IEMed Mediterranean Yearbook 2021



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The Geopolitics of Pandemic-related Assistance to the Western Balkans

Nikolaos Tzifakis

Associate Professor
Department of Political Science and International Relations,
University of Peloponnese, Corinth

Covid-19 brought to the surface many structural vulnerabilities in the Western Balkans, a European periphery marked by its weak economies and inefficient and underfinanced healthcare and social welfare systems. There has been a pressing need for external support and several external actors (such as the EU, China, Russia and Turkey) have stepped in to provide assistance. Under normal circumstances, the prompt response of a plurality of actors should have been a very positive development for the region. However, this is not entirely the case. External actors have been in direct competition in a fierce race for geopolitical influence and preeminence, striving to position themselves ahead of the others for the challenges and opportunities of the post-pandemic period.

The EU distinguishes itself from the other external actors for its comprehensive pandemic-related assistance to the region that has exceeded €3.3 billion. Its concerns cover a range of priorities, from supporting national healthcare systems to stimulating socio-economic recovery. The EU has also donated more than 23 million pieces of personal protective equipment, as well as dozens of ambulances, ventilators and intensive care monitors. Moreover, Brussels has given €70 million for the procurement of EU-approved vaccines; promised to provide 651,000 vaccine doses until August 2021; and said it would also deliver more than 1.1 million vaccine doses until June 2021, which have been allocated to the region via the COVAX mechanism.[1] Yet, while the EU has provided unparalleled pandemic-related assistance to the Western Balkans, it has lost the public diplomacy contest to the other external actors, who have been given a disproportionate amount of credit, for the delivery of rather symbolic levels of aid. This chapter briefly presents the health assistance efforts of China, Russia and Turkey (i.e., the most important non-Western external actors) in the region from the outbreak of the pandemic to the end of April 2021, and concludes with some comparative findings.

China: It’s Business Time

Although China has been blamed for having mismanaged the pandemic outbreak, it strove to turn the tables on its critics and portray itself as a pioneer in the management of the Covid-19 crisis and as a preeminent provider of health assistance. It fought the (dis)information war to change the narrative about the Covid-19 origins, and established itself as a global leader of essential medical goods for the fight against the pandemic. According to a study, Chinese exports of Covid-19-related medical supplies skyrocketed in 2020, with the value of exports of respirator masks and related textiles increasing more than twelvefold in comparison to 2019.[2] China also engaged in a race against time and against the world’s leading pharmaceutical companies to be the first to develop an effective and affordable vaccine, partly for the prestige this would afford, but also in order to secure a large share of the global vaccine market. Overall, it used pandemic-related aid to stimulate business opportunities worldwide. For instance, its donations of vaccines have so far been directed to 56 countries, 55 out of which participate in the “Belt and Road Initiative,” which has been reinvigorated during the pandemic with the advancement of the “health silk road” idea.[3]

The Chinese health assistance towards the Western Balkans was distributed to all countries in the region but Kosovo, whose statehood Beijing has not recognized. While the quantities of medical goods delivered to each recipient country were publicly announced, China has not released any information concerning the ratio between donations and sales in these deliveries. Medical supplies were mostly sent during the March-April 2020 period and consisted of thousands of masks, testing kits, gloves, goggles, and protective clothing. The largest part of Chinese health assistance – that also included the equipment for two Covid-19 testing laboratories and a team of medical experts – was directed to Serbia. Beijing and Belgrade have built a strategic partnership, which has further deepened during the pandemic with new deals concerning transfers of military equipment, and the construction of the Belgrade subway. The two countries have also launched talks for the construction of an oil refinery plant in Smederevo and Serbia’s purchase of high-speed trains.[4] Serbia’s President, Aleksandar Vucic, has facilitated the spread of Chinese influence in the region. Not only has he praised (backed by the regime-friendly media) the Chinese health assistance to Serbia (going so far as to contrast it with the corresponding EU aid), but he has also been the first European leader to place his trust in Sinopharm, the Chinese vaccine, despite the lack of reliable scientific information about its safety and efficacy. Serbia ordered two million doses of Sinopharm and quickly attained high inoculation numbers (it had the highest rate in Europe until March 2021), setting the example for other countries in the region to follow its course. Beijing rewarded Belgrade with an agreement to finance (together with the United Arab Emirates) the establishment of a vaccine production factory in Serbia,[5] while it encouraged the region’s interest in Sinopharm with modest donations of vaccines to Bosnia and Herzegovina and Montenegro (50,000 and 30,000 doses respectively).

Russia: Friends Matter

Contrary to China, which sent health assistance to more than 150 countries, Russia concentrated its pandemic-related aid to a small number of states that were selected on the basis of political expediency. These included either key countries in Moscow’s campaign to seek relief from the Ukraine-related economic sanctions, or countries with which it shares friendly relations and to which it wanted to demonstrate its solidarity. Russian health assistance has, overall, been rather symbolic, but its effect has been amplified by an accompanying disinformation campaign aimed at denigrating the West’s health management efforts. Moscow also participated in the global race for the swift development of a vaccine that would meet high standards of safety and efficacy. Interestingly, Russia named its vaccine “Sputnik V,” after the Soviet Union’s first ever satellite launch, while it precipitated the vaccine’s release onto the market for as early as October 2020, before the completion of Phase III trials. In this way, Russia sought to claim itself as the first country to develop a vaccine against Covid-19, intending not only to make an impression, but also to secure a large share of the vaccine market. Notably, Russia has made very few donations of vaccines, which in many cases have served as “free samples” to countries that had already expressed interest in the procurement of Sputnik V doses.[6]

Russia used its health assistance in the Western Balkans as a way of dishing out rewards and sanctions. While it sent support in the Spring of 2020 to its two main allies in the region, namely Serbia and Republika Srpska (the Serbian entity in Bosnia and Herzegovina), it ignored the relatively simple demands for cooperation of Montenegro and North Macedonia, the two newest NATO members, concerning the evacuation of those countries’ citizens.[7]Apart from medical supplies, its pandemic-related aid to Serbia and Republika Srpska included the deployment of military medical expert teams, assigned to decontaminate facilities. The coordination of Russian health assistance by its Ministry of Defence was the cause of some concern among external observers, who reasonably questioned Moscow’s true motives.

Russia has not so far donated any vaccine doses to the Western Balkans. However, Sputnik V has been promoted in the region by Serbia, which ordered tens of thousands of doses, despite the lack of peer-reviewed studies concerning its merits. Serbia’s very successful inoculation campaign (that was owed to the procurement of substantial quantities of every available vaccine on the market) stimulated a wider interest in the region for the Russian vaccine as well. Eventually, Russia rewarded Serbia’s endorsement of Sputnik V by conceding to the demand for the establishment of a vaccine production facility in Belgrade.[8]

Turkey: All Politics Are Personal

The outbreak of the pandemic hit Turkey at a difficult time. The economy was in trouble, with high inflation and a steady depreciation of its national currency. In 2020, Turkey was also engaged (more or less directly) militarily in three different theatres of armed hostilities (i.e., in Syria, in Libya and in Nagorno Karabakh), making new enemies and stretching to the limits its margins of diplomatic manoeuvre. Indeed, the gap between Turkey and the West has widened during the period in question due to divergent views and interests over a large array of issues. However, Recep Tayyip Erdogan, Turkey’s President, perceived an opportunity in the Covid-19 crisis to project soft power abroad, affirm the country’s self-styled image as a rising great power and cultivate his own domestic profile as an influential world leader. Turkey responded positively to all international demands for assistance, sending small quantities of medical supplies to 158 countries. It has also recently striven to develop its own vaccine, whose release is planned for the end of summer 2021.[9]

Turkey has shown particular interest in the Western Balkans, which were part of the Ottoman Empire and fall within the wider region delineated by President Erdogan as the “borders of our [the Turkish people’s] heart.”[10]Turkey does not want to cede space to other external actors (such as Russia and China) to exercise influence in the region. It expressed its solidarity to all Western Balkan countries in the Spring of 2020 with modest donations of medical supplies, consisting of thousands of masks, protective clothes, goggles and testing kits. To the extent that Turkey has not yet developed a vaccine, it has also not participated actively in vaccine diplomacy. It has just made two donations totalling 40,000 doses of the Chinese-manufactured CoronaVac (also known as Sinovac) vaccine to Bosnia and Herzegovina in March-April 2021, where pandemic rates were flaring.[11]Crucially, all decisions concerning Turkey’s pandemic-related aid deliveries to the Western Balkans were taken by President Erdogan himself, following communications with his counterparts in the region. Erdogan’s strong interpersonal relations with most Western Balkan leaders, and the latters’ personal gratitude to the Turkish President for Ankara’s acts of support, point to a particular model of personal diplomacy that best serves the interests of the decision-makers involved. Indeed, Turkey’s most remarkable health assistance gesture to the region was the construction of a fully equipped 150-bed hospital in Fier, in Albania. The hospital was promised to Albania’s Prime Minister, Edi Rama, by President Erdogan at the beginning of the year and was constructed very quickly, within less than three months. Notably, it was inaugurated by the Turkish President on 21 April 2021, i.e., just four days ahead of the Albanian parliamentary elections, thereby clearly boosting Rama’s chances of re-election.[12]

In lieu of Conclusions

Covid-19 and the mitigation of its effects have not brought new external players to the Western Balkans. External actors which had already established a strong foothold in the region during the previous years are those who mobilized to offer pandemic-related support in order to consolidate their influence and garner themselves the best position for the post-pandemic world.

While the EU donated substantial levels of assistance, the other external actors examined in this study proceeded with mostly symbolic acts of support during the researched period. Still, public perceptions in the region reflect a different story. According to several public opinion surveys, in 2020, Serbians believed that the Chinese and Russian levels of assistance were superior to the corresponding levels of aid provided by the EU. Admittedly, Brussels has failed to convey to the Western Balkans a message of genuine concern, while it has committed a series of policy errors, the last one being the serious mismanagement of the question of prompt vaccine delivery. The low appreciation of EU support should also be attributed to the disinformation campaign launched by both external (mainly Russian and Chinese) and local media, which have systematically denigrated the West’s pandemic-related policies. Last, but not least, the Chinese, Russian and Turkish initiatives in the region have benefitted from the support of local leaderships (e.g. the Serbian President, Aleksandar Vucic, in the cases of China and Russia and the Prime Minister of Albania, Edi Rama, in the case of Turkey), who have profiled themselves domestically as privileged interlocutors of the leaders of those external actors and have invested much in strengthening the corresponding interpersonal relations. Therefore, the hard lesson that the EU should draw from the Western Balkans is that the way external health assistance is presented and perceived locally is no less important than the volume of assistance itself.


Bieber, Florian and Tzifakis, Nikolaos, (eds). The Western Balkans in the World: Linkages and Relations with Non-Western Countries. Abingdon, Oxon: Routledge, 2020.

Latal, Srecko, “COVID-19 Raises Geopolitical Stakes in the Balkans.” Prague: Prague Security Studies Institute, September 2020.

Madhi, Gentiola, “‘Our brother Erdogan’ – From official to personal relations of political leaders of Albania and Kosovo with the Turkish President.” Prague: Prague Security Studies Institute, February 2021.

Ozturk, Ahmet Erdi, “Turkey’s Activities in the Western Balkans During the Covid-19 Crisis.” In: Valeska Esch and Viktoria Palm (eds), The Covid-19 Pandemic in the Western Balkans: Consequences and Policy Approach . Berlin: Aspen Institute, 2020: 60-64.

Tzifakis, Nikolaos and Prelec, Tena, “From mask to vaccine diplomacy: Geopolitical competition in the Western Balkans.” In: Giorgio Fruscione, (ed.) Pandemic in the Balkans: Geopolitics and Democracy at Stake. Milan: LedizioniLediPublishing, Italian Institute for International Political Studies (ISPI), 2021: 12-33.