By Rachel Cooper, Director of Transparency International’s Health Initiative
During a time of health crisis, such as the global COVID-19 pandemic, we need our health systems to be working at their very best. This means we need to be confident of the safety and efficacy of any new vaccines or therapeutics, our health workers must have the equipment they need to do their job whilst protecting themselves and others, and healthcare must be accessible for all. We are seeing researchers, companies, national leaders, procurement officers, and health workers working at break-neck speed to manage the COVID-19 pandemic. Nevertheless, in this rush we must remain conscious and proactive against forces that undermine our health systems; one of which is corruption.
Transparency of research and clinical trials
At the time of writing, there are more than 500 COVID-19 clinical trials underway. The speed at which research and development of new vaccines, therapeutics and technologies is occurring is unprecedented. However, there are already rising concerns over the scientific integrity of this research. One very topical potential treatment is hydroxychloroquine, the anti-malarial drug that has been championed by Donald Trump and authorized for emergency use by the FDA, despite a lack of clinical trial evidence to prove its effectiveness.
Even in normal times there are serious concerns regarding the transparency of research, particularly around clinical trials. Publication rates of publicly funded clinical trials are notoriously low. Industry-funded trials fare better, but their reports are often full of redacted text or, sometimes, data manipulated to produce favourable results. Both cases greatly undermine transparency and public health. Given that drug regulatory agencies will be under pressure to review any potential COVID-19 vaccine or treatment as quickly as possible, clinical trial data must be published in its entirety to ensure safety and efficacy of any new COVID-19 medical tools.
Procurement and corruption
We already know that procurement in health systems is particularly vulnerable, with estimates that up to 25 per cent of all money spent in procurement globally is lost to corruption. With the increased demand for medicines and equipment there is a potential increased risk of collusion, and of profiteering by suppliers demanding higher prices from governments with little option but to pay. We are already seeing stories of governments being sold faulty health technology and protective equipment. For example, in The Netherlands the government had to re-call 600,000 faulty masks that did not provide sufficient protection and risked making healthcare workers more vulnerable to exposure.
If open contracting were in place then procurement performance would be well documented and could be used to inform decision-making in subsequent procurements of similar products, thus increasing efficiency of health system expenditure. Additionally, open contracting would reduce the space for potential collusion between a government procurement officer and a supplier providing faulty products.
Bribery and healthcare
Hospitals are struggling to cope with COVID-19 as they face bed shortages and lack sufficient health workforce. This raises concerns over the increased risk of bribes. In 2019, the Global Corruption Barometer for Africa and the Middle East and North Africa 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. In the context of an outbreak, health professionals will have to prioritise care to those who most need it or might most benefit from it. Consequently, we might see an increase in the frequency of those patients willing to pay a bribe to receive care, leaving those most vulnerable who are unable to pay at the bottom of the list.
The above risks are not new. We have all known about them and the harmful impact they have on our health systems for a long time. There is an undeniable need for urgency to deliver a vaccine, diagnostics and treatment, but we cannot let this need for speed be at the cost of safety and rigour in our health systems. We are not sure where this pandemic will take us, but hopefully we can come out of it with more transparent health systems where health for all is truly prioritised.