Why and how did China and Russia, countries often seen as lagging behind in scientific research and development, manage to develop COVID-19 vaccines that: 1) reached the market faster than leading Western counterparts; 2) accounted for nearly half of the global vaccine supply during the pandemic; and 3) proved safe and effective against a novel infectious disease, and in all likelihood, saved hundreds of millions of lives? And why was Russia’s Sputnik V—the most effective among these vaccines—less likely to gain global approval and uptake than China’s less effective counterparts? Many observers have dismissed these questions by invoking the alleged inferiority of non-Western vaccines in that they had low effectiveness and were subject to lax regulation. Yet even China’s least successful alternative induced significant public health benefits in various continent, while many Western candidates, including those backed by Big Pharma, were never deployed for mass use. And we should remember that all countries suspended their regular-time standards and protocols and adopted new ones—legally grounded or not—to contested degrees in an effort to expedite vaccine development.

This project draws on three years of fieldwork in China and Russia, including collection of textual evidence, over fifty interviews, and observations of pharmaceutical business meetings—conducted in both countries’ native languages, to examine their COVID-19 vaccine development campaigns. I trace the two countries’ remarkable achievements—and limitations—to their distinct technology and health strategies, which are themselves rooted in their distinct trajectories of post-socialist transformation in the late twentieth century, social contexts during the pandemic, and historical contingencies. I show that: on the one hand, Chinese stakeholders prioritized drug safety. This entailed the embrace of traditional vaccine platforms and compliance with global regulatory standards, coordinated by a risk averse, Leninist developmental state. On the other hand, Russian developers prioritized vaccine efficacy. This entailed ambitious experimentation with less-established technologies and the repudiation of global standards, experimentation which grew out of the inter-ministerial “free-for-all” under a fragmented autocracy. As a result, while both countries achieved remarkable outcomes, China’s less effective vaccines inoculated more people worldwide at the expense of delayed innovation.

This project compares not only China and Russia but also individual vaccine candidates within and across the two countries. It tests the macro-comparative insight that, under emergency conditions, actors facing hurdles in technological upgrading and/or regulatory harmonization are more likely to succeed when they adopt contrarian strategies that trade off between the two, rather than following canonized models that emphasize the elevation of both. Specifically, I conduct an event history analysis of more than 200 COVID-19 vaccine candidates worldwide, controlling for organizational, financial, and temporal factors, and supplement the findings with comparative-historical evidence from the United States, Cuba, and Taiwan—each of which achieved notable COVID-19 vaccine successes through divergent strategies.

The implications of this article are multifold. First, by demonstrating the possibilities of non-Western science and technology, it joins a growing literature that demonstrates the various pathways through which late-developing, illiberal states innovate. Second, it invites a rethinking of how and why pharmaceutical advances occur. Third, it contributes to broader sociological debates on value and valuation in two ways: 1) It challenges both constructivist and realist accounts of drug valuation, showing that while notions of “quality” and “standards” are socially constructed, they aren’t purely so. Vaccines had to work—at least to some degree—to achieve approval and distribution. But in emergency contexts, reasonable minds could disagree over what counted as “good enough.” 2) It highlights how strategic actors can exploit the gap between objective and perceived valuations of innovation to advance their interests, as shown in both the Chinese and Russian cases where stakeholders—often intentionally—put different emphases on technological upgrading and regulatory harmonization.