Abstracts Lead states compete for influence and followers, and the COVID-19 pandemic served as an important reminder that health aid can be a foreign policy tool. How and to which countries do states distribute aid amidst a global crisis and great power rivalry? This article integrates multiple literatures and presents a novel typology of strategies: preserving existing partnerships, pressuring opponents, protecting recipients based on need, and peeling off countries from geopolitical rivals. It analyzes how the US and China distributed life-saving COVID-19 vaccines through 2021-2022. Regression results and Bayesian reasoning of original elite interviews suggest the US approach is characterized by protecting and peeling, while patterns of Chinese distribution suggest a combination of pressuring, preserving, and protecting. Case studies of Paraguay and Nicaragua – historic allies of Taiwan - further support these conclusions. This raises questions regarding the circumstances under which aid provision is instrumental and how rivals compete during global crises.
Rikio Inouye (2026) studied this question.