Why and how did China and Russia, countries often seen as lagging behind the West in biopharmaceutical innovation, 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—among the most effective COVID-19 vaccines in the world—struggled to gain global approval and uptake than China’s less effective counterparts? Many observers have dismissed these questions by invoking the alleged inferiority of these non-Western vaccines in that they had lower efficacy and were subject to “corner-cutting.” Yet even one of China’s least effective vaccines proved to induce significant public health benefits, while many Western candidates, including those backed by Big Pharma, were never deployed at scale. And we should remember that all countries suspended their regular-time standards and protocols and adopted new ones to contested degrees in an effort to expedite rollout.

This dissertation draws on three years of fieldwork in China and Russia, including collection of documentary evidence, interviews, and observations of pharmaceutical 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, socio-technological contexts during the pandemic, and historical contingencies. I show that: on the one hand, Chinese stakeholders prioritized regulatory legitimacy and vaccine safety, which entailed the embrace of traditional vaccine platforms and compliance with harmonized R&D and regulatory norms, coordinated by a risk averse, Leninist developmental state. On the other hand, Russian actors prioritized technological upgrading, embracing less-established ideas and solutions while relegating established international standards and protocols to the sidelines—a pathway emerging from an inter-departmental “free-for-all” under a fragmented yet geopolitically-driven autocracy. As a result, while both countries achieved historically significant outcomes that reshaped the global vaccine market, China’s less effective vaccines inoculated more people worldwide at the cost 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 dissertation are threefold. First, it joins a growing literature that demonstrates the various pathways through which late-developing, illiberal states innovate. Second, by drawing on a case of emergency time innovation, it invites a rethinking 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 times, reasonable minds could disagree on how good is “good enough.” 2) It highlights how strategic actors can exploit the gap between objective and perceived valuations of innovation to advance their goals.