mixed assessment of Chinese vaccine diplomacy in Southeast Asia, with most studies focusing on the region as a whole rather than specific soft power outcomes. Some studies suggest reshaped relations, mixed reception due to expansionist concerns, lack of strategic trust, and improved image. A few single-case studies on Indonesia and Malaysia exist, but there is a lack of systematic multiple-case studies analyzing the Philippines and Vietnam from a soft power perspective. Existing case studies on the Philippines and Vietnam suggest no significant positive effects on bilateral relations or mitigation of distrust towards China.

This study employed a multiple-case study research design, focusing on the Philippines and Vietnam as cases. These countries are chosen for their ASEAN membership, proximity to China, and vocal concerns regarding Chinese assertiveness in the SCS. The study uses a deductive thematic analysis based on four soft power indicators: public opinion, foreign policy, attractiveness, and business and trade. Data collection involved a literature search of academic and newspaper articles (63 articles total) published between May 26 and June 13, 2022, from databases such as Google Scholar, Web of Science, PubMed, Scopus, JSTOR, ScienceDirect, and Nexis Uni. Five supplementary sources (four ISEAS-Yusof Ishak Institute surveys and one book chapter) were also included. Thematic analysis, using the four pre-defined soft power indicators, was used to analyze the data.

**Philippines:** Public opinion remained largely negative towards China despite vaccine diplomacy, with pre-existing distrust exacerbated by issues like allegations of corruption in vaccine procurement, higher prices paid compared to other countries, delayed deliveries, and controversies surrounding vaccine authorization. While the Philippines received substantial vaccine aid from China, its foreign policy toward China regarding SCS disputes did not change significantly; instead, the Philippines strengthened ties with the United States. China's attractiveness to Filipinos remained low. While Chinese investments increased, it's unclear if this constitutes a significant win for vaccine diplomacy. **Vietnam:** Similar to the Philippines, Vietnam exhibited pre-existing anti-China sentiment and distrust towards Chinese vaccines, resulting in a negative public opinion despite vaccine deliveries. Vietnam did not alter its foreign policy stance on the SCS dispute. However, a notable finding is that China's attractiveness to the Vietnamese public seemingly increased. There is no evidence to suggest an increase in business and trade due to vaccine diplomacy. Overall, the study reveals that Chinese vaccine diplomacy yielded mixed results, with only a slight increase in attractiveness in Vietnam and business/trade in the Philippines. The public opinion and foreign policy indicators consistently showed either neutral or negative impacts for China.

The findings indicate that Chinese vaccine diplomacy in the Philippines and Vietnam failed to achieve its primary goal of enhancing soft power. The pre-existing anti-China sentiment, compounded by issues with vaccine delivery and pricing, significantly hindered China's efforts. The less-than-ideal efficacy of Chinese vaccines compared to Western alternatives further limited its success. China's hard power actions, specifically its assertive stance in the SCS, overshadowed its soft power initiatives. The success of the United States in leveraging its vaccine diplomacy in both countries underscores the complexity of influencing foreign policy through soft power alone. The study suggests that a more balanced approach integrating hard and soft power, coupled with strategic awareness of the political landscape, is crucial for effective foreign policy.

This multiple-case study demonstrates the limited success of Chinese vaccine diplomacy in the Philippines and Vietnam. While some minor gains were observed in attractiveness and business/trade, the overall impact on public opinion and foreign policy was negative or neutral. Future research should conduct longitudinal studies to assess the long-term effects, examine other countries' experiences, compare Chinese and American vaccine diplomacy, and explore ways to improve global health diplomacy by prioritizing equitable vaccine access and addressing asymmetrical power relations.

This study primarily establishes correlations rather than causal relationships between Chinese vaccine diplomacy and soft power indicators. Data limitations include language barriers (local language articles were excluded), the short timeframe between vaccine diplomacy and data collection, reliance on existing literature, and challenges in measuring the attractiveness indicator (reliance on hypothetical preferences due to pandemic-related travel restrictions).