Caught in a vaccine no man's land, European countries are scrambling for Chinese and Russian shots

(CNN)As the United Kingdom celebrates giving at least one dose of the coronavirus vaccine to 15 million people and the EU surpasses 23 million doses distributed, several other European countries have not yet managed to put a single shot in arms.

Kosovo, Montenegro, and Bosnia and Herzegovina are still waiting to receive their first vaccine shipments, while rollouts in Albania and Northern Macedonia have so far been limited to a few hundred people.

The Western Balkan countries are key allies and possible future members of the European Union, but they have been left out of the bloc's immediate vaccine supply plans.

The EU has secured more than 2.3 billion doses of various coronavirus vaccines and said it expects to share some of those with others. It also set aside €70 million ($85 million) for the Western Balkan region to purchase some of these doses in the future, but since its own rollout has been slow and delayed, those countries are still waiting.

And as relatively wealthy countries -- at least in the global context -- they are also not a top priority for programs designed to help the world's poorest countries access vaccines.

They have joined the COVAX program, which is aiming to make access to vaccines more equitable across the world, but the scheme's limited supply means its primary focus is on the 92 low and middle income countries that can't afford vaccines without funding and the Western Balkan countries are not among those. As self-financing COVAX members, they are set to receive 850,000 doses of a combination of coronavirus vaccines -- but when these might arrive is unclear.

"The constant tragedy of the Western Balkans is that they are on the fringe," said Allison Carragher, a visiting scholar at Carnegie Europe, a global policy think tank. "They're all aspirational EU members, so they looked at the EU program first, but that has been mangled and delayed by supply chain issues."

Many see the EU's omission of Western Balkan countries as a missed opportunity. "This is a small region in terms of population, which means that with a small investment in vaccines, the EU would have gained a lot in terms of soft power and influence in the region," said Alba Cela, the executive director of the Albanian Institute for International Studies. The fact that the EU didn't do this is "allowing for other actors to play a role," she added.

Engjellushe Morina, senior policy fellow at the European Council on Foreign Relation said that this feeling of being left behind could have serious implications for the region's security.

"Europe has really neglected the region for such a long time and it makes the region vulnerable to other external actors," she said, "This is where Russia comes in. This is where China comes in. This is where Turkey comes in, and they have filled in the void in different aspects."

China steps in

Faced with the possibility of a long wait, Serbia, the largest of the six Western Balkan countries, took matters into its own hands and looked for vaccines elsewhere. China and Russia were ready to step in.

The Serbian government said China has so far supplied it with 1.5 million doses of the Sinopharm vaccine, catapulting the country of 7 million to the top ranks of the global vaccination race. Around 850,000 people have been vaccinated against Covid-19 in Serbia as of Monday, according to the government.

The bulk of them received the Chinese vaccine, although the government said it has also received 90,000 doses of the Russian Sputnik V vaccine, and 40,950 of the Pfizer/BioNtech vaccine. The price Serbia paid for the vaccines has not been disclosed.

Adnan Cerimagic, senior analyst at ESI, a policy and research institute, said that without the Chinese vaccine, Serbia would be in a similar position to the rest of the region. "The entire success of the vaccination program relies on China and I think it has worked for China too, using Serbia as a place where they can have an impact in Europe ... the media reports say that thanks to the Chinese vaccine, Serbia is doing better than Germany and many other countries," he said.

Carragher said the deal has been a win-win situation. "There's definitely a clear benefit for Serbia, not only reputationally, by being the top vaccinator on the continent of Europe, but also a legitimization of the government, which has been backsliding democratically," she said. "But here, you know, whenever you're the first in Europe, it looks like you're doing something good."

China has a lot to gain too. "President Xi has said that his goal is to make this region the first region in the world that's fully covered by the Belt and Road initiative and from that perspective, alliances like this can be leveraged for other diplomatic priorities," Carragher said. The Belt and Road Initiative is China's signature global infrastructure policy which seeks to create new trade corridors linking China to Asia, Africa and Europe.

"It's also about the underlying principle behind the vaccine program, that's what they're also selling, legitimizing a lack of transparency and vaccines [being] widely deployed before actually being declared safe," Carragher added, pointing to the fact that Russia started its vaccination program before finalizing clinical trials, while China has not published their data in a peer-reviewed publication.

China has struck back following criticism over its lack of transparency around vaccines, launching attacks on shots manufactured by other companies and countries. Russia was criticized for its early rollout of its then-unproved vaccine. But earlier this month, peer-reviewed results of Sputnik V's Phase 3 trial showed it has very high efficacy rates — providing something of a vindication for the country.

The vaccines are not China's first venture into the Western Balkans either -- in the past decade, it has invested heavily in Serbia, Montenegro, Croatia, Bosnia and Herzegovina and Macedonia, financing large infrastructure and resource projects, including highways in Bosnia and Herzegovina and mines and factories in Serbia. It has also opened Confucius Institutes and university sinology departments across the region.

Serbia's rollout has been such a success that it has allowed the government to engage in its own round of regional vaccine diplomacy.

Last week, it donated 4,688 of its Pfizer/BioNTech doses to Northern Macedonia, which is still waiting for any of the more than 100,000 doses it secured through COVAX. The donation was touted as a major sign of cooperation, with the Serbian President Aleksandar Vucic and the Prime Minister of Northern Macedonia Zoran Zaev taking part in a handover ceremony at the border.

On Wednesday, Serbia announced it would donate 4,000 doses of the Russian vaccine to Montenegro, which is also still waiting for its other deliveries.

The donations are a symbolic gestures. But in this historically volatile, vulnerable region, symbols like this matter.

When the Serbian government announced it would provide vaccines for Serbs living in Kosovo, the government of Kosovo accused it of playing politics with vaccines and "smuggling uncertified pharmaceutical products" into the country. Kosovo declared independence from Serbia in 2008 and most western countries, including the United States, recognize it as an independent state. Serbia, however, does not recognize Kosovo's independence.

Kosovo has ordered over 100,000 doses of the vaccine from COVAX and is expecting deliveries from the EU as part of the €70 million scheme.

The Serbian government also said it donated some of its doses of the Russian Sputnik V vaccine to the Republika Srpska -- one of the two highly autonomous entities that form Bosnia and Herzegovina. Vaccination of the first 1,000 health care workers started there last week, according to the website of the Republika Srpska's Health Ministry. The region has also ordered 400,000 doses of the Russian vaccine. The government of the country's Bosniak-Croat entity, Federation of Bosnia and Herzegovina, said it ordered 800,000 doses through the EU scheme.

Separately, the Presidency of Bosnia and Herzegovina, the body that governs the whole country, has ordered 1.2 million doses through the COVAX program.

Albania has secured 500,000 doses of the Pfizer vaccine via a direct contract with the company, although according to the government, less than 10,000 have been delivered so far -- not enough to vaccinate the country's 23,000 health care workers. On top of its Pfizer deal, Albania has also ordered about 1.1 million doses through COVAX, ensuring it will have enough doses for its entire population.

'The EU could have done more'

While the EU has promised to help the region purchase Covid-19 vaccines, there's no indication yet of how this will work.

But from a strategic and security point of view, the region is crucial for the EU. It is geographically entirely surrounded by EU member states, but remains vulnerable. Albania, Montenegro, North Macedonia and Serbia are all officially EU candidate countries, while Bosnia and Herzegovina and Kosovo are seen as potential future candidates.

Cela said this proximity to the EU is why this is not just about showing solidarity with poorer neighbors. "There's a lack of strategic vision. If this region is to be integrated -- and it is de facto integrated in the EU already, because we have free movement and we have a lot of people traveling back and forth, in practical terms -- it makes no sense for the EU not to provide the region with vaccines," she said, highlighting that having low vaccination rates in neighboring countries would represent a risk to the EU.

"It's a very hot topic here right now," Cela said, noting that the overwhelming feeling in the region is that the European Union could have done more for the Western Balkans.