Rikio Inouye

Preserve, Pressure, Protect, and Peel: The US–China Rivalry and the Politics of Vaccine Provision

Rikio Inouye

International Studies Quarterly 70(1): sqag005, 2026 Open Access

Award APSA Award for Best Paper – Foreign Policy (2024)

Publisher's Version (Open Access)
Cite (BibTeX)
@article{inouye2026preserve,
  title = {Preserve, Pressure, Protect, and Peel: The US–China Rivalry and the Politics of Vaccine Provision},
  author = {Rikio Inouye},
  year = {2026},
  journal = {International Studies Quarterly},
  volume = {70},
  number = {1},
  pages = {sqag005},
  doi = {10.1093/isq/sqag005},
  url = {https://www.rikioinouye.org/publication/preserve-pressure-protect-peel/}
}

Abstract

Lead states compete for influence and followers, and the COVID-19 pandemic served as an important reminder that health aid can be a foreign policy tool. How and to which countries do states distribute aid amidst a global crisis and great power rivalry? This article integrates multiple literatures and presents a novel typology of strategies: preserving existing partnerships, pressuring opponents, protecting recipients based on need, and peeling off countries from geopolitical rivals. It analyzes how the US and China distributed life-saving COVID-19 vaccines through 2021-2022. Regression results and Bayesian reasoning of original elite interviews suggest the US approach is characterized by protecting and peeling, while patterns of Chinese distribution suggest a combination of pressuring, preserving, and protecting. Case studies of Paraguay and Nicaragua – historic allies of Taiwan - further support these conclusions. This raises questions regarding the circumstances under which aid provision is instrumental and how rivals compete during global crises.

Keywords: foreign aid, great-power rivalry, vaccine diplomacy, COVID-19, China, United States, Taiwan, Paraguay, Nicaragua, elite interviews

See Also