多年前,筆者曾簡單比較印度與中國在2015年尼泊爾大地震(2.0)及回顧2004年南亞大海嘯(1.0)後,對尼、斯兩國所進行的援助措施。2019年底,COVID-19(又稱武漢肺炎或新冠病毒等)造成各國嚴重疫情,亦重挫南亞各國經濟動能,隨著生物與疫苗技術的研發,各大藥廠陸續推出針對此波疫情的專用疫苗,但在外交場域上,中、印兩國的較勁也再度浮上臺面。


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Nepal Quake 中印救災政治學


著|林鑫佑,《南亞觀察》主編
*本文聚焦於印度與中國就援助各國COVID-19疫苗一事進行探究,文中亦論及生物科技之相關研究、報導,並引附原文。針對生物科技專業知識如有進一步之疑問,應另多加尋求專業之確認。

印度COVID-19疫苗

目前印度政府批准並生產的COVID-19疫苗主要有兩款:Covishield與Covaxin。

Covishield是由知名藥廠阿斯特捷利康(AZ, Astra Zeneca)與牛津大學研發,並由印度血清研究所(SII, Serum Institute of India)生產的疫苗,也就是臺灣俗稱的「牛津疫苗」。Covishield也是世界衛生組織(WHO)繼美國輝瑞(Pfizer)疫苗後,第二款被批准使用的COVID-19疫苗,其主要生產地是阿斯特捷利康韓國藥廠以及上述的印度血清研究所。

Covaxin則是一款由印度國內疫苗製造商婆羅多生技(Bharat Biotech)與印度醫學研究理事會(ICMR, Indian Council of Medical Research)共同研發的疫苗,雖尚未取得WHO批准,但已由印度國內批准施打。

COVID-19疫苗示意圖,圖片來源

印度COVID-19疫苗優與劣

疫苗技術有不同的種類,當前COVID-19疫苗所應用的包含mRNA 疫苗、全病毒疫苗、病毒載體疫苗、蛋白質次單元疫苗、滅活疫苗等各種技術。Covishield所採用的為病毒載體疫苗,亦即將COVID-19病毒蛋白編入黑猩猩腺病毒載體,並在傳遞至人體後,製造棘狀蛋白引發抗體出現。俄羅斯開發的疫苗Sputnik V亦屬之。

Covaxin採用技術為滅活疫苗,是由已殺滅的COVID-19病原體製成,透過其中的抗原誘導細胞免疫的產生。中國所生產的國藥疫苗與科興疫苗亦採用相同技術。

這兩款疫苗的優點在於能在 2 至 8°C的環境中儲存 6 個月,換句話說,只要有家用的冰箱設施,也能夠進行疫苗的保存,這使得該類疫苗對偏鄉、基礎交通建設不完全的國家、地區來說十分有利。相較於美國輝瑞(Pfizer)、莫德納(Moderna)所生產的疫苗,則必須分別保存在零下70°C及20°C的環境中,但這也導致部分國家被迫放棄此一選項。

成本上的優勢上,Covishield與Covaxin的成本售價相對低廉,每劑最低成本僅約200至295盧比(約2至5美元)[1],相較美國輝瑞疫苗每劑約1,431盧比(約20美元)、莫德納疫苗每劑約2,348至2,715盧比(約32至38美元)、中國國藥疫苗每劑約5,650盧比(約77美元)來說根本是佛心價!

但或許「有一好沒兩好」,Covishield與Covaxin的劣勢在於其疫苗的有效率[2]

跟多數疫苗相同,Covishield與Covaxin皆需要接種兩次,期間間隔約4週以上,但其疫苗有效率僅約7成,這點尚不比美國輝瑞、莫德納等疫苗所宣稱的9成以上。此外印度各地自1月以來接腫該兩款疫苗後,皆有出現不適或死亡的病患(各廠疫苗皆有適應性上的風險)。為了能夠迅速地因應特殊傳染疾病或疫情,疫苗在通過二期試驗,確認安全與有效性後便能開始施打,但婆羅多生技並未在第一時間說明可施打疫苗(Covaxin)及不建議施打者的條件,導致部分言論對疫苗效果感到質疑。

印度 V.S 中國的疫苗援助

1月中下旬,印度總理莫迪喊出「鄰國優先」(Neighbourhood First)的口號,除召集周邊國家召開相關防疫合作會議外,亦率先向南亞各國無償贈與Covishield疫苗;另一方面,印度所生產的疫苗數量佔全球疫苗近6成,因此也盼藉此進行全球性的防疫工程。

在此政策下,印度不吝與南亞各國「分享」疫苗,在各受贈國中,以孟加拉(2,000,000劑/541,038人)、尼泊爾(1,000,000劑/272,840人)、多明尼加(70,000劑/230,563人)及緬甸(1,700,000劑/141,637人)的確診人數最為嚴重,印度也因此贈與相應數量的疫苗劑量。

在這波疫情中,印度對外輸出的疫苗可以分成「無償贈與」及「他國採購」兩類。根據印度外交部的統計,輸出的疫苗以Covishield為主,共計有22,970,000劑,其中「無償贈與」部分計有6,470,000劑,佔輸出總量的28.2%,分別輸出至南亞、中東及東南亞各國,未來更預計贈與蒙古、中南美洲及太平洋等島國;「他國採購」部分則計有16,500,000劑,佔輸出總量的71.8%,多為南亞、東南亞、中東、北非及中南美洲等國所採購(最後查閱時間:2月16日)[9]

儘管中國也亟欲捐贈疫苗給「一帶一路」沿線國家,但南亞地區這塊拼圖似已由印度「先馳得點」,致中國所捐贈的疫苗轉以非洲、東南亞等國為主。中國外交部在說詞上雖讚揚了印度的疫苗外交,然而中國官媒卻擺出另一套說詞,認為印度的舉動已嚴重干預中國與他國的互動關係,甚至擾亂了中國與孟加拉有關疫苗的臨床試驗計畫。另外,由於巴基斯坦並未在印度贈與疫苗之列,為此有媒體指出「在南亞與印度洋地區國家中,目前似乎只有中國的「鐵桿盟友」巴基斯坦願意接受中國捐贈疫苗[3]。」


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施威全專欄:中國疫苗送非洲,巨龍的禮物或食人獸的黏液?


捐贈疫苗是穩定疫情的考量?還是外交場域的齟齬?

先說結論,筆者認為疫苗外交著實地是場外交場域的爭奪戰。人道主義的精神與意涵是國家軟實力的展現,並早已體現在國家的各種外交場合或戰略作為中,然而疫苗外交或許也能有效地舒緩當前疫情,為部分國家帶來防疫的希望。

印度的「鄰國優先」政策的概念早在過去尼赫魯時期便有相關的指引方針,進而在前總理古吉拉爾時代(Inder Kumar Gujral)被強調,演變至今甚至可以說是根植於印度戰略文化的重要思維之一。與其相近的「東進政策」(Act East)也是關連性的外交政策之一。

印度號稱南亞大國,也高舉「鄰國優先」的標語,但這並不代表印度不與周邊鄰國發生衝突。套用臺灣經驗,大國在旁,必時時提防。

2015年印度與孟加拉解決了有關邊界飛地及人口的爭議問題,但隨後的水源問題及2019年印度《2019年公民身份法》排除了穆斯林的爭議,也引起了孟國不滿與關切,致印、孟兩國漸行漸遠,對此中國也趁機推展與達卡的外交關係。


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當資本主義遇上新冠肺炎 – 寫在孟加拉政府的年度預算公布之後(上)
當資本主義遇上新冠肺炎 – 寫在孟加拉政府的年度預算公布之後(下)


今年2月的緬甸政變,印度外交部表示擔憂,認為應維護法律與民主轉型的進程。事實上,印度一直以來都對周邊的軍事獨裁政權感到不安,印度政府過去雖曾批評緬甸軍政府時期的獨裁作為,然更深切的考量應在於,軍政府領導下的緬甸亟有尋求中國協助的可能,對印度而言難免是個外交風險。

尼、印的邊界問題是殖民時期所留下,卻遲未痊癒的瘡疤。去(2020)年5月,印度打算修築一條從達爾丘拉(Dharchula)通往里普列克(Lipulekh)的公路,說可減少朝聖者的交通時間,但其位處尼泊爾宣稱的領土範圍內,不僅造成加德滿都的不滿,也引起中國的關注;緊接著6月中旬,尼泊爾遂將兩國存在主權爭議的部分領土-卡拉帕尼(Kalapani)、里普列克和林比亞都拉(Limpiyadhura)-劃入新地圖中,尼、印兩國雖未致實體的衝突,但卻也凸顯南亞小國對印度的挑戰與抗議。

面對疫情肆虐,印度提供的Covishield疫苗或將為印度與南亞各國的雙邊關係帶來改善,甚至建立起區域外的新互動。孟加拉總理哈西娜的在去年的視訊會議中,對莫迪提出的「鄰國優先」政策,表示印度為孟加拉「真正的朋友」;一向被認為親中的尼泊爾總理奧利(K.P. Sharma Oli),因安全疑慮而婉拒中國提供的疫苗,1月尼國外交部長普拉迪普·賈瓦利(Pradeep Gyawali)出訪印度,提出有關疫苗的請求,事後奧利政府亦公開對印度捐贈疫苗表達感謝;更不用說面對本次緬甸政變,印度政府的措辭相對和緩,且仍持續出售原先承諾緬甸的Covishield疫苗。

在防疫安全考量上,南亞的主要各國,多與印度有領土上的鄰接,部分地區的居民甚至密切往來,換言之,只要陸路鄰國做好防疫,對印度將有益無損。不丹雖與印度接攘,但該國至今年一月才有第一起通報的死亡案例,加上人口稀少,所獲得的疫苗尚足應付國內疫情;而斯里蘭卡與印度有一海之隔,相對陸路鄰國也較能對其做好防疫措施。

COVID-19病毒示意圖,圖片來源

疫苗外交的成果仍待觀察

疫苗外交期望達成的效果不外乎是取得政治外交上的優勢,兼顧緩和嚴峻的疫情情勢,以南亞作為觀察區域,印度至少在第一階段取得前者的勝利。

但必須注意,印度當前仍是繼美國後確診武漢肺炎的「第二大國」,而其所生產的疫苗不論對本國或受贈國,能否達到預期中的效果,仍有待持續的觀察。在預期效果尚未明朗的情況下,也不能夠完全排除早前獲贈印度疫苗的南亞諸國在後續接受/採購中國疫苗的可能性,這些第一批接受/採購印度或中國疫苗的國家,可望成為其他國家的「觀察指標」,以作為日後決定接受/採購何種疫苗的參考。

再者,人道主義的援助,或是本次疫苗的捐助,都難成為「永無衝突」的保證,短時間內,印度與周邊國家的關係可望有所進展或改善,甚至營造出「南亞團結抗疫」的榮景,而印度的大國聲譽也將收遠播之效,不過與鄰國間的根本衝突如果猶仍存在,待疫情平復後,爭議恐怕會再次浮現。印、中在環印度洋地區的權力競合亦難因此而弭平。

疫苗外交的「勝負」仍未定論,但就防疫上至少是一個不錯的開始。


作者按

[1]疫苗在出口後仍會因為運費、保存、管理等延生出不同的成本費用

[2]疫苗有效率的計算會根據施打對象的年紀、症狀、實驗期間等各種變數而有所差異。同時,因為各國藥廠在臨床試驗時的施打對象通常源自於本國人以及不同的實驗生物,因此在各地實際施打的情況亦可能有所不同。

[3]靠近非洲的印度洋島國,塞席爾亦有施打中國國藥疫苗,但這批疫苗(50,000劑)並非來直接來自於中國,而是由阿拉伯聯合大公國所捐贈,但阿拉伯聯合大公國自己也向印度採購了200,000劑Covishield疫苗。


本文圖片來源:Unsplash

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    “She’s good, man. Aren’t you, Nina?””Yes, babe, I’m fine, thanks. You go catch up with your friends, I’ll bring dinner out soon.” My husband left as I looked back at Rodney. God, he’s so fucking assertive. It turned me on so much. We continued to such each other’s lips a while longer before I realized I had to take the food out of the oven. The boys all sat down at the dining table as I served dinner. There were only six seats at our table and I had nowhere to sit. I went to grab a stool from the kitchen but Rodney looked at me and patted his lap. I walked over to him and sat on his leg…
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  14. meri16239530 says:

    We drank all the beer (mostly because of the peppers) and then began working the bottle. We laughed hysterically about absolutely nothing.”Do you know how I got my last boyfriend?” She asked. “I was in a bar with some friends and this guy kept staring at me. Every time I looked over he was staring at me! So when I finished my beer I slid the neck of the bottle into my mouth… the whole neck… and when it was all the way down I looked over and watched him squirm as I pulled it out. A few minute later the waitress brought me a long neck Budweiser from him.””You didn’t!””I sure as hell did! ……
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  15. heroineism7408047 says:

    ” I’m gonna take a shower. “” Wait up on me then. “I noticed her smiling as I responded, the redness of excitement growing back in her cheeks. Without even looking in her eyes I could easily tell the words “shower sex” were flashing in neon lights inside her brain. Had she planned to lure me in? I calmly got up and went for the pile of my clothes we’d thrown in a corner last night and then put on my underwear and jeans, since I hadn’t really thought of bringing clean spares. She then led me to the bathroom, her ass waving side to side with each step, a clear factor that she was very…
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  16. demonologist547521 says:

    The wall to Mexico had begun construction and he had already begun to dissolve Obamacare. However, as the breeze blew a few golden leaves over the sun drenched lawn, little did he know that the next 24 hours would change his life and perhaps that of the nation forever.He made his way over to the Roosevelt desk. He decided he wouldn’t bother with a tie today he only had a few appointments, one of which was with the England Women’s cricket team. Whatever cricket was. He was sure an advisor would inform him so he didn’t look stupid. His shirt and trousers were freshly pressed and his hair…
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  17. Leon1021408186 says:

    I really don’t get involved in my husband’s business but have met many of his clients and occasionally run some errands for him. Patrick, his client, lived in a very exclusive neighborhood in a wonderful house on a large estate. He was obviously successful but I don’t know what he did or what the papers were that I was delivering to him. It was a hot day so I dressed lightly in a white sundress with the idea of going shopping at the mall after I delivered the papers. Patrick met me at the door wearing a robe. He was a big burly man in his sixties, a bit of a pot belly but ruggedly handsome…
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  18. BRUXSA1657178 says:

    “Never seen you here before.””Do you come to this hotel so often?” I asked.”It’s a good place to observe people.””And find desperate women.””Just another appealing aspect.””Are you here with Wilson?” I pointed to the sign. “Nah, there’s always some stupid party or reunion here. So, are you a desperate woman?” He placed a hand on my thigh.  The corners of his mouth were turned up and he kept looking me over.  I’m okay with arrogant, but this guy was really sure of himself. His ego was starting to make me nauseous. I realized that I could use him for pleasure, but I imagined the smug…
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