This week we're looking at the impact of China's misinformation offensive against Western-made vaccines.

CHINA’S VACCINE MISINFORMATION OFFENSIVE — China is mounting a vast online propaganda campaign against Western-made coronavirus vaccines – and the mischief-making is already shading global attitudes toward those shots.

The Chinese Communist Party’s new brand of aggressively online diplomatic defenders, known as “Wolf Warriors” after a popular nationalistic film franchise, have added vaccine conspiracy theories to their trolling repertoire after promoting alternative theories about the coronavirus’ origins.

While China observers said the exact purpose of the vaccine smear campaign isn’t clear, that’s almost beside the point. In just a few weeks, it’s already seeding doubts about the safety of shots from Pfizer/BioNTech and Moderna, providing talking points for vaccine skeptics in the United States and giving countries rhetorical cover to purchase Chinese-made vaccines that appear to be less effective than the two leading Western ones.

“It feels like the propagandists have gone all in on Russian-style nihilistic disinformation, without understanding or just not caring about the damage it is doing,” said Bill Bishop, a close China watcher and author of the Sinocism newsletter.

Sowing doubt: Claims that the Pfizer and Moderna shots are risky or even deadly have been boosted by headlines from nationalist Chinese media and in remarks from Chinese officials. The head of China’s Center for Disease Control and Prevention raised eyebrows when he questioned the safety of the mRNA shots.

The top hits for "Pfizer vaccine" in Google Translate read like a trip down a vaccine skeptic’s Facebook page, with headlines playing up deaths or sudden illnesses of people in France, Germany, Mexico, Norway and Portugal shortly after their jabs.

“Why were US media silent on Pfizer vaccine deaths?” one headline posited.

Similar questions are peppering WeChat and the Chinese microblogging site Weibo, where one post alleged the Pfizer shot caused brain damage, while another declared it to be just 29 percent effective. (Reminder: Those claims are false.) These were paired with another post boasting of global demand for China’s shots.

The Wolf Warriors’ claims have grown louder just as global confidence has waned in China’s homegrown vaccines. That has fired up online “diplomats” as well as some Chinese state media outlets, with the nationalist tabloid Global Times accusing Western media of hyping any “unfavorable information” about Chinese-made vaccines. Russia’s also getting in on the act: The Twitter account for the country’s Sputnik V shot retweeted the Chinese report that it says highlights “vaccine politics and double standard of media coverage.”

It’s not clear whether these reports are aimed solely at defending and boosting the Chinese vaccines – even though they come amid growing confusion about the efficacy of the Chinese shots. A Brazil trial found Sinovac had just a 50 percent efficacy rate; one in Turkey said it was 91 percent. Neither Sinovac nor Sinopharm, which has said its vaccine is 79 percent efficacious, have published peer-reviewed data.

Needy countries are still buying: Still, some hard-hit countries struggling to strike deals with Pfizer and Moderna are buying the China-made vaccines. Even a 50 percent effective vaccine can be helpful.

Regional strongman Rodrigo Duterte, the Philippines president, bought 25 million doses of the Sinovac shot. After critics complained he didn’t get the Pfizer vaccine, he borrowed Chinese talking points about the company’s shot potentially causing deaths in Norway. (Norway’s authorities said there’s no evidence that deaths were linked to the vaccine, though the prime minister told Bloomberg the country may hold back shots for particularly frail or terminally ill seniors.) And Cambodian dictator Hun Sen, a major Chinese ally, welcomed 1 million shots donated by his country’s “friend,” Beijing.

The impact: Whatever the end game, and however officially or unofficially sanctioned the disinformation campaign is, its effects are real. Social media accounts for American “health freedom” organizations where vaccine skeptics air their views have echoed the stories blown up by the Wolf Warriors, as well as familiar accusations of the U.S. pharmaceutical industry profiteering from the pandemic.

Dali Yang, a political science professor at the University of Chicago who’s been tracking the messaging, noted that the news outlets who’ve amplified these reports tend to traffic in nationalist rhetoric. He also predicts the rhetoric will temper now that China’s seeing more outbreaks and leaders have to come up with their own inoculation strategy.

But the virus propaganda wars have raged from the beginning, and they aren’t going away. China still faces criticism over its secretive handling of the first known Covid-19 cases as it hosts a team of international experts investigating the virus origins. Beijing has tried to flip the script, accusing other countries of being responsible for the virus and attacking their pandemic responses.

Just this week, President Xi Jinping told the virtual World Economic Forum he wants nations to “come together against global challenges,” and he boasted of China’s support for ‘international cooperation on COVID vaccines.”

That was his line for Davos, at least.

WELCOME BACK TO GLOBAL PULSE, where your host is still surprised about how often Covid vaccinations are coming up in conversations with family. My uncle and aunt — both over 65, one of them with diabetes — have already flipped their positions once about getting vaccinated, and I wonder how often that might change until the vaccine is finally available to them.

Global Pulse is a team effort. Thanks to Susannah Luthi for guest-writing this week's Big Idea and to editors Jason Millman and Joanne Kenen.

CAUGHT IN THE MIDDLE — Rich countries have bought hundreds of millions of coronavirus vaccine doses, most of the global supply. The world’s poorest countries should get about one-fifth of their vaccine needs subsidized through a global vaccine equity effort (COVAX), with the first doses set to arrive next month.

But more than a quarter of the world’s countries fall somewhere in the middle: not rich enough to snap up major vaccine supply and not poor enough — at least on paper — to get support.

They are what the World Bank calls the upper middle-income countries, where the gross national income per capita ranges from $4,046 to $12,535. Countries as diverse as Argentina, Indonesia and South Africa fall into this category. Many have been hit hard by the virus.

The 50 or so countries in this group represent about a third of the 100 million infections reported globally. Just 10 have started vaccinating, and some governments are facing internal criticism for falling behind in the vaccine race.

Most of them have scrambled to strike bilateral deals with vaccine makers in the West — Colombia, Costa Rica, Ecuador and Lebanon, among them. Others have opted for those made in the East: Argentina, Brazil, Iran and Turkey.

What’s a good deal? Facing pressure to secure vaccines, South Africa announced a deal this month for 1.5 million doses of the AstraZeneca/Oxford University shot made by India’s Serum Institute. The price tag: $5.25 per dose, the same that the much richer Saudi Arabia is expected to pay and higher than the $3.03 per dose for European Union countries, which include some of the world’s wealthiest, are expected to pay AstraZeneca. (The bloc and the company are now fighting over reduced supplies.)

South Africa President Cyril Ramaphosa this week called on rich countries who’ve bought more doses than they could use to stop hoarding, warning that countries in dire need are largely being shut out. That includes his own country, which has the highest number of infections on the continent at more than 1.4 million reported cases and is grappling with a virus variant that could make existing vaccines slightly less effective.

Ramaphosa, who also chairs the African Union, earlier this month said that the bloc representing 1.3 billion people has a provisional deal for 270 million doses from Pfizer, AstraZeneca and Johnson & Johnson. But the first doses may not arrive before April. The Africa CDC said today the Union bought another 400 million doses of AstraZeneca shots from the Serum Institute.

The waiting game: Other countries, including many in South America, are also trying to negotiate bilateral deals. But it may not be until 2022 or 2023 that most of the region gets vaccinated, said Michael Touchton, a global health professor at the University of Miami whose research has focused on Latin America. The countries have also had problems obtaining related supplies, he said. Brazil’s President Jair Bolsonaro suspended the purchase of hundreds of millions of syringes this month over price increases, for example.

The region, meanwhile, is struggling with some of the highest numbers of Covid cases and deaths in the world. That’s partly because it has disproportionately more older people with chronic diseases compared with other developing countries, said Felicia Knaul, the director of the Institute for Advanced Studies of the Americas at the University of Miami.

“A platform like COVAX is perhaps not where they’re the first in line,” she said, adding that there are other paths. That includes working through the Pan American Health Organization, which she noted has a history of helping finance vaccines for the region.

DEVELOPING COUNTRIES DESPERATE FOR OXYGEN — Hospitals in many developing countries have run out of medical oxygen to threat Covid-19 patients, leading to more preventable deaths.

Brazil is the worst affected, needing more than 300,000 oxygen cylinders per day. The situation is so bad in the Amazon city of Manaus that Venezuela shipped supplies there, despite the country's own oxygen needs.

In the Eastern African nation of Malawi, which recorded almost twice as many Covid-19 deaths this month (349) than all of 2020, the need for oxygen has increased tenfold this month, according to the Every Breath Counts Coalition, a public-private partnership working to end preventable child pneumonia deaths.

“The problem is no one is helping the lower and middle-income countries’ governments pay for the oxygen,” said the group’s Leith Greenslade. The group called for the international agencies leading the Covid-19 response to immediately begin negotiations with the most affected countries, financing institutions and medical oxygen companies to help alleviate shortages.

LEBANON’S QUAGMIRE — How many crises can a nation bear at the same time? Some are afraid that Lebanon is in the midst of finding out.

The country's 6.8 million people — including more than 1.5 million refugees — are going through one of the strictest lockdowns in the world. Since Jan. 14 and through at least Feb. 8, only essential workers can leave home. Even groceries must be delivered.

With some 40 percent of the population living below the poverty line after an economic crisis that preceded the pandemic, the restrictions have spurred protests in recent days as people find themselves with barely any assistance.

The country’s caretaker government is hoping these strict measures will help ease the spike in infections, which have overwhelmed emergency rooms in Beirut. Lebanon reported an ever-increasing number of infections since mid-December, reaching almost 4,800 cases per day in mid-January when the lockdown kicked in. The number of daily cases has just started to decrease over the past week.

The crisis that lingered: Until July, Lebanon appeared to weather the pandemic well, reporting daily case numbers typically in the double digits. Then came the massive explosion that stunned the world.

Case numbers took off in the aftermath of that Aug. 4 explosion in Beirut, which killed more than 170 people, injured more than 6,500 and left 300,000 homeless. Two hospitals that were part of a plan to expand Covid-19 treatment capacity were destroyed, with 500 beds lost. Hospitals still functioning were overwhelmed with patients from the blast.

A central drug warehouse housing personal protective equipment and trauma supplies was also severely damaged. “It really hit the health sector very hard,” said Iman Shankiti, the World Health Organization representative in Lebanon.

Many young volunteers turned out to clean downtown Beirut. In many cases, without masks, said Rabih Torbay, the president and CEO of Project HOPE, a global health and humanitarian relief organization that played a major role in the Lebanon response.

The tragedy hit home for Torbay, who grew up in Lebanon during the country’s 15-year civil war and had family members injured in the explosion. He was in Beirut within 48 hours of the blast and said the desperation he saw on people’s faces was worse than during the war.

The explosion was for some the perverse cherry on the top, said WHO’s Shankiti. Due to the economic crisis, the Lebanese currency collapsed, prompting some to leave the country recently. That included 500 doctors, or about 3 percent of the country’s registered physicians, according to the Lebanese Order of Physicians.

A health care system that used to be one of the region's best and that others had come to rely on is now on the brink of collapse, Torbay said. He is also worried that a subsidy for imports of essential goods, including medicines, may change after March as part of the government’s effort to rein in public spending, potentially leading to increases in the price of basic drugs.

He called on international institutions and rich countries to provide a comprehensive rescue package for Lebanon’s health system to ensure that people can afford basic drugs and to halt the exodus of health workers. “What happened in Lebanon between the economic collapse, Covid, and the explosion was a little bit too much for the health care system to sustain,” he said.

A small ray of hope: The first batch of 2.1 million Pfizer/BioNTech vaccine doses, which were mostly funded through a World Bank loan, are due to land in Lebanon next month.

Shankiti said that she hoped the restrictions and the arrival of vaccines will meaningfully help and provide a reason for the Lebanese to be optimistic after this long crisis. “I don’t want people just to give up,” she said.

POLITICO: Europe must soon decide how tough it will be in a global fight over restricting vaccine exports.

Nature: Why did the world’s pandemic warning system fail when Covid hit?

The Lancet: The epidemiologist leading Brazil’s largest Covid-19 study details the attacks he’s received from President Jair Bolsonaro and other politicians.

Gates Foundation: Bill and Melinda Gates pitch a global alert system to prevent the next pandemic.

New Zimbabwe: Activists condemn plan to make vaccine available only to health workers and government officials.