Covid Response Marred Badly by Corruption in Health Systems

Bharat Dogra

There are increasing apprehensions worldwide that the ability to minimize pandemic related distress and damage is being compromised seriously by widespread corrupt practices at various levels. Several warnings have being voiced already that this is leading to very heavy costs and even loss of precious human lives.

In order to appreciate how heavy  such costs can be, some key information about the tainting of health systems by corruption even before the advent of Covid-19 can be useful. It is shocking to know that even in pre-Covid times corruption was responsible at least partially for about 140000 child deaths in the age-group up to 5 years. Infant and child mortality in countries having high levels of corruption has been found to be at least twice as high in countries with high levels of corruption compared to infant and child mortality in countries with low levels of corruption. The financial costs of health fraud and corruption have been estimated at a whopping $  455 billion  in the most widely cited study on this issue. Even this may be an underestimate as another study of fraud costs in the health system of just one country the USA estimated this to be $100 billion and $170 billion. ( All these are estimates based on various well-regarded studies quoted in a book of the National Science Academy of the USA titled Crossing the Global Quality Chasm : Improving Health Care Worldwide).

It was in this pre-existing situation of high and widespread prevalence of corruption in the world health systems that the Covid pandemic struck in 2020. Predictably, when the corrupt elements were already so strongly entrenched they also had a strong tendency to use  the new situation to their further advantage by using their old tricks (and learning a few new ones as well). As a report of Transparency International, ( U.K, branch) titled ‘Corruption and Covid-19’ ( hereafter referred to as the TI report ) has so aptly observed, “ Supply chain shortages, the need for a rapid response and the general disruption caused by the pandemic have made governments, public sector procurement  and business easy targets for those who would exploit the crisis for personal gain.”

In these conditions, the TI report notes, in many countries normal oversight in the health procurement process was bypassed in the name of expediency and decisions were made without ensuring transparency . The first antibody tests the UK government bought in bulk were found to be so unreliable   that they were unusable.  Other equipment also proved to be substandard. Brazil, the USA, Slovenia, Bosnia and Romania  were among those several countries where lucrative contracts were awarded to the well-connected, potentially to the detriment of those with more expertise. In the UK, the TI Report notes, in some cases even businesses with no expertise at all were given million pound orders.

In fact the influence of corruption goes beyond such contracts. As the TI report tells us, some businesses have seized on  the crisis to attempt to aggressively influence decisions governments are taking on wider issues. “ The  disruption caused by COVID-19 combined with the need for swift decision has created the perfect conditions for these irresponsible lobbying practices to thrive.”

The TI Report notes with concern that now involved in the race for vaccines and treatments for Covid too many pharmaceutical companies  and public research bodies are already notorious for failure to publish full results and lack of transparency in their data, creating opportunities for data manipulation which in turn can put the public at risk.

A German organization NEMEXIS conducted a study of Covid related corruption in 58 countries, covering 76 per cent of world population, based mainly on responses from anti-fraud activists. This study found corruption in purchase of Personal Protective Equipment ( PPE) to be most prevalent—this was reported from 81 per cent of the countries covered in this survey. Apart from the loss to scarce budgets, any compromise of quality of PPE caused by corruption is of course of even greater concern compared to the direct budget loss. This can also be stated in the context of purchase of other equipment regarding which too corrupt practices were reported in the majority of countries covered by the NEMEXIS survey,

Perhaps the most disturbing finding of this survey is that respondents linked fraud and corruption to suspected deaths in one-third of the countries covered by the survey. In one fourth of the countries early warning whistleblowers ( who tried to expose corruption) had suffered. What is no less disturbing is the expressed  view of as many as 80 per cent of the respondents of this study that they consider the impact of fraud and corruption on their health system to be very important or  important—in fact 59 per cent said this is very important while 21 per cent said that this is important.

In another study the Lawyers’ Council for Civil and Economic Rights ( New York City Bar and Cyrus K. Vance Centre for International Justice) has stated that government contracts for the corona-virus response have been riddled with irregularities in dozens of countries.

Clearly corruption in Covid related matters can prove very costly in various ways, including loss of precious human lives. In the case of the health systems of a developed country like the U.K. this corruption has been found to be very extensive by various studies and investigations already, and one shudders to think  what is the real situation in those  regions ( such as South Asia) where levels of corruption in health systems in normal times had been found to be much, much higher. There has been a lot of sporadic evidence based on real horror stories but this needs to be brought together by better organized investigations. Certainly there is a very strong case, as a pointed out in the studies quoted above, for strengthening anti-corruption measures and protection of whistleblowers.