Help with strings attached? China's medical assistance and political allegiances during the Covid-19 pandemic.

• Chinese medical assistance is significantly related to supporting China on human rights matters. • Countries supporting China on Hong Kong and Xinjiang matters received over double the amount of medical equipment and vaccine donations. • China's medical equipment donations matched the recipients' pandemic situation's severity, but vaccine donations did not. • As countries became less dependent on Chinese vaccine donations, political alignment mattered less. • Some recipients of Chinese vaccines moved from a neutral stance to one of defense or condemnation. The Covid-19 pandemic exposed all economies to a shortage of medical supplies alongside economic, institutional, and social challenges, prompting the Chinese government to step up its efforts to aid countries in need. At the same time, China faced a series of condemnations of its domestic human rights situation. This paper examines Chinese medical assistance and the relationship with recipient countries' position on key China-related human rights issues as a measure of political support. We find that support on human rights issues is significantly related to the receipt of Chinese medical assistance in 2020 and of vaccines in 2021. Countries that supported China in either of the two joint statements delivered at the UN on Hong Kong and Xinjiang received 125% and 174% more medical equipment and 205% and 166% more vaccine donations respectively, than those holding a contrary stance. Vaccine trade presents an even stronger association with such measures. Findings also show that political alignment and geographical proximity were more important in the first part of 2021, while these waned when the availability of new vaccines rose in the second half of the year. The association between Covid-19 assistance and political support on human rights issues post-Covid shows mixed results. Countries receiving assistance either moved from a neutral stance into one of defense of China or voted in favor of the UNHRC decision in 2022 to investigate human rights violations in Xinjiang. This indicates that while there is an ongoing politicization of human rights issues, countries do not necessarily give in to pressures. In conclusion, these findings and further analysis support fundamental concerns that vaccine donations during the Covid-19 pandemic have been mostly driven by geopolitics and not by the severity of the pandemic. [ABSTRACT FROM AUTHOR]