Russian, American and Chinese COVID-19 Vaccine Diplomacy in Central Asia

By Sara Adkins, reporting from Almaty, Kazakhstan through the University of Georgia's Russian Overseas Flagship Capstone program.

(This article was originally printed in the Spring 2026 edition of our print magazine. To see the entire magazine, click here.)

At the end of December 2019, the People’s Republic of China reported to the World Health Organization (WHO) cases of pneumonia of unknown etiology. Not even three months later, on March 11, 2020, the WHO declared the outbreak a pandemic. With the discovery of the etiological agent, SARS-CoV-2, a so-called ‘vaccine race’ began between several countries, with the goal of not only reducing the number of cases and lifting isolation protocols, but also of distributing vaccine doses around the world. This practice, when done in a diplomatic capacity, is referred to as vaccine diplomacy.

Vaccine diplomacy is a type of medical diplomacy, characterized by the delivery of vaccines or vaccine-producing technology to foreign countries. In an era when major world powers actively exert soft power through international public health institutions and initiatives, distributing vaccines against SARS-CoV-2 became an opportunity to strengthen diplomatic ties with countries of interest, and in doing so, combat the influence of other international governments in these regions. Vaccine diplomacy became a foreign policy tool for confrontation, rather than collaboration. This shift in function occurred during the COVID-19 pandemic, as throughout the 20th century, vaccine development, for example, against polio, was achieved by a more unified international community. Vaccine campaigns during infectious disease outbreaks not only lower infection rates, but also alleviate economic disruptions and stress in communities, allowing citizens to return to a sense of normalcy. For this reason, vaccine diplomacy is an effective and powerful way to exert soft power and achieve goals abroad. The increased political significance of vaccine diplomacy seen during the COVID-19 pandemic has been attributed to the global scale of the outbreak. Although the modern era has been no stranger to endemics of viral infections (Lassa fever, Ebola, bird flu, etc.), the COVID-19 pandemic reached an unprecedented global scale. Nations were not prepared for this, nor the speed of infection rates, and as a result, fighting the pandemic was swiftly placed on the global agenda.

The geopolitical interests of countries, as well as their internal fight against COVID-19 shaped  their ability or interest in conducting vaccine diplomacy abroad. Central Asia, located between Russia and China, has always occupied a transitory and strategically important status within Eurasia. Since the fall of the Soviet Union, the Russian Federation’s foreign policy has been dominated by the desire to keep post-Soviet countries within the Russian sphere of influence. In addition to using vaccine diplomacy to maintain and even improve relations with Central Asian governments, Russia had a vested interest in limiting the spread of COVID in Central Asia. Given the exchange of migrant workers that occurs between Russia and Central Asia, supplying vaccines was a protective measure for limiting the number of potentially infected workers entering Russia from the region. China regards this region as a strategic opportunity for economic growth as a transit hub for distributing its products around the world, as well as a trade partner in the energy sphere. Furthermore, intense diplomacy was pursued as a means of combating Sinophobia that rose in the region as a result of the pandemic. Improving relations through medical diplomacy was seen as a way to simplify the implementation of economic projects in the region. Though the United States’ current presence in the region is rather fragmented, collaboration is regarded as an attempt to align the interests of Central Asian states with the broader American agenda pertaining to Russia, China, and Afghanistan. 

Of the 59 million inhabitants of Central Asia, over 1 million were infected with COVID over the course of the pandemic and over 20,000 died as a result. However, it is essential to mention that while Kazakhstan and Kyrgyzstan reported statistical mortality rates that roughly corresponded with world mortality rates, Uzbekistan reported rates roughly 13 times below the world rate and Tajikistan reported rates 51 times lower. Turkmenistan entirely denied any cases of COVID-19 infections within the country. These statistics lead experts to question the accuracy of reports of cases across Central Asia, notably in Tajikistan and Turkmenistan. 

In addition to quarantine measures, vaccination campaigns were the main hope for Central Asian states for defeating the pandemic. Largely lacking the facilities and means to develop their own vaccines, experiencing economic troubles and watching as infection rates climbed within their countries, Kazakhstan, Kyrgyzstan and Uzbekistan attentively followed vaccine development and production in other countries. Given the strategic political, economic and geographic characteristics of Central Asia in the post-Soviet world, major world powers also expressed interest in delivering their vaccines to the region. Though Russia was a natural choice as a partner, given the close political and economic ties and nearly identical public health systems, Uzbekistan, Kyrgyzstan and Kazakhstan did not stop there. Collaboration also ensued between Central Asia and China, as well as the United States, given their global presence in the public health sphere and level of scientific advancements. This multi-vectorness was not only a result of economic and health distress, but also echoes a foreign policy strategy that Central Asian countries have been seeking to maintain, not only relying on diplomatic ties with Russia, but also collaborating with China and the West. 

It is vital to mention that in addition to varying goals in the region, the United States, China and Russia all had varying contexts within their country, regarding COVID-19 infection rates and the pharmaceutical institutions developing the vaccines. This created varying timelines for delivery and collaboration. Very strict, swift and effective lockdown measures allowed China to turn its attention to diplomatic endeavors. As of May 2021, over 40% of the five national vaccines produced in China were exported to other countries. Russia and the United States, however, experienced a longer period of high infection rates. Despite this shared fact, they prioritized vaccine diplomacy differently. Russia swiftly began negotiations for dose delivery and domestic production facilities in Central Asia upon developing a vaccine. In contrast, the United States conducted so-called ‘vaccine nationalism,’ prioritizing vaccination of US citizens before selling vaccines abroad. Furthermore, private American pharmaceutical companies developed the American vaccines, meaning that the US government then made deals with these companies for doses. Having bought more doses than needed, the US sold these doses abroad, only after infection rates were brought under control domestically. However, this strategy has received criticism due to limiting the stock of doses for countries that did not have the means to develop or produce their own vaccine, and in turn, potentially prolonging the pandemic. Chinese and Russian COVID-19 vaccine development was carried out by government-controlled institutions. Unlike the United States, China and Russia were immediately in control of their domestically produced vaccine doses, which created a natural path for their swift use as foreign policy tools.

From the Spring of 2021, when vaccine distribution started, to November 2021, around 48 million doses of COVID vaccines were delivered to Uzbekistan, Kyrgyzstan and Kazakhstan from the United States, Russia and China. The United States sold the region doses of ‘Pfizer-BioNTech’ and ‘Moderna,’ Russia - ‘Sputnik V’ (meaning ‘companion’ in Russian) and China - ‘Coronavac,’ ‘ZF-UZ-VAC2001,’ ‘Sinopharm,’ and ‘Vero Cell.’ According to researchers from the Pirogov Russian National Research Medical University, as of November 2021, over 70% of the vaccines received by Central Asian governments were Chinese. Because of their relatively lower price, the absence of strict temperature requirements for storage (especially important for Kazakhstan, considering the size of the country) and long waiting periods for American vaccines, Chinese vaccines were a logical choice. Another important factor was the slow delivery of promised Russian vaccines, which necessitated Central Asian governments to turn to China to compensate. 

As the most populous country in Central Asia, Uzbekistan received tens of millions more vaccines than Kazakhstan and Kyrgyzstan. Russia agreed in September 2020 to deliver 35 million doses of Sputnik V to Uzbekistan. However, according to data from November 2021, only 720,500 doses were sent. Uzbekistan expressed interest in producing Sputnik V domestically, which was realized in September 2021. Active delivery of the American vaccines Moderna and Pfizer occurred in the summer and fall of 2021, with 3 million (free) and 2 million doses, respectively, sent to Uzbekistan. Chinese vaccines in Uzbekistan made up an overwhelming majority of those received, totaling almost 28 million by November 2021, 26 million of which were the ZF-UZ-VAC2001 vaccine. In fact, ZF-UZ-VAC2001 trials were carried out in Uzbekistan with the participation of 7,000 Uzbek volunteers. As a result, the country purchased doses for a discounted, though unknown, price. However, open-source research conducted by public health experts in Central Asia, funded by the Fogarty International Center of the National Institutes of Health, showed that this campaign caused controversy in the country. Social media posts about this collaborative endeavor featured language that accused China of using Uzbekistan citizens as guinea pigs, monkeys and rabbits in place of their own citizens. 

Kyrgyzstan began actively receiving vaccine deliveries starting in the summer of 2021, facing similar problems as Uzbekistan with the delayed delivery of the Russian Sputnik V. Despite requesting 500,000 doses in January 2021, that summer, only 100,000 had been received. The country also expressed interest in producing Sputnik V locally, but Russia turned down the idea due to an insufficient level of technological advancement in the Kyrgyz pharmaceutical industry and an absence of interest. Russia only sent 100,000 doses of Sputnik, according to data from November 2021. The United States sent over double that, almost 260,000 doses. By far, Chinese vaccine diplomacy was the most voluminous; China sent over 2,700,000 doses, and in some shipments even covered transportation and delivery fees. Overall, due to the economic difficulties induced by the pandemic, Kyrgyzstan received hundreds of thousands of vaccine doses free of charge from all three countries.

Whereas in Uzbekistan and Kyrgyzstan, where China clearly contributed the most to vaccine stocks, in Kazakhstan, Russia played a much more competitive role, combatting the presence of Chinese soft power. It is also no coincidence that days before the official registration of the Russian vaccine Sputnik V, information was already published on Kazakh government websites regarding the local production of the Sputnik V vaccine, which was realized by the end of 2020. Furthermore, Kazakhstan was the first Central Asian country to receive Sputnik V deliveries. This is likely due to Kazakhstan’s ability to pay for the vaccines and close political and economic relations. Overall, by November 2021, Russia sent over 5,000,000 doses, China - 5,500,000, and the United States - 646,000 doses. 

Ultimately, it cannot be said that vaccine diplomacy plays a definitive role in defining relations between nations, but it can certainly influence the course of events. Based on data across these countries during the first year of active vaccine diplomacy and subsequent foreign relations events, the following conclusions can be made: despite America’s modest contribution to the fight against the pandemic in Central Asia, the country’s humanitarian and political reputation in the region remains relatively unchanged and Central Asian nations still express interest in furthering US-Central Asian relations in many spheres. Describing changes to Russian-Central-Asian relations as a result of active vaccine diplomacy, however, is much more difficult due to the full-scale invasion of Ukraine in early 2022, among other policies put in place since the pandemic. On one hand, Central Asian governments have ushered in a period of diversification in foreign relations, slowly moving away from Russian dependence in favor of a more balanced, multi-vectored foreign policy. However, according to research from the Magnitogorsk State Technical University, Russia was able to improve its image in the eyes of the Kazakh political elite thanks to active collaboration during this period. To this day, collaboration in the public health sphere between Russia and Central Asia remains active. By far, the most successful vaccine diplomacy was conducted by China, which is logical considering the scale of its campaign. After this active phase of collaboration, China has managed to promote a number of projects in the region and established a visa-free regime with Kazakhstan. 

This approach to fighting the pandemic, which on one hand was rooted in collaboration and on the other hand was doused in geopolitical confrontation, hints at new conventions for battling international health crises in the future. The pandemic also set the stage for information wars and accusatory remarks regarding the virus and its release, emphasizing the confrontational aspect of this crisis. Furthermore, regional action underscores the sovereignty of Central Asian governments, who sought collaboration not only with Russia, but also with other world powers. Though the entire international community should work to prevent a public health crisis of this scale in the future, in the case of another such challenge, we can expect collaboration to reflect geopolitical interests of major world powers, and more importantly, we can hope to be better equipped to limit health and economic disruptions in our communities.