The political economy of vaccine distribution and China's Belt and Road Initiative

To what extent do national strategic interests influence countries' distribution of health assistance during a global health crisis? We examine China's global COVID-19 vaccine allocation, focusing on the relationship between its vaccine prioritization and its geopolitical expansion through the Belt and Road Initiative (BRI). We claim China uses its vaccine diplomacy as a comprehensive tool to promote its grand strategy and expand its global leadership and influence. Employing a newly available dataset on Chinese COVID-19 vaccine deliveries for a cross-section of 108 BRI member countries, our study shows that countries with foreign direct investment flows into BRI projects have received more vaccines from China. Our findings confirm that donor strategic concerns affect bilateral foreign assistance. Our results remain robust to several robustness checks, including endogeneity concerns. © 2023 The Author(s). Published by Cambridge University Press on behalf of V.K. Aggarwal.

Do bigger health budgets cushion pandemics? An empirical test of COVID-19 deaths across the world

How has government healthcare spending prepared countries for tackling the COVID-19 pandemic? Arguably, spending is the primary policy tool of governments in providing effective health. We argue that the effectiveness of spending in reducing COVID deaths is conditional on the existence of healthcare equity and lower political corruption, because the health sector is particularly susceptible to political spending. Our results, obtained using ordinary least squares (OLS) and two-stage least squares (2SLS) estimation, suggest that higher spending targeted at reducing inequitable access to health has reduced COVID deaths. Consistent with the findings of others, our results indirectly suggest that health spending is necessary, but not sufficient unless accompanied by building resilience against the spread of deadly disease. Equitable health systems ease the effects of COVID presumably because they allow states to reach and treat people. Spending aimed at increasing health system capacity by increasing access thus seems a sound strategy for fighting the spread of disease, ultimately benefiting us all.

Healthcare equity and COVID-19: assessing the relative effectiveness of egalitarian governance and healthcare system capacity on the COVID-19 pandemic

Scholars of public health typically focus on societal equity for explaining public health outcomes. Indeed, the COVID-19 pandemic has led to a spate of studies showing a tight connection between inequitable access to healthcare, welfare services, and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question a bit differently by asking whether more 'egalitarian' forms of democracy matter, given that they should contain more equitable healthcare access and societal infrastructure, such as social capital and trust, for achieving a broader collective good. Our results suggest that more equitable access to healthcare does indeed increase testing rates and lower the death rate. Broader egalitarian processes, measured as egalitarian democracy, however, show the opposite effects, suggesting that factors associated with healthcare capacity to reach and treat matter more than broader societal factors associated with egalitarian governance.