News 06th Apr 2020

How Business Can Protect Our Health Systems

Rachel Cooper

Director, Health Initiative

Rachel joined Transparency International in November 2017, to lead the Pharma and Healthcare Programme’s flagship project on open contracting in the health sector and to drive change in policy and practice across pharma and healthcare research and development, manufacturing, marketing and service delivery. She joins TI-UK after a career in the Foreign Office and delivering global health projects with INGOs and medical royal colleges.

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During a global health crisis such as the current COVID-19 pandemic the capabilities of health systems are pushed to the extreme. This pressure to respond quickly to urgent demand creates opportunities for corruption in health research, development, procurement and delivery. Transparency in research and development of COVID-19 health care technology and procurement are key to ensure public health interests are prioritised above corporate interests.

We are seeing a huge amount of resource mobilisation from governments and donors around the world to fund COVID-19 research and development of new treatments, technologies, vaccines and diagnostics. To reflect this demand we are seeing businesses step up to support efforts such allowed the development of a new breathing aid for COVID-19 patients in just 10 days. We are seeing more and more companies and academic researchers developing potential COVID-19 vaccines at unprecedented speed. However, there are serious concerns regarding the transparency of this research, particularly around clinical trials. Publication rates of publicly-funded clinical trials are notoriously low[i], industry-funded trials fare better on this but are known for those reports to be full of redacted text or even the data itself can be manipulated to produce favourable results[ii]. Both cases greatly undermine transparency and public health. All clinical trial data must be published in its entirety to support further innovation and to ensure safety and efficacy of any new COVID-19 medical tools.

We must learn from the past, such as the example of Tamiflu – a drug which the world spent over $18 billion on stockpiling to treat Swine Flu[iii], before it transpired four years later that it was no better than paracetamol[iv]. If there had been full transparency of clinical trial data, we could have avoided this waste of resources and patients would not have been taking unnecessary medication. Yet, we are at risk of this again after declarations of support for Chloroquine (a malaria drug) to treat COVID-19; as result we’re already seeing evidence of overdoses and hoarding of this drug[v]. These claims are being tested now. However, whilst we wait for the scientific evidence to see if it’s effective companies, scientists and governments should not be stockpiling or supporting its use for COVID-19[vi]. The results of these trials must be published in their entirety so they can be scrutinised by researchers before resources and lives are put at risk.

Procurement in health systems is one of the activities most hard-hit by corruption. With medicine and medical supplies shortages being reported, there will be an additional strain on procurement. It’s estimated that 10-25% of all money spent in procurement globally is lost to corruption[vii], and in the EU 28% of health corruption cases are related specifically to procurement of medical equipment[viii]. With the increased demand for medicines and equipment there’s also the potential increased risk of collusion and that suppliers might demand higher prices knowing that governments have no other option but to pay. We are 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, which didn’t provide sufficient protection[ix] and the Spanish government had to send back 9,000 ineffective COVID-19 test kits[x].

Having open and transparent contracting processes would allow red flags of corruption to be more easily spotted, leaving corrupt actors less space to hide and ensuring governments are charged reasonable prices so they can provide the best care possible. If open contracting is in place, procurement performance would be well-documented and could be utilised in decision-making when buying similar products, increasing efficiency of health system financial management and procurement. Additionally, open contracting would reduce the space for potential collusion between a government procurement officer and the supplier providing faulty products.

This is a watershed moment for our health systems. Hopefully it will make every sector think how we can manage this crisis in the most effective and transparent way possible to ensure that public health, not corporate interests is the priority.

 

[i] https://988e032c-518c-4d3b-b8e1-0f903f16a792.filesusr.com/ugd/01f35d_42e869002189401d80a672d4ecff3f73.pdf?index=true

[ii] https://www.bmj.com/content/367/bmj.l6576

[iii] https://www.bmj.com/content/348/bmj.g2524

[iv] https://www.cochrane.org/CD002745/ARI_amantadine-and-rimantadine-to-prevent-and-treat-influenza-a-in-children-and-the-elderly

[v] https://www.theguardian.com/science/2020/mar/25/can-chloroquine-really-help-treat-coronavirus-patients

[vi] https://www.gov.uk/government/news/chloroquine-and-hydroxychloroquine-not-licensed-for-coronavirus-covid-19-treatment?utm_source=e9b36c55-1a1f-4fb8-8215-bb1bf1f82cdd&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

[vii] 5 UNODC, 2013. Guidebook on Anti-Corruption in Public Procurement and the Management of Public Finances, p.1

[viii] http://ti-health.org/wp-content/uploads/2017/01/Making_The_Case_for_Open_Contracting_TI_PHP_Web.pdf

[ix] https://nos.nl/artikel/2328673-honderdduizenden-chinese-mondmaskers-teruggeroepen-uit-nederlandse-ziekenhuizen.html

[x] https://www.businessinsider.com/coronavirus-spain-says-rapid-tests-sent-from-china-missing-cases-2020-3?op=1&r=US&IR=T