As communities around the world face an unprecedented global health crisis with the rapid spread of the coronavirus or COVID19 pandemic, our governments’ first priority should be promoting our health and safety.
But extraordinary outbreaks like this one also tend to expose cracks in our health systems, highlighting potential risks and opportunities for corruption – corruption that may undermine the response to the pandemic and deprive people of health care.
Even in ordinary times, corruption in the health sector causes losses of over US$500 billion every year.
Health systems on the brink of collapse
Across the globe, over 164 countries are struggling to keep up with this pandemic. More than 200,000 people have contracted the virus and more than 8,000 have died fighting it – devastating numbers that increase daily.
An extreme volume of patients seeking medical care threatens to overwhelm already fragile national health systems. Many countries face dire shortages in healthy medical professionals able to provide lifesaving care, and have limited testing and treatment options available to treat the coronavirus.
Unfortunately, corruption often thrives during times of crisis, particularly when institutions and oversight are weak, and public trust is low.
We’ve learned from previous global health emergencies, like the Ebola virus and swine flu, that even in times of crisis, there are those who aim to profit from others’ misfortune.
Identifying these corruption risks before they happen can help strengthen our global response and get health care to those who need it most.
Procuring drugs and medical equipment
The procurement of medicines and supplies in health systems is typically one of the most vulnerable areas for corruption.
According to the UN Office on Drugs and Crime (UNODC), approximately 10 – 25 per cent of all money spent on procurement globally is lost to corruption. In the EU, 28 per cent of health corruption cases are related specifically to procurement of medical equipment.
And that’s during normal times.
Preventing price gouging
Around the world, countries are reporting shortages in both medicines and medical supplies due to the coronavirus. This puts additional strain on already fragile procurement processes and increases the risk that suppliers, knowing that government have little choice but to pay, may extort governments by demanding higher prices.
Having open and transparent contracting processes in place helps mitigate against these risks. With nowhere to hide, corrupt actors are unable to practice price gouging and must charge governments reasonable prices.
Stockpiling supplies such as masks, gloves and hand sanitizer is also contributing to shortages in medical supplies. In attempts to profit from public panic, some traders have been inflating prices for ordinary consumers.
In India, the government responded by setting up a hotline for citizens to report items being sold above the recommended retail price. In the US and around the world, Amazon is actively removing inflated listings or false products that claim to cure or protect against the virus.
Governments and companies must do more to prevent unethical profiteering and the private sector should not put profit before all else.
Sharing information on shortages
As a result of COVID-19, drug manufacturers in China, India and other countries are also scaling back production of prescription medicines, including antibiotics, as well as key ingredients for other drugs.
But despite these shortages of important medicines, government agencies, like the US Food and Drug Administration (FDA), won’t release the names of these drugs. This lack of transparency is particularly frustrating for providers, patients and consumers who rely on these critical medicines.
Without transparent information about which drugs may experience shortages, health systems have no way of preparing other solutions, such as finding alternative manufacturers.
In times of crisis, rather than protecting corporate interests, governments should make drug shortage information publicly available to ensure access to lifesaving medicines.
Funding for treatment and vaccine development
As countries continue to scramble to keep up with the pandemic, the race is on for researchers and scientists to develop drugs and a vaccine against COVID-19. As a result, governments have been investing more in research and development.
For example, since 2002, the US has spent nearly US$700 million on research into coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). More recently, the UK pledged £20 million to coronavirus research and the EU increased its budget to €47.5 million.
While many governments are ramping up funds to distribute nationwide, as well as among states, provinces and local communities, in order to aid in the emergency response they must be careful to reduce corruption risks.
With such large outflows of money, governments should work to track and monitor funds to ensure they’re not used to line corrupt pockets.
Transparency of clinical trial data
The development of COVID-19 medicines and vaccines is critical, as is the publication of results from clinical trials to show what is effective – and equally important – what is not, so that researchers can learn from existing studies and not lose time chasing scientific dead ends.
Yet, publication rates of clinical study results are notoriously low, particularly for publicly funded research, including in the EU. While privately funded clinical trials have a slightly better publication rate, many reports include large amounts of redacted text to protect commercially sensitive data.
A 2009 report from the US Institutes of Medicine (IOM) found widespread financial conflicts of interest across medical research, education, and practice due to private influence. Other studies of private research highlight that data itself can be manipulated to produce favourable results in clinical trials. This influence of private industry over public health undermines the transparency of important research and puts the health of countless individuals, families and communities at risk.
The development of drugs and a vaccine against coronavirus should be a transparent and collaborative effort, not a secret competition between private companies or even national governments.
Earlier this week, media reports highlighted a US-Germany show-down over the development of a coronavirus vaccine, which does little to inspire confidence in our government leaders and sets a bad example for the rest of the world in how to act in times of crisis.
Lessons from Swine flu
According to the British Medical Journal (BMJ), the swine flu outbreak in 2009-2010 resulted in global spending of approximately US$18 billion to stockpile Tamiflu, the prescribed treatment for the epidemic.
However, following a scientific review of clinical trial data involving four years of protracted efforts to obtain information from Swiss-based pharmaceutical manufacturer, Roche, scientists found that Tamiflu was no better than paracetamol in treating swine flu.
Preventing general misinformation and protecting whistleblowers
In the midst of this growing global health emergency, there are serious concerns about the spread of misinformation and the real threat against health professionals for speaking out about the realities of COVID-19.
In Wuhan, China, the epicentre of the pandemic, a health care provider and whistle-blower, Li Wenliang, tried to raise early warnings about the severity of the pandemic but was silenced by government officials.
In the US, a political back-and-forth over messaging is playing out between Vice President Mike Pence, who is in charge of the government’s response to COVID-19, and top health experts, including career professionals like the director of the National Institute of Allergy and Infectious Disease (NIAID).
Mixed messaging can result in low levels of trust in governments and the spread of fake news, a development the World Health Organisation labelled as an ‘infodemic’.
It’s crucial that governments act in an open and transparent manner in order to build and maintain trust from citizens.
As hospitals struggle to cope with COVID-19 and face increasing shortages in staff, beds, ventilators and other equipment, bribery risks are a major concern.
Medical providers are currently facing very difficult decisions about which patients to treat based on who needs care most.
This creates an environment ripe for bribery.
In 2019, the Global Corruption Barometer for Africa and the Middle East and North Africa (MENA) found bribery rates in hospitals and health centres to be 14 per cent each. In Latin America and the Caribbean, the rate is 10 per cent.
Patients willing to pay a bribe to receive medical care as soon as possible could leave those most vulnerable and unable to pay at the bottom of the waiting list.
Lessons from Ebola
The outbreak, spread, and slow containment of the Ebola virus from 2014 – 2016 provides lessons about corruption in times of crisis.
The International Red Cross estimated the cost of corruption to the outbreak in Guinea and Sierra Leone to be more than US$6 million. Reports show that the Ebola epidemic resulted in the diversion and mismanagement of funds, misreporting of salaries, payments for duplicate supplies, and bribery of health professionals to receive medical care and leave quarantined zones.
Lessons from SARS
As a result of the SARS outbreak in 2003, Taiwan established a national command centre to help coordinate and tackle future health emergencies. By strengthening transparency, harnessing new technology and developing a robust prevention plan, the country is better-positioned to respond to large-scale pandemics, like coronavirus.
Following the outbreaks of both Ebola in West Africa and SARS in Asia, health care infrastructure has improved thanks to increased scrutiny and additional resources dedicated towards strengthening health systems.
A way forward
As the COVID-19 pandemic continues to spread, it’s important to have open and frank discussions about the vulnerabilities in our health systems that make them more susceptible to corruption.
Transparency International urges governments to act with greater transparency to improve the procurement of lifesaving medicines and vaccines, promote open and transparent contracts, prevent price gouging of drugs and medical supplies, and share information about important drug shortages in a timely way.
In addition, governments should improve transparency of clinical trial data so that scientists can build on existing research instead of starting from scratch.
Equally important, governments should do more to prevent the spread of misinformation, protect whistleblowers in their efforts to save lives and reduce the risk of bribery in hospitals and health centres.
Finally, reducing the influence of large, private interests is essential for governments to make better decisions for the public good. Public health, not political or corporate interests, must always come out on top.
This is an expanded version of an article previously published on the Transparency International Health Initiative website by Natalie Rhodes.
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