With COVID-19 pandemics, the term ‘vaccine diplomacy’ has been increasingly used in a political, medical and social discourse as a specific component of international relations of key importance, where international cooperation in the area of controlling infectious diseases has rather a long history.

It dates back at least to the XIV century, when a quarantine system was used in the city of Dubrovnik on the Adriatic coast of the Mediterranean Sea during the Middle Ages [1], and turns into multilateral cooperation in 1851, when the International Sanitary Conference on Cholera Prevention took place with subsequent control of plague and yellow fever threats [2].

This resulted in formation first of the Pan American Health Organization [3] and then of the World Health Organization (WHO), which is currently a specialized institution and part of the United Nations [4].

According to the western sources, vaccination is commonly associated with a name of Edward Jenner, an English doctor, who created a safe smallpox vaccine. But this event occurred in 1796 only, whereas Catherine the Great was vaccinated against smallpox 30 years before it, on October 23, 1768. Variolation was not a totally safe technique, and caused mortality of up to 2%. It, however, could save from death, that affected up to 40% of population. The technique consisted in taking infected material from a person affected with smallpox and putting it beneath an unaffected person’s skin. The inoculated individual had a mild case of smallpox, and a more serious case was prevented. Catherine the Great ordered to publish and widely distribute data about her vaccination both in Russia, and abroad, ‘so that others could also use the same techniques and save themselves from danger easily’ [5]. This is as an example of Russian and international vaccine diplomacy, as the Empress made the vaccine fashionable, Russia’s image was perceived as positive and Catherine II was treated as an educated and progressive ruler. Noblemen and sovereigns took up the initiative and vaccination started a parade over the globe. However, the word ‘vaccine’ was not used yet; it came into official use when Jenner created a cowpox vaccine, derived from the Latin word ‘vacca’ for ‘cow’. A Catherine II medal inscribed ‘She has set an example’ was established to commemorate the first vaccine.

The subject of the Empress’s vaccination was even touched by the Italian ballet master Gasparo Angiolini in ‘Defeated Prejudice’, where science had an allegorical struggle against superstition. As Russia occupied leading positions in the fight with smallpox using vaccination, France’s Louis XV died of the disease. Having found the news, Catherine II reportedly called the death a “barbarism”, as ‘science can heal the disease already’ [5].

Jenner, who created the vaccine, used his influence during the war between England and France in 1803–1815 for humanitarian purposes to reduce the stress of war and help prisoners and other people who got into trouble. Napoleon once said. ‘Jenner — we can’t refuse that man anything’ [6].

Development of Russian vaccination, creation of vaccines and international advances in that area, initiated since the reign of Catherine II, were marked with outstanding achievements and gave many benefits to the world. The Russian vaccine diplomacy supported the vaccine for rabies created by a French microbiologist Louis Pasteur in 1885, and was marked by a contribution of 100,000 francs by Tsar Alexander III for the Pasteur Institute and foundation of the second and third biological stations in Odessa and Moscow in 1886.

Nikolay Sklifosofsky was an initiator of the Pasteur station in Moscow. When the station opened, Louis Pasteur sent his signed portrait, which is preserved till now. Our country confirmed its leading role in vaccination, when a network of 80 Pasteur vaccination stations and a hundred of its branches were created throughout the country by 1938, and when our vaccine could win the victory over poliomyelitis in the 1960-s, attaining international acknowledgement and admiration. The vaccine produced by the Institute of Poliomyelitis and Viral Encephalitis of the USSR Academy of Medical Sciences was imported to over than 60 countries [5].

In Japan, mothers of children with poliomyelitis came out in the streets and demanded to allow import and use of the Soviet vaccine. The authority has to offer concessions, which saved over 20 million children.

A Soviet- Japanese movie Step was released inspired by the story of overcoming political hurdles for the sake of life. It introduced the topic of vaccine diplomacy to the screen.

Vaccination against poliomyelitis in the form of pills offered by Professor Mikhail Chumakov was an element of Russian vaccine diplomacy. The candy pills were given to schoolchildren during lessons and enjoyed high popularity among children and adults, not requiring participation of medical personnel. The simple idea seemed to have a wide response and was considered as a discovery.

At the international level, professor Chumakov called upon special care when working with dangerous viruses and careful tracing of their genesis. When the WHO decided to destroy all black smallpox strains in 1990, the professor strongly disagreed with this point of view. He explained that in case of a new outbreak the mankind would turn out to be helpless due to the lack of source material.

The term ‘global health diplomacy’, offered by Dr. Peter Bourne, Special Assistant to President Jimmy Carter for Health Issues, has already been used by that time [7]. Global health was confirmed within the Millennium Development Goals (2000) and global health diplomacy was placed firmly in the area of international diplomacy [8].

Vaccine diplomacy is taken as part of global health diplomacy, though the international efforts to control dangerous infectious diseases and development of events against the background of COVID-19 pandemics determined an independent role and special value of the diplomacy. In a crisis environment, when a threat to health and lives of people emerged at the national, regional and global scale, it was comprehended that such dangerous diseases as HIV/AIDS, Ebola, bird flu, etc. pose a threat to economic development, safety and interests of countries and their population [9]. Potential threats of bioterrorism and use of biological weapon, leakage of biodestructive materials and viruses from biolaboratories and research centers were added to challenges in the form of epidemics. Concentrated efforts of the world community, associated with prevention of dangerous diseases, were urgently required. However, some countries were guided by their narrow national interests or traditions and avoided cooperation; for instance, Indonesia, that refused to share its data about bird flu, or Nigeria and Pakistan, which were against vaccination for religious reasons [10, 11].

According to the declaration of Ministers of Foreign Affairs adopted by seven countries such as Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand in Oslo in 2007, global health was taken as part of external policy [12].

Global health diplomacy was considered as a process, in which health is positioned in foreign policy negotiations and new types of global healthcare management are created [13, 14]. Quite recently it was defined as ‘a system of organization, communications and negotiations, shaping the global political environment in the area of healthcare and its determinants’ [15].

In this case, not only diplomats, but also experts with certain knowledge in respective areas of healthcare are responsible for development of certain problems and negotiations, and this is a specific feature of global health diplomacy [16].

Global health diplomacy is implemented both in the classical forms of bilateral and multilateral diplomacy in accordance with the Westfalen principles and provisions of the Charter of the United Nations with conclusion of agreements and conventions, and by way of interactions of non-governmental organizations, professional community and participation of interested business communities, manufacturers and consumers of pharmaceuticals and medical services [17, 18].

Science diplomacy is an important element of global health diplomacy. It is used to ensure interaction of scientists and implement their professional solidarity regarding healthcare; it commonly opposes the struggle against health priority and safety of a human being to political and commercial interests of the strong and those companies that focus on pure profit making.

Vaccine diplomacy affects almost all principal aspects of health diplomacy. It is motivated by requirements for prevention, decrease of distribution and elimination of dangerous diseases with vaccination, dealing with the entire complex of issues associated with development, delivery to customers and ultimate use of the vaccines. Development and production of vaccines as an effective and safe biological product demand high level of science and technology, special knowledge, qualified personnel and respective production conditions and capabilities typical of not that many countries.

As it was dramatically illustrated by COVID-19 pandemic, Russia, USA, Great Britain, China and India were able to provide a fast response to the challenge and create an adequate vaccine to save millions of people. Moreover, Russia was the first to register Sputnik V vaccine and offer two more other vaccines subsequently. The result was not accidental. The achieved success was based on highly efficient Russian scientific school and over 250 years of vaccination experience in our country, leading by example.

However, instead of combining efforts of the key countries in the West and East, that are the principal actors of vaccine diplomacy, and fostering the efforts to suppress the pandemic, western politicians did something quite the opposite. Pharmacological companies, running into money when producing and marketing pharmaceuticals, weren’t going to solve the humanitarian problems of survival during the pandemic and miss profit. Doctors and experts engaged in trials, use and promotion of vaccines, weren’t ready for that as well. They got used to sell their services at a high price and didn’t want to be deprived of their habitual profit. Geopolitical competitors of the Russian Sputnik V such as Pfizer and Moderna represent business projects not designed for charity. The USA didn’t intent to buy millions of doses to render assistance to needy countries, laying emphasis on priority support of its own people.

At the same time, the USA didn’t want to lose a good opportunity for their global promotion due to vaccine diplomacy, being aware that they are outpaced by their geopolitical competitors Russia, China and India, as the latter submitted vaccines to other countries on special terms or free of charge. Preferential terms can include transfer of technologies and aid in establishing own production of vaccines.

The traditional instruments of a country’s expanded influence in other countries (profitable loan, customs credit and tax benefit, indirect financing through delivery of raw materials and goods at an understated price, scientific and cultural exchange, admission at institutions, etc.) were added to the instruments of vaccine diplomacy. Their active use began when a vaccine against coronavirus was required.

Unexpectedly for the western competitors, Russia gained the lead in the evolving vaccine race. It was found out that Sputnik V was more effective, with its clinical and diplomatic effect being more powerful than the vaccine diplomacy of competitors.

Using the example of San Marino, it was obvious that Russia, which provided its vaccine, was now perceived by inhabitants of this small country not as a large and faraway state, but as a close friend in distress. By continuing the traditions of the Russian civilization code based on humanism and compassion, vaccine diplomacy of Russia acts as an effective soft force, influencing the minds and gaining followers owing to its attractiveness, whereas the West relies on force and violence.

However, western politicians never continue their attempts to dishonor competitors, implant doubt in their vaccine quality and accuse them of maintaining venal vaccine diplomacy for political profit. When visiting the plant of the US pharmaceutical giant Pfizer in Michigan, H. Maas, a German politician, who served as the Minister of Foreign Affairs, stated that ‘the Russian and Chinese can’t maintain their complex vaccination diplomacy aimed at increase of their prominence in the world only’ [19]. He then concluded that it was necessary to advance a vaccine by Pfizer, with its production based in Germany.

By responding to the announcement, the Press Secretary for the President of Russia Dmitry Peskov condemned politization of vaccination, whereas the Press Secretary for the Ministry of Foreign Affairs of the Russian Federation Maria Zakharova said that the statements by the Minister of Foreign Affairs Clément Beaune about non-admission to France of those tourists vaccinated with a Russian vaccine were unacceptable [19].

Speaking at the summit of the EU concerning vaccination in the end of February 2021, President of France E. Macron declared that China and Russia had triggered a vaccine war. It was probably associated with the fact that citizens of different European countries accused the EU in delaying recognition of the Russian vaccine and demanded its approval. It was obvious that ‘COVID-19 subjected the solidarity of the EU countries to testing, as they didn’t always hasten to help one another’ [20].

The pandemic challenge implied that ‘in accordance with the research of sociologists, in March 2021, almost every second person in the world (45%) considered COVID-19 as the most troublesome problem’ [21].

Along with severe pandemic consequences for the entire world, geopolitical competition, mistrust, protectionism and unequal access to vaccination, concern of a person with protection against coronavirus is a powerful driver of vaccine diplomacy.

Pandemic-born human dramas and tragedies are currently occurring in different parts and countries of the world that suffer from a shortage or lack of vaccines. The countries that need vaccines are helped not only by Russia, but also by China and India, though certain competitive obligations are present in the relations and vaccine diplomacy of the two global players. For instance, India deprived leadership from China by selling the vaccine in Nepal and on the Maldives, but refused to provide the vaccine to Pakistan, allowing China immediately to capture the market, where the Russian Sputnik V had already been presented [22].

Vaccine diplomacy is being developed at the diverse level, both within the activity of the UN and its special institutions with the primary responsibility of the World Health Organization, and in global and regional formats of G7, G20, BRICS, SCO, many international organizations, intergovernmental and non-governmental associations. Vaccine diplomacy has a considerable peace- making and humanitarian potential, an ability to carry mediation between the conflicting parties and discontinue military activities with the vaccination campaign [23].

The term ‘scientific vaccine diplomacy’ has been created as part of the vaccine diplomacy concept within the ideas of global health diplomacy. The term denotes interaction and collaboration of scientists regarding the issues of scientific development and usage of vaccines and conducting associated studies and experiments [24].

CONCLUSION

Thus, the unique character of vaccine diplomacy is owing to originality of vaccines themselves. They are considered as the most powerful and effective medical intervention into a human organism to preserve life and health. According to some estimates, modern vaccines saved more lives than it was lost during the world wars of the XX century [25].

It, however, should be noticed that the Russian vaccine diplomacy, that rests upon the significant success of Russian science and was the first to develop and offer a coronavirus vaccine to the world, opens up new opportunities for many partnerships along the path of broader pharmaceutical diplomacy.