Temporally speaking, our work will be circumscribed mainly to the 2011–2020 period. Firstly, we will develop the characteristics of the *internal dynamic*, analyzing some historical interaction patterns that formed the singular Yemeni identity, and the dramatic changes and power disputes that started in 2011 as a result of the ex-President Ali Abdullah Saleh's resignation.

In second place, we will see how in 2015 this conflictive dynamic became intertwined and fed back with the *regional dynamic*, becoming an international war where Saudi Arabia (SA), Iran, the United Arab Emirates (UAE), and other regional powers intervened based on their own interests. Finally, we will analyze the Pandemic's impact in the healthcare field and also in the conflict's dynamic.

Every event of international impact must be explained by a conjunction of material and immaterial factors. This means that the geopolitical and economic aspects play an important role, but they must be combined with ideological and identitarian aspects. The latter will occupy a central place in our work, because they are fundamental in the region of Middle East and North Africa (MENA), where multiple identities coexist, determining the behavior of actors.

From the perspective of constructivism, Alexander Wendt (1992) affirms that identities are socially built, and are "inherently relational" (Wendt, 1992, p. 397), that is to say that the actors intersubjectively build their identities and perceive themselves and others through reciprocal interactions. Although the identity structure can be changed by changing the bonding pattern, change can be very difficult when these have been consolidated and institutionalized.

These identities are the "basis of interests," since "actors do not have a "portfolio" of interests they carry around independently of the social context" (Wendt, 1992, p. 398), and "people act toward objects, including other actors, on the basis of the meanings that the objects have for them" (Wendt, 1992, pp. 396–397).

By applying these concepts to international politics, Wendt (1992) criticizes Waltz's neorealism, showing that neither the anarchy of the international system,1 nor the different distributions of material resources between the actors explain their actions. To Wendt (1992), these are determined by "the intersubjectivity constituted structure of identities and interest in the system" (Wendt, 1992, p. 401).2

Anarchy and the distribution of power are insufficient to tell us which is which. US military power has different significance for Canada than for Cuba, despite their similar "structural positions", just as British missiles have a different significance for the United States than do Soviet missiles. (Wendt, 1992, p. 397)

1 "Anarchy" meaning the non-existence of a supranational power that acts homogeneously to that of national states within their territory.

2 Waltz affirms that international structure is the one that determines the actions of the units, which has three dimensions: the constitutive principles (anarchy), the interacting units (states), and the distribution of material capacities. Wendt (1992) must add a "fourth dimension" which is "the intersubjectivily constituted structure of identities and interest in the system" (Wendt, 1992, p. 401).

At the same time, in order to refer to the alliances that occur in the conflict, we will use Soler I Lecha's (2017) concepts of "liquid alliances" and "solid alliances." The author explains that in the MENA region:

There are no solid blocks and when an alliance is forged it is not based on a common identity or project, but in fear. The perception of what or who represents a threat changes depending on specific events and this is how single subject alliances proliferate which usually have an expiration date. They are liquid alliances that adapt to circumstances. (Soler I lecha, 2017, p. 148)

This implies that many rivalries are liquid too, so that "actors traditionally estranged make common front in a specific issue without thereby recognizing themselves as allies" (Soler I Lecha, 2017, p. 148). However, "the liquid has been winning over the solid without fully replacing it," so there are actors who maintain constant rivalries and also seek to form solid alliances. Rather, "in the alliance and in the rivalry the solid coexists with the liquid" (Soler I Lecha, 2017, p. 155).

# **38.2 The Internal Dynamic**

# *38.2.1 Yemeni Identity*

Below, we will briefly develop some historical processes and interaction patterns that shaped the Yemeni identity and that will allow us to elucidate how the interests and objectives of each one of the actors have been built.

*Constant foreign interference*: Its geographical position, close to one of the most important trade routes, was a strategic point for different global powers. The Ottoman Empire, Great Britain, and the Soviet Union, in different moments and intensities, had a strong influence in the formation of modern Yemen (Ferreira Bermúdez, 2017). However, Saudi Arabia's interference deserves a special section. For the Saudi Monarchy, Yemen is a potentially threatening nation, one that must remain weak and under their sphere of influence (Clausen, 2015). This view resides in various factors: Demographically, it is the only country in the Peninsula to numerically match it; its people are fierce; it is the only republic in the Peninsula; and it has been a wedge through which Republicanism and Marxism have entered the Gulf.

*North–south division:* This is one of the most conflictive cleavages in Yemen, which has divided the country politically, economically, and religiously. While the north obtained its formal independence with the Ottomans Empire's fall, the south emancipated itself from the British in 1967 and became part of the socialist block. The 1990's unification was pragmatic and disorderly, motivated among other things, by the discovery of oil fields in the common border areas. The north, in a stronger position, co-opted the majority of the economic resources and the most important political positions, which motivated a short secessionist war in 1994. Still today, the southern groups, like al-Hirak, claim to have been colonized by the north.

*Tribalism vs. Nation State:* Yemeni civilization is one of oldest in the world, and since forever it has been a tribal one (Ferreira Bermúdez, 2017). Although the relationship between the central power and the tribes has been tense, Manea (1996) affirms that in different periods, the imamates and the central government managed to cooperate effectively with tribes, providing governance; and Bawazir et al. (2017) affirm that current chaos would be worse without the contribution of tribal legal systems in those places where the sovereignty of the State is almost absent. Even so, the concept of Nation State has not been integrated into the Yemeni identity.

(..) Yemenis find it difficult, especially in tribal and remote areas, to accept the concept of a Sovereign State. For them, there is no connection between their national identity and a state that claims to represent that identity. These are two separate issues. As far as they are concerned, the state is a mere synonym of the political elite who holds the power in Yemen to the detriment of the country. (Manea, 1996, p. 7)

*Religious sectarianism*: In Yemen, the different interpretations of the Quran have lived together harmoniously (Brehony, 2015). Even though the majority belong to the Sunni Shafi´i branch, in the north there is an important attachment to Zaidism, belonging to Shiism,3 in approximately 30% of the population.

It was not until the 1990s that Islamist parties appeared, with the creation of al-Islah party, which included sectors of the Muslim Brotherhood and salafists (Brehony, 2015), and the Ansar Allah—or Houthis, in honor to its fundator, Al-Haouti—movement, principally zaidi from the northern province Saada, who reacted to the rise of Saudi's Wahhabism, the economic and social marginalization, corruption, and the alignment with US foreign policy (Brehony, 2015; Dip, 2020a, 2020b). In 2004, the Al-Haouti headed an uprising against the central government, starting what was known as "Saada wars," a succession of six armed conflicts between 2004 and 2010.

Finally, Al Qaeda also emerged in the Arab Peninsula (AQAP). In fact, the organization's first attack against the USA was in October 2000 in Yemen, against the US Navy destroyer USS Cole, which was anchored in Aden (Osman, 2015).

# *38.2.2 The Yemeni Spring: Alí Abdullah Saleh Fall*

Another characteristic of Yemen's political identity has been the elitism of its leadership. Comins (2013) defines the Yemeni political system before 2011 as a "politicaltribal-military based on patronage order" (p. 4). The ex-president, Ali Abdullah Saleh, was the leading figure, who was in power for over thirty years. Coming from the influential northern tribal Confederacy Hashid, he received part of his legitimacy from it, while placing his close relatives and friends in key places of the administration and the Army. With wide pragmatism, he co-opted political support of other leaders and influential sectors, while the General People's Congress (GPC) Party was the basis for his personal projection in power (Brehony, 2015).

3 However, Zaydism is a different version of Twelfth Shiism practiced in Iran.

However, in January 2011, inspired by the Jasmine's Revolution, started a series of demonstrations led by young professional and university students—who were not affiliated with the traditional political elites. Although in the beginning, there were isolated demonstrations, after Hosni Mubark's fall in Egypt, demonstrators took the streets massively with a clear objective: the undisputed removal of Saleh and his family from power.

The roots of this process are in the Yemeni economic and political systems (Clausen, 2015). Historically, the State was unable to provide the minimum social services, becoming the poorest country of the Arab world. Although Yemen had a multiparty system, elections, and relative press freedom, Saleh managed a sophisticated network of nepotism and corruption, by which he controlled the opposition parties and the tribal elites (Comins, 2013). But, the catalyst factor was when the GPC stated that it was willing to move forward on a bill that would not only allow Saleh's re-election in 2013, but also would allow him to be in charge for life.

While the young took the streets peacefully, the traditional opposition maintained a cautious attitude. The Join Meeting Parties (JMP), formed in 2005 by al-Islah and other smaller parties, put their bet on negotiating a progressive transition. But March 18 was a key day, when the government attacked the demonstrators in the squares, resulting in 52 deceased. Just a few days later, the main General Ali Mohsen, the most important leaders of the Hashid Confederation, and al-Islah party, declared their support to the demonstrators.

Ironically, the most powerful supporters of the democracy movement are veteran regime insiders. Defections did not result from a democratic enlightenment within the elite, but are emblematic of Saleh's failed alliance policy. The increasing concentration of power around his immediate family breached unwritten power-sharing agreements within the regime's inner circle. (Thiel, 2012, p. 45)

At the same time, the Houthis and al-Hirak secessionists joined the protests. It was from this point that the young claimed that their revolution had been *kidnapped* by old personalities who had nothing to do with their demands (Comins, 2013; Zahonero, 2013).

As expected, the unleashed instability set off alarms in Riyadh and the other Gulf capitals. Then, the Gulf Council Cooperation (GCC), through the Gulf Initiative, started to negotiate with Saleh and the JMP. The monarchies were worried about the vacuum of power in his neighboring country, but especially feared the Houthis' empowerment. Due to their political-religious similarity with Iran, they feared that they were used as a wedge through which Teheran could establish its influence in the Arabian Peninsula. We must not forget that in the Saada wars, Riyadh supported Saleh against the Houthis, alleging that the northern rebels were supported by the Islamic Republic.

Finally, after long months and strong international pressure, Saleh agreed to leave the presidency in exchange for immunity. From there on, a two-year process of transition will finalize in the final holding of elections. The one chosen by consensus to occupy the executive position in that period was his vice president, Abd Rabbuh Mansur Hadi. However, this transition was destined to failure because it was negotiated only between the CPG and the JMP. The young, Houthis and Southerners, were not included. Clausen (2015) synthesizes it very well:

The Yemeni transition was triggered by the youth-led protests and a strong demand for real political change. Yet, it ended up as an elite-led political bargain, better described as a reshuffling of elites than as fundamental change. It is important to highlight that this was facilitated by the UN and the Gulf states, which prioritized short term stability and dealt with established political actors. (p. 20)

# *38.2.3 Failed Transition: From the National Dialogue Conference to the Armed Conflict*

Part of the transition process consisted of a broad call to all the social forces to elaborate a new constitution. Thus, President Hadi announced the holding of the National Dialogue Conference (NDC) which would become the "foundation stone" of a new Yemen (Lackner, 2016, p. 42).

However, once again the dynamics that shaped Yemeni identity were reflected. While the NDC was taking place in a luxury hotel in Sana, the people were starving in other parts of the country, and crime, murders and terrorist attacks multiplied. At the same time, Saleh was responsible for hindering and obstructing the negotiations; the Southerners threatened to leave the conference if they were denied secessionism; and the Houthis claimed that the small number of representatives they had been given reproduced a historical discriminatory dynamic. Inevitably, the NDC didn't reach any consensus on the key issues.

In April 2014, Hadi formed the National Authority for the Implementation of the Outcomes of the NDC. However, by then, the tension between the Houthis and Hadi's government was high, and while Houthis' representatives were negotiating in the NDC, they continued fighting in the Northern provinces to consolidate their presence (Lackner, 2016).

In that context, something unexpected happened: the alliance between the Houthis and Saleh. Clearly, this was a liquid alliance, highly pragmatic, based only in the rejection of Hadi, and Saleh's desire of keeping his power. With the support of the armed forces loyal to Saleh, the Houthis began to descend toward the south, and in September, they reached Sana. After a few days of fighting, they managed to obtain the prime minister's resignation and made a new government agreement.

However, instability continued, and in January 2015, the Houthis took control of the Government Palace and Hadi was forced to resign. Nevertheless, the president could escape and take refuge in Aden, from where he denounced the Houthis' coup d'État. More and more militarily entrenched, the Houthis descended further south, encircling the new capital. Back then, Hadi made the decision to fly to Saudi Arabia and ask the GCC to take steps to reinstate him in government.

# **38.3 The Regional Dynamic**

# *38.3.1 Internationalization of the Conflict*

The CCG's request for intervention marked the definitive intertwining of the conflict with regional dynamics. In March 2015, Saudi Arabia decided to lead a military coalition of mainly Sunni-Arab countries and intervene in Yemen in order to reinstate President Hadi. According to Riyadh's official version, Iran was behind the Houthis, and wanted to undermine regional stability and expand its influence. Therefore, they were acting in "legitimate defense" against Iranian aggression.

On March 26, Saudi Arabia with the United Arab Emirates, Qatar, Morocco, Bahrain, Kuwait, Sudan, Egypt, Jordan, and Senegal launched the operation *Decisive Storm*. According to what was planned, it would be brief and its objective was to clear the rebels from the capital, destroy their heavy weaponry, and redirect the Initiative process (Dip, 2019). This was an unprecedented decision in Saudis' foreign policy, traditionally reactive and slow. This is part of a new, more personal, active, and aggressive orientation of Crown Prince Mohamed Bin Salman (MBS), with the perception that the *status quo* was no longer favorable and that doing nothing implied greater losses (Kinninmont, 2017; Serr, 2018; Soler I Lecha, 2018).

# *38.3.2 Hegemonic Dispute*

Once again, we must see the *regional identities structure* to understand this new stage of the conflict. Between the Gulf monarchies, there is a shared vision of two greater threats: the Iranian presence and the political Islam of the Muslim Brotherhood and its branches. However, each one has its own interest, and they differ in the perception of which of these two threats is most pressing.

However, the rivalry between Iran and Saudi Arabia occupies a prominent place. Intersubjectively, antagonistic and conflicting identities have been formed between Riyadh and Tehran, based on a series of factors: "religious (Wahhabi-Shiite), ethnic (Arab-Persian), political (monarchy-theocratic republic), and economic (around the oil policy)." In turn, "both countries perceive themselves as regional powers that seek to expand and consolidate their influence" and took advantage of the fronts opened by the Arab Spring for that (Dip, 2019, p. 3).

As Wilf (2017) and Serr (2018) say, Yemen, similar to Syria, Iraq, and Libya, has been transformed in a battlefield, where geopolitical regional interests are being settled, and the regional powers instrumentalize the "loyalty to religion, sect, ethnicity, tribe and nation as well as the ability to forge ever-shifting alliances in the service of specific goals" (Wilf 2017, p. 12). But Sana is "the geographical, social and political Achilles' heel of the Arabian Peninsula" (Wilf, 2017, p. 11), so that for Riyadh, it takes on a much greater importance.

# *38.3.3 Iranian* **Proxy War** *and Saudi Coalition Breakdown*

In the internationalization of the conflict, two antagonistic factions were conformed that could be qualified as two *liquid alliance groups*: On the one hand, Hadi's internationally recognized government, along with al-Islah, the southerner separatists and the Arab coalition led by Riyadh, on the other hand, the Houthis with Saleh and Teheran.

Although the Persians denied their engagement in the conflict, evidence proves that they intervened in favor of the Houthis in at least three ways: funding, training, and providing weapons (Akin, 2019; Dip, 2019; Serr, 2018; Sharp, 2019).4 This coincides with what Munford (2013) defines as *proxy war*:

Proxy wars are the product of a relationship between a benefactor, who is a state or non-state actor external to the dynamic of an existing conflict, and the chosen proxies who are the conduit for the benefactor's weapons, training and funding.  (p. 40)

However, Teheran has avoided getting involved directly, since it has more urgent geopolitical interests that demand its forces, for instance, the Syrian conflict (Zahonero, 2018a, 2018b). At the same time, it is conscious of the importance that Yemen has for the Saudis and the probable rise of violence and tension that a direct intervention could have generated. Being the main referent of Shiism, a great part of its regional projection has been based on the "defense" of Islamic Shiite minorities (Hernández López, 2018; Serr, 2018:5; Wilf, 2017). However, the relationship between the Houthis and Iran has a great dose of liquidity, since rebel leaders have not followed all Iranian guidelines, and they have their own interests (Dip, 2019).

Unlike its rival, Saudi Arabia decided to intervene decisively in its neighboring country for two reasons: the strategic weight for its national security and its intentions of regional leadership. KSA deployed more than 150.000 troops, 100 war-planes and mobilized its Navy. Its allies made smaller contributions, but they supported Riyadh: Egypt mobilized Navy units; UAE provided 30 jets along with Bahrain and Kuwait 15, Qatar 10, Jordan 6, Morocco 6, and Sudan 3 (Dip, 2019). After blocking the rebels by air and sea, the coalition actions were based mainly on air airstrikes, and financing the Yemeni troops. Riyadh and Abu Dhabi also deployed soldiers, but then opted to hire mercenaries. It is estimated that the Saud monarchy spent approximately between 5 and 6 billion dollars per month on the conflict (Hernández López, 2018).

Like Teheran, Riyadh appealed to a sectarian speech to unite positions (Zahonero, 2018a, 2018b). According to Wilf (2017) and Soler I Lecha (2017), the Saud family wants to unite the Sunni world under their leadership, and seek to create a "Sunni block" with the objective of counteracting Iran, softening their position against the

4 This help support assistance was granted through unofficial channels, which makes it hard to keep a reliable record of its dimension. However, Dip (2019) and Serr (2018) propose as evidence of this help the interception of Iranian ships with weapons and the use of sophisticated weapons by the Houthis, such as drones.

Muslin Brotherhood5 (Soler I Lecha, 2017). In turn, Hadi himself assumed a sectarian discourse, since in this way he obtained some legitimacy and managed to homogenize positions within the fragile alliance (Hernández López, 2018).

However, the results of the intervention were not as expected (Hernández López, 2018). Prince Salman trusted his Army excessively and downplayed the Houthis' fighting ability. Little by little, the conflict transformed into a close fight, and due to the Saudis' lack of experience, the mistaken bombing over civilian positions, such as schools and hospitals, multiplied (Serr, 2018).

# *38.3.4 Yemen in Flames: Dissolution of* **Liquid Alliances***, Extremism, and Humanitarian Crisis*

Throughout 2016–2017, the coalition handled in a disorderly way the disputes between its own members and continued with the fight with the Houthi rebels, who demonstrated great resilience, thanks to their alliance with Saleh and indirect Iranian support (Hernández López, 2018).

After a failed peace dialog meeting promoted by the UN in Kuwait, the rebels launched a missile attack into Saudi Arabia. As an answer, Riyadh decided to tighten the air and maritime blockades. This worsened people's condition, since it made the entrance of humanitarian aid extremely difficult (Hernández López, 2018; Sharp, 2019).

On the rebels' side, in 2017 the *liquid alliance* between the Houthis and Saleh was dissolved. This "marriage of convenience" (Serr, 2018) ended when Saleh, once again, changed his position and announced that he was ready to negotiate with the Saudis the cessation of fighting. The Houthis saw this as treason and in an unclear episode decided to kill him (Hernández López, 2018). With this decision, they obtained a wider room for maneuver, but they further pushed the possibilities for a peaceful solution away and gained a new enemy: Saleh's loyal troops (Akin, 2019; Hernández López, 2018).

On the official side, *liquid alliances* also entered into contradiction, reflecting the role of identities and how the internal and regional dynamics are intertwined. This time, the break was in the coalition between Saudi Arabia and the UAE, and it was related to the al-Islah party, main support for Hadi, and the southerners separatist.

In 2017, arguing to be excluded from Hadi's government, al-Hirak, and other southern secessionist groups formed the Southern Transitional Council (STC). While Riyadh, fearing Hadi's weakening, showed its rejection, Abu Dhabi expressed its support for the southerners, whom it had already been supporting and financing (Akin, 2019). This fracture reached such a point that during 2018–2019, both factions, supposedly "allied", fought each other repeatedly (Akins, 2019; Hernández López, 2018).

5 This could be seen reflected in the attempted dialogue with Hamas and with the support of al-Islah.

There are many reasons that explain Abu Dhabi's behavior. We must not lose sight of the fact that, despite its low profile, it has become an increasingly important power. *Little Sparta*, as former US Defense Secretary James Mattis described the UAE, is the second largest economy of the Arab world and has invested more than 5% of its GDP in defense (Soler I Lecha, 2018). It has acquired military experience in UN peacekeeping missions and the fight against the Jihadist in Syria (Akin, 2019; Serr, 2018). Geopolitically, the Bab al Mandab strait and Africa's Horn are strategic because of the important trade routes. Having an independent South Yemen close to its interests becomes functional (Zahonero, 2018a, 2018b). Clearly, the UAE has its own strategic objectives and wants to act autonomously from Riyadh (Fabbani, 2020; Hernández López, 2018; Soler I Lecha, 2017).

However, we should not underestimate the close ties of al-Islah with the Muslim Brotherhood. The "Brothers" have been a source of conflicts between the Gulf monarchies, and Qatar's support to this movement caused a relationship breakdown with its neighbors and the blockade since 2017. Although Doha retired itself from the coalition, and al-Islah renounced formally to the Brotherhood, to the UAE, it is still a threat (Espinosa, 2020; Soler I Lecha, 2018; Zahonero, 2018a, 2018b).

The clashes within the anti-Houthi coalition clearly reflect how the *liquid alliances*  work and its contradictory coexistence with the *solid alliances*. The relationship Riyadh-Abu Dhabi is perhaps one of the most stable in the region, and both have worked together at different moments.6 Nevertheless, in spite of recognizing themselves as allies, they are at the same time funding and supporting conflicting factions in Yemeni territory. Furthermore, the Emirati behavior significantly affects its Saudi ally, weakening and undermining its international projection (Hernández López, 2018).

AQAP took advantage of the power vacuum. The prevailing chaos was extremely functional for them and allowed them to increase their influence in main areas of the Yemeni territory, to the point of forming a mini-caliphate in the port city of Mukalla. From there they took control of part of the Yemeni Central Bank reserves and exported oil illegally (Hernández López, 2018). Again, the Saudis' and Emiratis' acts were controversial at that point. On the one hand, AQAP presence legitimized their intervention and allowed maintaining USA' support. While, on the other hand, the Sunni jihadists have fought the Houthis for belonging to Shiism, many voices denounced a certain degree of tolerance of the coalition troops (Zahonero, 2018a, 2018b).

This is why Akin (2019) talks about three wars inside Yemen: the Houthis against the official alliance; Hadi against the STC southerners; and the war against extremism. But the most harmed have been Yemeni civilians. The international blockade, the destruction of the infrastructure, and the violation of Human Rights committed by every faction involved have caused hunger, lack of water, and disease became

6 Both monarchies share goals and threats, and the personal relationship between MBS and Mohamed Bin Zayed (MBZ) is excellent, to the point that the Emirati leader is regarded as a mentor for his young Saudi neighbor (Soler I Lecha, 2018).

common currency, affecting principally the most vulnerable, women and children (Hernández López, 2018).

# *38.3.5 2020: COVID-19 Pandemic, Geopolitical Readjustment, and Deepening of Humanitarian Crisis*

The 2020 started with a series of events that caused upheaval in the region, such as the advance of the Syrian government over Idlib, and the murder of General Soleimani. But few minds imagined that 2020 would be the scenario of one of the most important Pandemics in history, whose impact and effects cannot still be dimensioned. However, as Zaccara (IREMAI-GEMO, 2020) says, Middle East geographical position, between China and Europe, inevitably made it a region strongly affected by COVID-19 Pandemic, and "despite the fact that no region in the world has remained immune, the detection of the first cases of the virus (…) was the prelude for a great sandstorm that approached covering everything" (Paredes Rodríguez, 2020, p. 129).

Paredes Rodríguez (2020), following Rosenau (1997), stated that the Coronavirus produced a "fragmegration" situation, which means the conjunction of integrating forces with fragmenting forces. In this way, little by little, all the states of the region were affected by the spread of the virus and were integrated under a common threat, for which they had to cooperate and introduce similar measures. But at the same time, the conflictive and convulsive dynamics underlying the region provided a strong complexity, fragmenting, and re-editing conflicts.

Although it was one of the latest countries to register cases, "worrying but inevitably" COVID-19 arrived in Yemen. Even though on April 10 "0 case" was detected, specialists believe that probably the virus was already in the country, but that it could not be reported because of the scarce testing capability of the Yemeni healthcare system (Doctors without Borders, 2020).

# *38.3.6 Reorientation of actor's Positions*

The main foreign actors involved in the conflict were quickly affected by the effects of the virus. The most affected was the Islamic Republic of Iran, which on February 19 detected its "0 case" in the city of Qom. But a few days later, the first cases in the Gulf monarchies slowly started to be reported. In this context, fearing what could happen with de COVID-19 Pandemic in the conflict areas, UN's General Secretary, Antonio Guterres demanded the international community a great ceasefire that allowed refocusing on the fight against the virus: "that is why today, I am calling for an immediate global ceasefire in all corners of the world. It's time to put armed conflicts in lockdown and focus together on the true fight for our lives" (United Nations, 2020a, 2020b).

The answer of the Gulf States was initially positive. Qatar and UAE cooperated in the healthcare field, and Saudi Arabia, echoing Guterres's request, unilaterally declared a two-week ceasefire in Yemen, which was extended for another thirty days, with the aim of fostering negotiations for a definitive ceasefire (Niño, 2020). However, we must consider the situation that the Saudis were facing. After more than five years, the war in Yemen was a complete failure. The areas controlled by the rebels were almost in the same situation as before the intervention and the coalition was involved in strong internal disputes. Besides, the multimillion-dollar cost of maintaining daily operations was draining the coffers of the Monarchy, while its international image was getting worse due to the terrible reports of Human Rights violations and war crimes.

In addition, the international oil demand fell drastically due to the Pandemic to the point that on April 20, in an historical fact for capitalism, crude futures prices were negative (Dip, 2020a, 2020b). In a context in which Riyadh dealt simultaneously with the economic crisis, the rivalry with Iran, the blockade to Qatar, and the war in Yemen, it was necessary to "close the tap" and stop the economic drain (Zaccara in IREMAI-GEMO, 2020). The COVID-19 Pandemic became an excellent opportunity to withdraw itself from its neighbor, without signifying a formal defeat.

But the Houthis saw that Saudis were using the Pandemic to "save the face" of its military failure (Espinosa, 2020) and declared that they did not accept the unilateral ceasefire. They presented a very high series of demands as a condition to leave the fighting and continued with their expansion to the Marib province, which is rich in oil resources and that has maintained itself relatively away from the war. In addition, after a brief truce by the end of April, the STC declared the self-government of their controlled southerner areas. It was one step away from declaring its effective independence and reviving the fights within the coalition.

In the following months, there were no substantial changes in the situation. While the STC left for the moment the self-government, and the Saudis tried to revitalize the agreement achieved with them at the end of 2019, in September the southerners withdrew from the talks because of the "irresponsible behavior of the parties" (Al Jazeera, 2020). On their part, the Houthis are strongly consolidated in the northwest of the country and have obtained International Community recognition as legitimate actors.

Aware of MBS's desire to withdraw from the conflict, they have approached him with ceasefire proposals, which have been described as "positive" by the Saudis (Barrington et al., 2020). However, mistrust is still great, and the end of the conflict still seems far away.

# *38.3.7 Deepening of the Humanitarian Crisis*

Although the impact of the Pandemic on the positions of the actors is not still clear, its effects on the healthcare and humanitarian aspects were catastrophically evident from the beginning. To fully understand the effects of the COVID-19 Pandemic, we must bear in mind that at the moment when the Virus was detected, the country was on the brink of total collapse after five years of war.

After years of bombing, all kind of infrastructure is demolished. Without flights, and with communication channels destroyed, mobility and humanitarian aid distribution find serious obstacles. Only half of the health infrastructure is working, two out of three Yemenis do not have access to basic medical care, and half the population has serious difficulties in accessing drinking water. According to the World Bank, there are three doctors and seven beds for every 10,000 people (Lootsma, 2020).

According to the United Nations High Committee for Refugees (UNHCR, 2020), 80% of the population needs humanitarian aid to survive, 4 million people have been forcibly displaced from their homes and there has been an increase in child marriage as a method of survival for girls. In addition, 12 million people face serious risk of starvation, signifying "the worst famine in 100 years in the region." For its part, due to the destruction of infrastructure, Yemen had the biggest cholera outbreak of the last times, with more than 1 million cases and 2300 deaths since 2017. At the same time, because of the low vaccination level, poliomyelitis has reappeared (Naranjo, 2020; UNHCR, 2020).

In this context, the COVID-19 Pandemic became the *coup de grace* for thousands of Yemenis' lives. Although about 2000 cases were officially reported, due to the low testing capacity, the UN's General Secretary stated the true number could be more than 1 million, and the mortality rate could come to 30%, far exceeding the world average (United Nations, 2020a, 2020b).

But the economical crisis also seriously affected the humanitarian crisis. Most countries have cut their budgets, and resources destined for humanitarian aid were one of the first to be adjusted. In a country like Yemen, where more than 80% of the population needs international aid, this has meant a severe blow. Much of the UN-sponsored programs have been severely curtailed, and many hospitals had to be closed due to lack of funds.

# **38.4 Conclusion**

Throughout this work, we could verify the importance of analyzing the Yemen conflict through a doubled optic, conjoining the domestic aspects with the international ones. Every analysis that excludes any of these dynamics will fall on simplifying an extremely complex phenomenon. Even though its roots are clearly in the political and economic system, its following evolution and its aggravation must be understood by also considering the regional geopolitical interests.

A conflictive internal dynamic, charged of political and tribal rivalries, elitism, nepotism, and corruption, has been intertwined and fed back with a regional dynamic marked by the hegemonic dispute between rival powers, such as Iran and Saudi Arabia, but also by other actors that play a low profile role, but have great impact capability, and accept an unstable order to protect their interests. In the last group, we can find the United Arab Emirates and a non-state transnational actor as AQAP.

In turn, we have proved the importance of identities as the base of the actor's interests and actions. Without this perspective, it would be impossible to understand how each part involved perceives itself, its vision of others, and what each one considers the most serious threat. This allows us to understand the depth of Saudi-Iranian rivalry, in which the littlest concession is seen as lost ground in an existential fight. But it also helps us to see the fracture within the anti-Houthi coalition, in which both the different perceptions about al-Islah and the Muslim Brotherhood come into play, as well as the historical claim of the southern sectors.

The COVID-19 Pandemic generated changes, especially on the external intervening actors. Mired in a costly and exhausting war, the Pandemic was the necessary incentive and excuse for the Kingdom of Saudi Arabia to withdraw, even though without much conviction. However, the changes have been driven by need and have not been so deep that could direct the process toward a clear solution.

Finally, the impact on the humanitarian dimension has been terrible. Being one of the poorest countries before the Arab Spring, the peoples' living conditions have come into open decline. With a destroyed healthcare system and high malnutrition rates, the Coronavirus has spread without limitations. If the numbers exposed by the UN are true, we are talking about the country with the greatest amount of COVID-19 deaths in the world, with approximately 300.000 deceased.

With little certainty about the future, the only thing that will surely remain constant in Yemen will be the suffering of its population. Even if the war ended today, it would take years to rebuild the country. Wrapped up in two convulsive and infamous dynamics, there is a high possibility that *the century's worst humanitarian crisis* will end up becoming *History's worst humanitarian crisis*.

# **References**

**Joel Foyth** is graduate student at the Faculty of Political Science and International Relations, National University of Rosario (UNR), Argentina. Associate Professor of the Seminar 'Politics, Religion and Economy in the International Relations of the Middle East and North Africa' at the National University of Rosario and Researcher at the Rosario Institute for Arab and Islamic World Studies (IREMAI) and the Middle East Study Group (GEMO) of the South-South Relations and Cooperation Program (PRECSUR). Specialized in International Relations and Economics in the Middle East and North Africa, Gulf geopolitics, Yemeni conflict, and Turkish foreign policy.

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

# **Chapter 39 China's COVID-19 Vaccine Diplomacy in the Gulf and Beyond: Efforts and Challenges**

**Wang Jin**

**Abstract** This chapter argues that the COVID-19 vaccine has become an important diplomatic tool to expand China's influence and set up a positive Chinese image in the Middle East. The study reports three important trends in China's COVID-19 vaccine diplomacy. It states that China's vaccine diplomacy toward the Middle East still faces challenges. On the one hand, the effectiveness of China's vaccine is not widely recognized. Some European and American experts still doubt the effect of China's vaccine made by Sinovac and Sinopharm. On the other hand, China's mechanism to constrain COVID-19 by national lockdown and universal vaccination might not be copied in the Middle East.

**Keywords** China · Middle East · COVID-19 · Vaccine

COVID-19 vaccine diplomacy has become apparent in international politics. Many states highlight the use of vaccine supplies as a tool of soft power projection and facilitation of positive ties with the other states. In a world where COVID-19 has been taking a terrifying human and financial toll, vaccine supplies promise relief and interact with pre-existing politics and foreign policy priorities (Woertz & Yellinek, 2021). China is using the COVID-19 vaccines as an important diplomatic tool to enhance its cooperation and understanding with the rest of the world. About 2.7 billion Chinese vaccines have been administered in China, while around 1 billion Chinese vaccine doses have been distributed to 110 other countries.

Although China was the first state where COVID-19 originated, the country successfully constrains the spread of the pandemic. The COVID-19 pandemic has swept the world in the past two years and caused over 250 million infections and five million deaths. China is the only state that successfully understood and contained the new pathogen. China had only 0.05% of the total number of global cases despite making up 19% of the whole world's population. China defines the success of limiting and preventing the COVID-19 as the success of the "China Model" and the "progressiveness of the Chinese political system" (Yao, 2021). By mobilizing public

W. Jin (B)

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Institute of Middle East Studies, Northwest University of China, Xi An, China e-mail<EMAIL_ADDRESS>
© The Author(s) 2023

M. M. Rahman and A. Al-Azm (eds.), *Social Change in the Gulf Region*, Gulf Studies 8, https://doi.org/10.1007/978-981-19-7796-1\_39

mask wearing, hand washings, social distancing, and restriction of public gatherings and traveling, China believes that its responses to the COVID-19 successfully show the "political structural advantages," which could be the major expression of the "Chinese Model" that for the rest of the world to learn from.

On the one hand, China attributes the success of preventing the COVID-19 to its political structure led by the Chinese Communist Party. As a coherent communist party, the Chinese Communist Party is the center of the political system and enjoys the highest authority for the decision-making process in China. According to Chinese Communists, the fundamental advantage is "mobilizing all national sectors, pooling all national resources, and coordinating all national efforts to complete a key task."

After the COVID-19 was found in Wuhan in late 2019, China mobilized the whole state to contain the pandemic. More than 42,000 healthcare workers were mobilized toward Wuhan within three months, and dozens of healthcare centers were established. Therefore, the Chinese Communist Party's strong leadership was interpreted as the key to preventing the COVID-19.

On the other hand, China believes that other states, primarily developing states, can learn its successful example of preventing the COVID-19. A nucleic acid testing system, personal data collection system, and vaccine research and production capabilities help China contain COVID-19. By organizing massive rapid nucleic acid testing, it is possible to diagnose patients as early as possible, detect asymptomatic infections, and assess the potential risk to the entire population. By tracing the personal data, especially the traveling records, it is possible for the health establishments to find the potential patients and to cut the COVID-19 transmission channels. Vaccination is a determinant of success, and China organizes major medical companies such as Sinovac and Sinopharm to research and produce many vaccines for the public.

# **39.1 China's COVID-19 Vaccines Assistance to the Middle East**

China believes it is necessary to help the Middle Eastern states prevent the COVID-19 epidemic. After the COVID-19 was successfully prevented in mid-2020, China gradually noticed the expansion of COVID-19 in the rest of the world. The spread of COVID-19 in the Middle East could threaten China's epidemic prevention. Every year tens of thousands of Chinese Muslims visit the Middle East, especially to Mecca and Medina of Saudi Arabia, for Ramadan. In June 2020 and 2021, the Chinese Islamic Association suspended the annual organized pilgrimage to Mecca and Medina due to the rapidly growing COVID-19 cases in Saudi Arabia. From late 2020, China suspends airline flights from Beijing, Shanghai, Chengdu, Hangzhou, and Guangzhou to Middle Eastern destinations, including Istanbul, from Abu Dubai and Muscat, to prevent importing COVID-19 cases from the Middle East.

Given that Istanbul, Doha, Abu Dubai, Bagdad, Tehran, Cario, and Muscat are all important transferring airports from China to the Middle East, Europe, and Africa, the suspension of flights made international trips very difficult. The COVID-19 also negatively affected China's goods imported to Middle East markets. Few foreigners were permitted to visit China due to the strict COVID-19 procedure. For example, the major Chinese miscellaneous goods exporting city, Yiwu, became empty and quiet, while the exporting data to the Middle East significantly declined.1

In March 2020, China organized an online medical experts conference to share its experience of preventing COVID-19 with Middle Eastern states, including medical experts from Egypt, Algeria, Palestine, Lebanon, Kuwait, Qatar, Saudi Arabia, the UAE, Tunisia, and Morocco. In April 2020, China also organized an online medical conference with experts from member states of the League of Arab States to discuss the expansion of COVID-19 in the Middle East. Meanwhile, China also organized an online bilateral conference between Chinese experts and Middle Eastern states to discuss the prevention of COVID-19.

China hopes to encourage direct cooperation with Middle Eastern states through COVID-19 prevention and vaccine donation. When the COVID-19 outbreak in Wuhan, several Middle Eastern states expressed condolence and sent donations to China. As the state cherishes the spirit of "repaying an obligation" (bao en), just as Chinese President Xi Jinping stresses: "the friendship and assistance provided by the international society at the difficult moment would be always be remembered by China, and China would do our best to help other states."2

China sent several medical teams to Middle Eastern states to share expertise and experience with local medical ministries and establishments. In March and April of 2020, China sent medical teams to Iran, Iraq, and Saudi Arabia, to direct the COVID-19 prevention. The medical team from China to Iran shared the Chinese prevention experience to Iran and transferred tons of medical goods to Iran medical ministry. The Chinese medical team to Iraq visited Bagdad, Basra, Kirkuk, and Erbil with medical facilities and established a nucleic acid testing lab for Iraq. Under the advice of the Chinese medical team, the Iraqi government imposed a curfew to suspend the COVID-19 expansion. A medical team visited Saudi Arabia at the invitation from Saudi Arabia, shared China's COVID-19 prevention experience with local hospitals, and constructed a cooperative mechanism with Saudi Arabia medical institutions.

China also assisted the COVID-19 prevention of Middle Eastern states by providing medical goods and materials waves. China sent several medical supplies to Iran, Iraq, and Saudi Arabia with the visits of Chinese medical teams in March and April of 2020. Chinese medical facilities and supplies were also sent to Algeria, Afghanistan, Syria, Tunisia, Lebanon, and Egypt in April and May 2020. Chinese local governments, companies, and social groups also donated to Middle Eastern states. Shanghai donated medical gloves and masks to Rabat of Morocco and Istanbul of Turkey. At the same time, China Railway Construction Corp, China State Construction Engineering Corporation, and Jack Ma Foundation bought several

1 "Overseas COVID-19 epidemic and its Influence to Yiwu," *the Paper*, September 14, 2021, https:// www.thepaper.cn/newsDetail\_forward\_14425337.

2 XI Jinping, "Unity and Cooperation is the Key to Combatting COVID-19" (tuanjie hezuo shi guoji shehui zhansheng yiqing zui youli wuqi), *Qiushi*, No. 8, 2020, pp. 1–8.

tons of medical facilities and goods to Sudan, Jordan, Algeria, Kuwait, and other Middle Eastern states. Chinese Association in Algeria bought a Nucleic acid detection reagent in China and transferred it to Algerian Red Crescent via flight.

Finally, China hopes to depict a blueprint of new international order by sharing fairly of the vaccines. After the spread of COVID-19, distribution of vaccine doses becomes a sensitive issue. On the one hand, very few states in the world have the capabilities to research and produce vaccines, while most states, especially most developing states, have to import vaccines from other states. On the other hand, most developing states have neither enough financial capabilities nor proper channels to import highly needed vaccines and other medical supplies to prevent COVID-19. In the Middle East, many states cannot contain the COVID-19 due to the rapid population increase rate and the poor medical treatment conditions. Just as Amnesty international criticizes the "wealthy countries" do not bear their "international obligations by waiving intellectual property rules for vaccines, tests, and treatments, and sharing lifesaving technology, G-7 leaders have opted for more of the same paltry half-measures."3

China maintains that the vaccines should be distributed fairly globally regardless of poor states or rich states, developed or developing states. Chinese leader Xi Jinping stresses that China would take measures to make vaccines accessible to both developing and developed states, and "will honor our commitment of giving assistance and support to other developing countries, and work to make vaccines a global public good accessible and affordable to people around the world."4

China has donated more than 100 million doses of vaccines to Pakistan, 1.7 million doses to Afghanistan, 114 million doses to Iran, 31.4 million doses to Turkey, 2.3 million doses to Iraq, 0.8 million doses to Syria, 0.3 million to Palestine, 0.7 million doses to Lebanon, 0.8 million doses to Jordan, 3 million doses to the UAE, and 0.1 million doses to Oman. These donating vaccine doses come from two major Chinese medical companies, Sinovac and Sinopharm. Donation of vaccine doses become an important component of China's soft power, a tool used to deepen friendships abroad and vie for recognition over its archrival, the US, despite festering disputes, could help boost China's image in vaccine-recipient countries that cannot easily source doses from other channels.

In order to help Middle Eastern states to produce more vaccines and upgrade their medical structures, China encouraged overseas manufacturers of Chinese vaccines together with Chinese medical firms. In the Global Health Summit of 2021, Chinese President Xi Jinping reiterated that China supported its vaccine companies and researching establishments to share vaccine technologies to other developing states and to carry out joint production in the developing states.5 Currently, most joint

3 "China's VOVID-19 Vaccine Diplomacy Reaches 100-Plus Countries," *VOA News*, September 18, 2021, https://www.voanews.com/a/china-s-covid-19-vaccine-diplomacy-reaches-100-plus-cou ntries/6233766.html.

4 "China Pledges Global Vaccine Cooperation amid Unequal Distribution Fears," *Global Times,*  November 23, 2020, https://www.globaltimes.cn/content/1207802.shtml.

5 "Full Text: Remarks by Chinese President Xi Jinping at the Global Health Summit," *Xinhua Net,*  May 21, 2021, http://www.xinhuanet.com/english/2021-05/21/c\_139961512.htm.

productions undertake only the "fill-and-finish" processes of manufacturing the vaccines, though further discussions on technology transfer have been discussed. Chinese CanSinoBio works with the Pakistani National Health Institution to produce 36 million Chinese vaccines per year in Pakistan. In the UAE, Chinese Sinopharm works together with Gulf Pharmaceutical Industries and Group to produce more than 200 million vaccines per year. In Turkey, Chinese Sinovac establishes a producing center. China's Sinovac works with Egyptian Vacsera to produce 200 million vaccines per year in Egypt. In Algeria, China's Sinovac works with Algerian Saidal to produce 96 million vaccines per year, while in Morocco, China's Sinopharm works with Sothema to produce 60 million vaccines per year.

# **39.2 China's Motivations of Vaccines Diplomacy**

China's COVID-19 vaccine diplomacy can be understood against China's internal social circumstances and China-US competition. The rise of China became the priority concern of the US and the Western world. The competition between China and the US is becoming increasingly more serious during uncertainty and instability. By China's understanding, the US rejects the Chinese Communist Party's legitimacy and aims to isolate China from the world. Therefore, it is necessary for China to take measures to defeat US offensives over COVID-19 issues, both at home and abroad.

The COVID-19 prevention is a major turning point for the Chinese Communist Party's political legitimacy. When the COVID-19 broke out in Wuhan in November 2019, the Chinese government's slow response, poor management, and bureaucratism were strongly criticized by the Chinese public. Thanks to the 7th Military World Games were held in Wuhan, whose opening ceremony was attended by Chinese President Xi Jinping and was described as an exercise for the 2022 Beijing Winter Olympic Games. Wuhan city government ignored the early alarming from local hospitals over "an unknown virus" and delayed the timely prevention of COVID-19 in Wuhan. Even after the order of "city-lockdown" was declared in early 2021, the order was leaked. Several hundreds of thousands of residents in Wuhan fled to other provinces and cities with possibilities of further spreading COVID-19. Even during the lockdown period of Wuhan, the local government's poor management system was criticized for lack of food, ill coordination, and failures of duties. Many Chinese in Wuhan held the memorial ceremony to Dr. Li Wenliang, the first doctor in Wuhan to publish the "unknown virus." They passed away due to the COVID-19 in February of 2021.6

From China's perspective, the US utilized the COVID-19 as a tool to challenge the Chinese Communist Party's political legitimacy. China is always alert to the possible political transition from communism to "western democracy" mobilized and encouraged by the US, just as what happened in Arab Spring of 2011. It was

6 When the news of Dr. Li Wenliang passing away was published on the internet, many Wuhan residents blew whistles by praising Dr. Li Wenliang as the "Whistleblower.".

only after the COVID-19 prevention took effectiveness in March and April of 2020, and especially after the COVID-19 swept the rest of the world, that the opinions inside China toward the government fundamentally shifted. The poor management of COVID-19 prevention destroyed the image of the "paradise" of US and western states in the minds of the Chinese and further enhanced the Chinese Communist Party's legitimacy.

By China's understanding, the relations between China and the US have entered the period of "competition of all directions and all levels" (Chen, 2020; Wang, 2020), and Trump's requirements of China's accountability for human and economic costs due to the slow response of Chinese local government toward the outbreak of COVID-19 are rejected as baseless and rude. From China's perspective, the US is trying to stigmatize China's image through COVID-19 and isolate China from the international industrial chain through sanctions and compensations toward China. Therefore, China needs to show the world its efforts over COVID-19 prevention and enthusiasms of assistance toward other states by providing vaccines to deal with the pressure from Washington.

After China's largely successful prevention of COVID-19, Washington's call for international sanctions against China further consolidates Beijing's competitive attitudes. China believes that the relations with the US have fundamentally changed since the administration of Donald Trump and maintains that US hostilities toward China are increasing irreversibly. Given that Joe Biden administration is calling for a "democratic alliance" against China and calls for international sanctions against China by Beijing's polity in Xinjiang and Hongkong, China must get support from the "non-western world," especially from the Middle Eastern states that suffer the US interventions and occupations.

China's COVID-19 vaccine diplomacy should not be understood as China's willingness to intervene in Middle Eastern regional affairs. China has neither enough knowledge nor willingness to intervene in the Middle Eastern regional affairs deeply, and China defines the Middle East as "graveyard of global powers" (daguo fenchang), given the histories of the Soviet Union's lesson in Afghanistan and the US' lesson in Afghanistan and Iraq (Wang, 2016).

From Beijing's view, China's image in Middle Eastern states has been long fabricated. It is an important opportunity for China to construct a positive image in the Middle East by sharing its successful experience of COVID-19 prevention and providing assistance to Middle Eastern states. China's image is defined as "Muslim oppressor" and "religion oppressor" by some media, and many maintain that China is implementing "ethnic cleaning" in Xinjiang against Uyghur ethnic groups. China rejects the accusation and maintains that it eliminates "Islamic extremism" and terrorism in Xinjiang. Therefore, China must offer assistance and help to Middle Eastern states to improve the ties and image in the region.

Meanwhile, China is criticized by the US as a "free rider" without bearing enough international responsibilities. The descriptions of China's development by the US and China are different. The US defines China as a developed state with the second strongest economy globally. In contrast, China defines itself as a developing state with very low GDP per capita and low gross national income per capita. Therefore, for the US and other western states, China should uphold more international duties by assisting the rest of the world, especially in arms control, energy development, fighting terrorism, and environment protection (Johnston, 1996; Richardson, 2011). With the advocation of the Belt and Road initiative in 2013, China realizes the importance of setting up the new image as a "global responsible power." Therefore, providing medical assistance to the Middle Eastern states is an opportunity for China to improve its image in the Middle East and set up a new image of a responsible power.

China's COVID-19 vaccine diplomacy in the Middle East aims at cultivating friendship with regional states to get their support over China's internal policies, especially over the Taiwan issue, Xinjiang issue, and the cooperation under the Belt and Road initiative. Many Middle Eastern countries provided help to China by sending medical aid or messages of solidarity in early 2020 at the pandemic's outbreak. China returned the favor by offering medical aid and dispatching medical experts to help these countries fight against the contagious disease. The anti-pandemic cooperation continued mainly in the form of China's donating the much-needed COVID-19 vaccines for the Middle Eastern countries. By vaccines donations to the Middle East and joint research and producing vaccines with Middle Eastern states, China successfully improves ties with the Middle Eastern states, especially those Muslim-majority states. Despite the pressure from Washington, most Middle Eastern states do not recognize the statehood of Taiwan, do not criticize China's policies in Xinjiang in public, and are still active to facilitate the cooperations with China under the Belt and Road initiative.

# **39.3 Challenges of China's Vaccines Diplomacy**

China donated and exported a large quantity of COVID-19 vaccines to Middle Eastern countries in dire need of them, at a time when Western countries largely stockpiled vaccines for their good. The vaccine cooperation between China and Middle Eastern countries, which helped stabilize the epidemic situation in the region, has sublimated their friendship, deepened mutual trust, and opened up new areas of cooperation. However, the challenges of China's vaccines diplomacy are apparent.

First, the effectiveness of the Chinese vaccine is not widely recognized by western states. Different from US-made vaccines, Chinese vaccines are inactivated vaccines. The effectiveness of the Chinese vaccine is always a debatable topic. As the leading Chinese vaccine makers, Sinovac and Sinopharm have been approved by the World Health Organization for the use against COVID-19. Both Sinopharm and Sinovac are inactivated vaccines, and they are safer theoretically than adenovirus vaccines. The Sinovac and Sinopharm vaccines have a major advantage over other COVID vaccines. They are easy to store and only need normal refrigeration.

However, the effectiveness of inactivated vaccines is doubted widely. The inactivated vaccines use killed virus to inject into people; the vaccines may not be as effective as Pfizer-BioNTech vaccines that use adenovirus technology. Even after China's vaccination rate reaches 80% (nearly 2.7 billion dozes) in December of 2021, new waves of the COVID-19 epidemic can penetrate China. Researches show that the immunity and protection capabilities wane within a half year after Sinopharm and Sinovac vaccines are injected, while Sinopharm and Sinovac are tested inadequately against Omicron.7

There are also discussions inside China about whether Chinese vaccines are effective, although the World Health Organization reports that Sinopharm's effectiveness reaches 79%.8 In 2021, waves of variants of the COVID-19, including the Delta variant and Omicron variant, swept several provinces in China, including Beijing, Shanghai, Jiangsu, Guangdong, Guizhou, Yunnan, Shaanxi, Inner Mongolia, and Henan. Due to the principle of "zero tolerance of local transmission," Chinese local governments launched rounds of provincial nucleic acid tests, while local transportation, business, and travel were forbidden. Some opinions maintained that "we should stop nucleic acid tests" and start "COVID-19 resistance tests" nationally to test the effectiveness of the vaccines. Some opinions even doubt whether it is necessary to inject vaccines nationwide.

Middle Eastern states realize that Sinopharm and Sinovac vaccines might not effectively prevent the variants of COVID-19. Israel chooses US Pfizer-BioNTech rather than Sinopharm and Sinovac in its vaccination campaign. The United Arab Emirates and Bahrain choose Pfizer-BioNTech as the booster shot for those initially immunized with vaccines developed by China's Sinopharm and Sinovac. As a new variant of the coronavirus ravaged the UK, India, South Africa, and other parts of the world, more Middle Eastern countries seem likely to follow Bahrain and the UAE's example.

Second, the experience of China's COVID-19 prevention could not be learned directly by Middle Eastern states. China's political system could not be copied directly into the Middle East. China concludes its successful experience of preventing the COVID-19 as the "leadership of Chinese Communists." At the same time, the Chinese Communist Party stresses that the success of COVID-19 prevention "proves the progressiveness of Chinese political system." Although Chinese assertive COVID-19 prevention measures prove successful, it is very costly and leads to more social and economic problems. For example, when the COVID-19 Omicron variant swept Xi'an, the capital city of Shaanxi of Northwestern China, in December of 2021, the local government declared a lockdown. More than 10 million residents were forbidden to leave their communities, and several rounds of nucleic acid tests were organized every 48 h for all of these 10 million residents. The lockdown led to economic suffering and social disputes. Only under the strong leadership of the Communist structure that the assertive lockdown and significant economic losses could be tolerated.

7 "Hong Kong Researchers Find that Two Doses of China's Sinovac Vaccine is Inadequate against Omicron," *The New York Times,* December 15, 2021, https://www.nytimes.com/2021/12/15/world/ asia/omicron-hong-kong-study.html.

8 "WHO Approval of Chinese Corona Vac COVID Vaccine Will is Crucial to Curbing Pandemic," *Nature*, June 4, 2021, https://www.nature.com/articles/d41586-021-01497-8.

Meanwhile, China's success in preventing COVID-19 depends largely upon the strict measures of local governments. China's COVID-19 control systems are more localized rather than centralized. Although top officials set priorities and norms, especially the "zero-tolerance principle" to the COVID-19 cases, local cities organize their own separate rules and regulations over COVID-19 prevention, use different versions of the health apps and date selection systems that display their testing and vaccination status, and often have problems sharing individual data with other provinces and cities. Someone traveling or even moving between cities may experience difficulties transferring their information that take days or weeks to fix.

Economically, China's measures of COVID-19 prevention and works to be fully vaccinated are unaffordable for many Middle Eastern states. The "zero-tolerance of local transmission" policy becomes very costly for China, especially local governments. The successful containment has also left China's population almost entirely vulnerable, and thus the country needs to persist with strong public health measures until population immunity is established through vaccination. China from early 2020 upholds the principle of "preventions of both COVID-19's external penetration and internal spread" (wai fang shuru, nei fang kuosan). The prevention measures isolate China from the rest of the world. Chinese visitors are difficult to visit foreign states due to the complicating prevention measures, while imports are difficult to reach China due to the strict testing procedures. China's economic growth has been significantly slowed down due to the COVID-19 epidemic and the strict prevention measures. For Middle Eastern states, China's "zero-tolerance" toward COVID-19 seems difficult or impossible to achieve, and China's experience over COVID-19 prevention, especially collecting personal data and traces, might lead to a political crisis.

Finally, China's image is still negative in some Middle Eastern societies due to the COVID-19 origin discussion. There are many cases that Chinese visitors in the Middle East are called as "virus," including Iran, Iraq, and Turkey. Some videos uploaded by Chinese travelers to the TikTok show that Middle Eastern people have negatively labeled China's image in the Middle East. The callings of Chinese as "virus" anger many Chinese, and many discussions on the internet question whether China should continue to help these Middle Eastern states.

China's images in Middle Eastern societies are under criticism. China's policy in Xinjiang is defined and described by many media in Middle Eastern states as "anti-Islam" or "ethnic cleanings." According to some accusations, China organizes harsh population-control measures to "require Muslims to renounce Islam and pledge loyalty to the Communist Party."9 China has always rejected the accusations in Xinjiang and defines the accusations as baseless and fake, and several Middle Eastern states support China's policies in Xinjiang. Saudi Arabia Crown Prince Mohammed bin Salman visited China in 2019 and praised China's "counterterrorism and de-extremism efforts," while the statement made by the Organization

9 "Why Do Some Muslim-Majority Countries Support China's Crackdown on Muslims," *The Washington Post,* May 4, 2021, https://www.washingtonpost.com/politics/2021/05/04/why-do-somemuslim-majority-countries-support-chinas-crackdown-muslims/.

of Islamic Cooperation also praised China for "providing care to its Muslim citizens." Egypt, the UAE, and Saudi Arabia expelled and arrested the Uyghur activities and deported them back to China. Iran, Qatar, and Turkey are also express support to China's "counter-terrorism" efforts.

However, different from their governments' official attitudes, many people across the Middle Eastern states choose to believe these accusations and strongly criticize China. Many Chinese travelers to Middle Eastern states asked by residents, especially in Iran and Turkey, about the fates of Uyghurs and Chinese Muslims and the "concentration camps in Xinjiang." Middle Eastern societies' misunderstandings toward Xinjiang lead to worries from Beijing. Therefore, China hopes to change the attitudes of Middle Eastern societies through COVID-19 assistance, especially the vaccines donations and joint producing efforts the construct a positive image in the Middle East.

# **39.4 Conclusion**

China takes the COVID-19 vaccine as an important tool to expand cooperation with Middle Eastern states. First, China hopes to construct close connections with Middle Eastern states, especially Qatar, the UAE, and Egypt, by setting up R&D branches and sharing medical technologies to resist the COVID-19. Second, China hopes to show the success of the "China Model" that successfully constrain the COVID-19 to the Middle East. By describing itself as the successful example of limiting the COVID-19 and the US and Europe as the failed examples, China hopes to show the "progressiveness" of its political system. Third, China hopes to show its "international responsibilities" by providing vaccines to the Middle East, especially Palestine, Iraq, Syria, and Egypt.

The influence of China's COVID-19 vaccine diplomacy toward the Middle East should not be overestimated. Due to the financial difficulties, China cannot meet all the demands of Middle Eastern states' needs for vaccines. China is under serious financial and economic problems at home, although China's GDP is still growing. Due to both the "trade-war" from Washington and the COVID-19, China's economic growth rate significantly declined, while the unemployment rate increased rapidly in 2021. Although China produced the inactivated vaccines by Sinopharm and Sinovac, Chinese medical technologies are still far from independent. Most of the medicines and medical facilities in Chinese hospitals are imported from the US, Japan, and Europe. China's medical assistance to the Middle Eastern states could be limited to vaccines, nucleic acid testing facilities, and China's "experience of COVID-19 prevention."

China's vaccine diplomacy treats the Middle East as a whole region without consideration of regional divisions and might lead to distrust of regional states toward China. Chinese donations of vaccines toward the Middle East could further lead to regional geopolitical divisions against China's interests in the Middle East. In Beijing's view, China is competing with the US to gain support from Middle Eastern

states' sympathies toward Beijing's "One China Principle." Therefore, China has to offer support to any Middle Eastern state, which requires the demands over vaccines from China. Against the backdrop of geopolitical complexities between Saudi Arabia, Qatar, UAE, Israel, Turkey, and Iran, China's assistance to certain Middle Eastern states might lead to distrust from another Middle Eastern state. For example, China's donations of COVID-19 to the Syrian government and Iran could be defined by Israel as "allies with enemies." At the same time, Qatar could describe China's joint production of vaccines with the UAE with suspicion.

The Middle Eastern states realize China's growing role in the region, while China also expresses great interest in developing ties with regional states. Through COVID-19 vaccine diplomacy, China successfully maintained and upgraded positive ties with regional states. However, most Middle Eastern states are still keen to see the US and the EU play a more active part in international vaccine distribution and administration. At the same time, China's image, ideology, culture, and claims are still unfamiliar to these regional states.

# **References**

**Wang Jin** is Associate Professor, the Institute of Middle East Studies, Northwest University in China, and Assistant Director of the Institute of Middle East Studies, Northwest University in China. He is also the commentator of Middle East politics for several Chinese leading TVs and Broadcasting programs, including China Central Television (CCTV), China Global Television Network (CGTN), and China Radio International (CRI).

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.


Lipid Peroxidation and the Redox Effects of Polyherbal

*Kale Oluwafemi Ezekiel*

### **Abstract**

The use of more than one herb in a medicinal preparation also known as polyherbal has increased geometrically in recent times. Over a hundred thousand scientists have cited "herbal" to strengthen its ethnopharmacological relevance in literature. Polyherbal (PH) is effective potential therapeutic compound used globally to treat oxidative stress-induced injuries which give credence for their traditional applications. However, some issues related to safety and adverse reactions due to PH have raised important public health debates. Lipid peroxidation (LPO) assay is widely used to assess the toxic endpoint of PH. This paper discusses some important roles that PH plays during oxidation–reduction processes.

**Keywords:** Polyherbal, Lipid Peroxidation, Oxidative Stress, Antioxidant, Ethnopharmacology

#### **1. Introduction**

Lipid peroxidation (LPO) is one of the oldest risk factors for oxidative stress and its mechanistic processes in disease modulation were first observed during the oxidative deterioration of edible materials [1]. The independent works of scientists in the identification of membrane shedding formed the earliest breakthrough for the study of lipid peroxidation [1, 2]. The biochemistry of oxygenase moiety was a light to the further understanding of the peroxidation of lipids [2]. The central roles play by small lipid molecules, free radicals and cytochrome p450 have been well established [3, 4]. The small lipid molecules are transformed into low-density lipoprotein (LDL). LDL modulations have contributed immensely to the studies on cellular biology. Both enzymatic and non-enzymatic approaches to scavenging LPO have been reported [5]. LPO has its root in several diseases including neurodegeneration, cardiovascular, respiratory, and cancers [2]. Consequently, the chemopreventive and protective roles of several antioxidants with proven efficacies have been documented in the literature. Although the different compounds of antioxidants have been identified, researchers have shown that it is by coordinated efforts that they can quench oxidative damage [6]. Evidence abounds of the involvement of LPO in several diseases and the protective roles of medicinal plant antioxidants [7, 8]. Often time in traditional medicine practices, medicinal compounds that perform a similar function are combined to obtain synergy [9, 10]. Thus, potential antioxidants are capable of preventing, protecting, and eliminating any form of identifiable oxidants [11]. The medicinal effects of functional food have been known for a long time. This observation was the result of preservative, anti-oxidative and antimicrobial actions found in ginger, nutmeg, turmeric, etc. These help arrest, repair,

and restore potential injuries [12]. The scavenging efforts by antioxidants provide auto-inhibition or sometimes intervention to the activity of LPO metabolites [13]. Interestingly, in the case of progressive disease, the presence of combined efforts of antioxidants can offer a cascade of reactions to stop the process involved. Despite the tremendous roles of natural product medicines, some issues related to safety and adverse reactions due to PH have raised important public health debates [14]. Lipid peroxidation assay is one of the simplest methods widely used to assess the toxic endpoint of PH. Thus, this paper discusses some important roles that PH plays during oxidation–reduction processes.


**2.3 Effects of drought on influence on photosynthetic pigments synthesis**

The content analysis of chlorophylls and carotenoids in the amaranth leaves showed that some changes were associated with drought (**Figure 4**). An increase of Chl a, b and Car was observed in the leaves of drought-affected amaranth species. In the leaves of *A. tricolor* L. cv. Valentina, the content of Chl a doubled; on the other hand, a slight decrease in the content of Chl b was noted. In the leaves of *A. cruentus* L. cv. Krepysh, the content of Chl b increased slightly in comparison with the content of Chl a. The content of carotenoids in the amaranth leaves increased in the conditions of

#### **Figure 2.**

*The protrusions of crystals (a) and Mineral inclusions in the cross-section leaves* Amaranthus tricolor *cv. Valentina.*

*Metabolite Profile of* Amaranthus tricolor *L. and* Amaranthus cruentus *L.… DOI: http://dx.doi.org/10.5772/intechopen.102375*

**Figure 3.**

*Mineral inclusions in the cross section of amaranth leaves and EDS crystal alalysis. SEM micrographs and corresponding EDX spectra of elements in the cross-section leaves* Amaranthus tricolor *cv. Valentina., sample 2000 X. The energy spectrum of the X-rays character emitted from the element of K, P and Ca.*

moisture deficiency: in the leaves of *A. tricolor* L., it increased 2.5 times, and in the leaves of *A. cruentus* L.—1.5–2.0 times compared with the control. These results are consistent with the data received from the testing on Choy sum in the dry season [25], which reported an increase in total carotenoid content under drought stress.

A high correlation was found between Chl a and Car (r = 0.985) and Chl b and Car (r = 0.977) in the leaves of *A. tricolor* L. and *A. cruentus* L., respectively. The observed changes in photosynthetic pigments of the leaves in drought are probably associated with free-radical-induced oxidation of Chl pigment [26], the destruction of some chloroplasts, and an increase in the activity of Chl catabolizing enzyme of chlorophyllase [27]. The increase in chlorophyll concentration under drought stress can be determined as an indicator of the plant tissues' resistance to abiotic stress under the drought conditions, which is fully consistent with the data of Jain et al., [28], who reported similar observations. Carotenoids are involved in drought stress resistance due to their ability to capture singlet oxygen. They can also inhibit lipid peroxidation

#### **Figure 4.**

*The content of chlorophyll* a *(Cla), chlorophyll* b *(Clb) and carotenoids (Car) in the leaves of amaranth (C4) under stress conditions of drought. Data are the mean SE of three replicates.*

and superoxide formation by dehydrating factors. Carotenoids and beta-carotene may play the main protective role in photosynthetic tissue as they directly help plants resist drought [29].