china isnt the only reason for cambodias vaccination success - China Isn’t the Only Reason for Cambodia’s Vaccination Success

There is a tendency in Cambodian political debates to overemphasize the importance of foreign powers, either as saviors or destroyers. The emerging conventional wisdom says that Cambodia’s vaccination campaign successes (with 78.1 percent of the population now fully vaccinated) is almost entirely down to China, the provider of nearly all vaccines Cambodia has used.

Prime Minister Hun Sen has done more than most to promote this narrative. “If I do not rely on China, whom do I rely on?” he commented in July. “Many people promised me much – but in the end, promises are not vaccines – and it was only the Chinese vaccines that actually arrived.” 

A month earlier, he said: “Without the donations and sales of vaccines from China, we would not have vaccinated the Cambodian people.”

A recent report by U.S.-based NPR was headlined “Cambodia’s ties with China helped it achieve a high COVID vaccination rate.” Ou Virak, of the Future Forum think tank, was paraphrased as saying: “Hun Sen also gets credit for going all in on the Chinese vaccines, even before they won approval from the World Health Organization, securing an abundant supply well ahead of other, wealthier countries.” In the same report, Benjamin Zawacki, of the Asia Foundation, called it a “perfect example of Hun Sen’s close relations with China paying dividends in a way that no one might have expected.”

There is a good deal of truth in these claims. China has so far delivered around 35 million two-dose vaccines to Cambodia, enough for its entire population. (Cambodia has also received millions of vaccines from other sources, such as the mainly Western-funded COVAX facility.) Moreover, China was the only real supplier ready to deliver such large numbers of vaccines in early 2020. Had Cambodia snubbed Sinopharm or Sinovac (as Hun Sen insinuated he might in December 2020) and instead waited for Western supplies or COVAX donations, it manifestly wouldn’t have achieved such high vaccination rates as quickly as it did (60 percent of the adult population fully vaccinated by mid-July)

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One recent study found that China has shipped 67 percent of its promised 100 million doses internationally, while the likes of Australia and Canada have each delivered only 8 percent. Nor can it be contested that friendship with Beijing has been a motivating factor for where China’s vaccines have been donated. Cambodia and Laos, Beijing’s two closest friends in Southeast Asia, have received vaccine donations from China accounting for 22 percent and 20 percent of their populations, respectively, according to the IMF-WHO COVID-19 Vaccine Supply Tracker database. Vietnam, Thailand, and Indonesia, by comparison, have received the equivalent of 2 percent, 1 percent, and 0 percent.

Examining the costs of vaccine procurement is difficult. It was reported in June that Cambodia spent $170 million on buying around 20 million vaccines, presumably those from China. We may assume, then, that it has spent nearly $250 million on the 30 million vaccines it has ordered from China. We know that Malaysia said in August it spent 4.36 billion ringgit (around $1.04 billion) on purchasing over 87 million COVID-19 vaccine doses, the majority from Pfizer-BioNTech but also around 20 million from Sinovac. As such, Cambodia clearly saved a good deal of state funds by relying on China-made vaccines.

But when speaking of Chinese benevolence and gratitude, it’s important to remember that the vast majority of vaccines Cambodia has received from China have been bought, not donated. It has received 6.3 million vaccines as donations from China but received 28.3 million purchased vaccines, according to Bridge’s China COVID-19 Vaccine Tracker. Laos has relied entirely on donated vaccines, which explains why it has received fewer (just 5.3 million vaccines from China since late 2020) and why it has vaccinated fewer people (just 38.2 percent of the population). 

Yes, Cambodia and Laos received more vaccine donations from China, but because the vast majority of Chinese vaccines globally have been sold and not donated (1.3 billion versus 90 million, according to one estimate), it changes the dynamics. Cambodia wasn’t allowed to buy vaccines simply because it was a friend of Beijing. After all, the largest purchaser of China-made vaccines has been Indonesia (215 million doses), followed by Brazil (around 100 million). 

Put differently, Beijing hasn’t made its vaccine sales dependent on its geopolitical ties. It has sold vaccines to any country that wants to buy them. This is why it is important to distinguish donations from sales. For vaccine donations, geopolitics matters — and Cambodia has been the largest recipient. But vaccine purchases, not vaccine donations, from China have been the deciding factor for Cambodia’s vaccination program — and vaccine purchases don’t come down to geopolitics. If it was all geopolitics, Beijing would have donated around 15 million vaccines to Laos, not just enough for 20 percent of its population. 

Put it in another way: Phnom Penh could have bought vaccines from China even if Hun Sen’s government hadn’t previously spent the last five or so years allying itself with Beijing, at the expense of its ties to the West. So it was decisions made in Phnom Penh, not in Beijing, that meant Cambodia received more than an ample supply of vaccines (and early on) so it could enroll as a lightning-speed inoculation campaign.

Moreover, other Southeast Asian countries have almost entirely depended on Chinese vaccines, yet they have by no means achieved anything like the vaccination successes of Cambodia. Laos has received 5.3 million vaccines from China since late 2020, yet it has fully vaccinated just 38.2 percent of its population. Indeed, Laos has decided not to buy vaccines, a decision made in Vientiane not Beijing. According to the IMF-WHO COVID-19 Vaccine Supply Tracker, Cambodia has secured enough vaccine pledges (bought or donated) for 105 percent of its population, compared to just 50 percent for Laos. On the other hand, Vietnam has secured enough for 119 percent of its population, yet just 25.8 percent of Vietnamese are fully-vaccinated to date. France has secured vaccines for 319 percent of its population, yet just 68 percent of the French are fully vaccinated. As such, there is no determined causation between receiving vaccines and running an efficient vaccination campaign.

Given the disparity, much of the reason for Cambodia’s successes lies at home, not abroad — and indeed, with how it used the vaccines, not how they were supplied. Cambodia had better finances to be able to afford to purchase vaccines from China. The Phnom Penh government went into the pandemic with one of the region’s lowest rates of external state debt to GDP — just 28.6 percent in 2019, according to the World Bank. Laos had one of the highest, at 53 percent that year. It’s also obvious that Cambodia (as well as Singapore, although for additional reasons) has benefited from having a relatively small population. Cambodia has just 16 million people, compared to Vietnam (93 million), Thailand (70 million), the Philippines (110 million), and Indonesia (273 million). However, Laos has a smaller population than Cambodia’s and it is more concentrated in urban areas, where large-scale vaccination is easier. Some 24 percent of Cambodia’s population is urban-dwelling, compared with 36 percent in Laos, according to the World Bank for 2020. 

Clearly, the Cambodian bureaucracy has been better at administering vaccines. If my analysis is correct, Cambodia has had 61 days when it was able to administer more than one dose per 100 people daily, according to Our World In Data. Laos was only able to do so between August 21-27, and most days the rate has been less than 0.5 doses per 100 people. Thailand was only able to do so for 28 days (September 27 -October 24). Even Malaysia, which has now fully vaccinated 75.9 percent of its population, only had 33 days where it inoculated its population at a rate higher than 1 dose per 100 people (July 10-September 11). 

As a result, it was never as axiomatic as it now appears that a large supply of vaccines from China would easily translate into high vaccination rates on the ground in Cambodia. But the Cambodian government decided to start a vaccination campaign earlier than other countries. Vietnam’s paltry rate stems from its hubris, thinking that it had more time than it actually did to wait. The Cambodian government’s decision to divide earlier doses between the Health Ministry and military meant that troops could be called in to greatly expand vaccination in harder to reach areas.

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One must also praise the Cambodian bureaucracy, which went into the pandemic without a great deal of trust in its competency. Or Vandine, a health ministry secretary of state and spokesperson, has emerged as an administrative hero of the pandemic. The central bank has also proved its mettle, winning regional awards.

However, success is Janus-faced for the long-ruling Cambodian People’s Party (CPP). Under its watch, HIV rates have fallen considerably, from 1.2 percent of the population in 2000 to 0.5 percent in 2018, according to UNDP data. The percentage of one-year-olds lacking immunization from measles fell from 35 percent in 2000, although it was still 16 percent in 2019, one of the highest rates in the region. On the other hand, the government has struggled with other “epidemics.” Malaria rates rose from 19.9 per 1,000 people in 2015 to 23.7 in 2018. In 2020, flooding killed vastly more Cambodians than COVID-19. Around 5.4 people died daily on Cambodian roads in 2019, and the number of fatalities caused by road traffic accidents increased by nearly 25 percent between 2009 and 2019. 

The COVID-19 pandemic, and in particular the vaccination campaign response, has shown the government can be effective and responsive in times of crisis. Now it must stick to this high standard.