The Quad’s Longevity Might Hinge on Its Health Plan

Since it was established in 2007, the Quadrilateral Security Dialogue (Quad) has come a long way. Its agenda today includes not just security cooperation but also a host of other issues, including cooperation on international health threats. One important factor, however, has hampered its ability to act: Cooperation gears up when a threat from China is perceived and subsides as the perception fades, or the need to conciliate China increases. This behavior has also unfortunately been mimicked in health cooperation. Yet the Quad’s health-related cooperation offers an important institution and norm-building agenda that could help construct an enduring partnership among the four countries—India, Japan, Australia and the United States. Formulating a long-term health security strategy for the Quad is essential, not just for strengthening the partnership, but also for building trust in its longevity and ability to contribute positively to the Indo-Pacific region.

The Quad came together due to the four countries’ efforts to coordinate a humanitarian response after the devastating 2004 Indian Ocean tsunami. At the first Quad summit in 2007, the driving idea was a free and open Indo-Pacific. But after 2007, cooperation through Quad diplomacy waxed and waned. In 2017, Quad 2.0, as it came to be known, shared a greater urgency about the rise of China and its growing influence in the Indo-Pacific. The Quad now had a wider agenda, creating space for thinking and interpreting security cooperation more broadly.

Then, in 2020, Covid-19 arrived on every country’s doorstep.

By October that year, during the meeting of the Quad foreign ministers in Tokyo, health was mentioned as an issue for cooperation. The pandemic highlighted the urgency of international cooperation to combat the virus, but the immediate impetus behind Quad cooperation on this issue was China’s vaccine diplomacy. By mid-2020, China had launched a global vaccine diplomacy effort. In response, the Quad decided to counter China’s vaccine measures. No formal health strategy or concrete long-term policy action was decided, but instead, as several senior government and private-sector officials in multiple Quad countries confirmed in private conversations, “health became an issue because of China.”

The Quad agreed that the U.S. Development Finance Corporation would make a loan investment of $50 million to the Indian pharmaceutical company Biological-E (Bio-E) to increase its capacity to manufacture up to one billion doses for donation to the Indo-Pacific region by the end of 2022. Some of those were Johnson & Johnson’s (J&J) single-dose shots. Bio-E received the funding in 2021 and by 2022, it had installed the capacity to manufacture 50 million J&J doses per month.

The Quad’s distribution of these vaccines, however, stalled. Reasons for this setback included, but were not limited to, the pandemic receding and rising vaccine hesitancy related to reports of stroke among those who received the J&J vaccine. Regardless, the upshot was that only one country—India—donated J&J vaccines under the Quad umbrella. The other three donated through bilateral agreements with other countries.

Despite this, the initiative enjoyed some success. Not only did India distribute approximately 290 million doses under the auspices of the Quad, but the initiative also demonstrated a public commitment to the Indo-Pacific region and the willingness and ability of the four Quad countries to expand their cooperation beyond hard security and provide public goods. Now, as the pandemic wanes, the Quad faces two broad, strategic questions: Can its members build on their momentum to expand their health security partnership? Can such a partnership sustainably exist without a focus on China?

The answer to both is yes.

The fledgling vaccine initiative was later girded by Quad expert meetings on simulating future pandemics, discussing how vaccine and research cooperation could look moving forward, and pandemic capabilities and responses.

The latter has been particularly relevant to the Quad health agenda. One hope among Quad health officials is that if the group, in addition to ramping up vaccine manufacturing, systematically focuses on management strategies—including training local health workforces—to detect and respond to pandemics more quickly, the Indo-Pacific region can avoid past “panic and neglect” cycles. The Quad should also think about what to do with large-scale capabilities that were revamped or built to meet mass vaccine production requirements, and are now lying idle and incurring costs.

The cancelled Sydney Quad summit was widely expected to answer questions about what the Quad’s future health security strategy would involve and how the group could regularize a long-term process for health cooperation. These answers will now be announced at a later date. But certain elements will be core to any long-term strategy. Covid-19 provided a sharp lesson about the fragility of health systems and the challenges of vaccine delivery. Early detection and limiting any future risk of a slow response will be important. It will also be necessary to talk about “coordination but not duplication.” That is, any Quad health security strategy needs to take into account that the Quad is not a formal alliance, and so does not offer integrated cooperation on health issues in the Indo-Pacific. On the other hand, solid internal coordination is needed so that any one Quad country’s efforts and resources are not duplicated by another’s.

Ultimately, even though China’s growing influence might have spurred the Quad’s initial health response, the answer to the Quad’s longevity lies in how thoughtfully the group can build a sustainable and inclusive foundation for future coordination. As Covid-19 demonstrated, viruses cross borders more quickly than wars, and health security is a basic human need, regardless of whether the recipient lives in a Quad country, an ally’s, or a competitor’s.