Vaccinating against corruption?

The publication by Pfizer and BioNTech of the interim efficacy results for their COVID-19 vaccine candidates made headline news around the world this week. With people now asking when, rather than if, a vaccine will become available it is critical that we begin to plan how we can ensure the right people get injected.

Whilst there have been concerted efforts at the international level to ensure there is equitable distribution of an eventual vaccine between countries through the COVAX facility, many countries have not fully developed equitable and transparent distribution plans. Reports from China a few weeks ago provided a glimpse of how dystopian vaccine distribution may be if we do not put the right safeguards in place. Get distribution wrong, and we will fail to defeat COVID-19.

Corruption was already draining the health sector of USD $500 billion annually, and it has now made its way into the COVID-19 response. Transparency International’s work in several countries monitoring procurements made in response to COVID-19 has already exposed corruption risks: In Kenya, we raised concerns over the inflation in prices of drugs and PPE in the COVID-19 response; and in Bangladesh we flagged the problem of ruling party committee involvement in the COVID-19 relief response - where a significant section of local level political leaders and activists are being reportedly found to be involved in widespread corruption of various types including embezzlement, hoarding and misappropriation of relief goods. These issues are not restricted to low and middle income countries with weaker health systems. In the UK, lucrative procurement contracts were reportedly awarded to dubious companies, some with government connections.

The clear unmet demand for a vaccine and willingness to pay for ‘immunity’ is cause for concern. Not only does it raise questions about equity in terms of who can pay, but it also opens the door to corruption in the unprecedented rush to create and deliver a vaccine. The vaccine is likely to have a high ‘street value’, making government supplies an attractive target for theft and diversion unless adequate safeguards are built into supply chains. Strong surveillance and oversight mechanisms will be needed to ensure that falsified and substandard vaccines do not get into circulation. Even when vaccines do make it to public hospitals and clinics, opportunities for corruption at the point of delivery, such as under-the-table payments, abound.

Since the start of the pandemic earlier this year the TI Health Initiative has been working with our national chapters, governments, and other funding agencies to try and minimise the corruption risks in the COVID-19 response. We pivoted our ongoing project work, strengthening procurement transparency in the health sector in Nepal, Kenya, Uganda, South Africa and Zambia, training journalists on how to uncover corruption in the health sector and scaling up social accountability activities.

In conjunction with Open Contracting Partnership (OCP), we are working with 9 countries, including 4 TI chapters, to actively monitor procurement to ensure equitable access to resources and medicines in the COVID-19 response.

As the pandemic has progressed, so has our work, and since the summer we have been engaging with funding agencies and governments to highlight the need to plan and act now to ensure an equitable and transparent national distribution process. We are currently working to develop country level frameworks to ensure distribution is equitable and transparent, and plan to monitor distribution globally. The challenges of distributing a COVID-19 vaccine are very different to those of other vaccines- target groups for many vaccines are young children, rather than adults for instance, and we do not know whether vaccines will be thermostable or require specialised cold chains.

At the Health Initiative we see the need for civil society to engage with governments in the planning and monitoring of distribution. National allocation frameworks must be developed transparently and collaboratively to ensure that distribution is equitable, and access to vaccines doesn’t become a weapon to discriminate against vulnerable groups.

We are also looking at how we can work with governments and those distributing vaccines to ensure that supply chains have corruption safeguards in place, and to ensure that systems are in place to actively monitor the implementation of the framework and vaccine rollout. These could range from the technologically complex, using RFID tracking on vaccines, through to awareness campaigns on reporting attempted corruption, and community-led distribution monitoring.

With so much resting on the successful deployment of a vaccine, one thing is clear- it cannot go wrong. The health sector has traditionally paid little attention to corruption and its impact on health outcomes. We believe that if we can get this right, a corruption free COVID-19 vaccine distribution will not only tackle the COVID-19 pandemic, but leave behind stronger health systems, that are better equipped to tackle the corruption pandemic in the health sector.

For more information on the work of the TI Health Initiative contact Jonathan Cushing, Head of Projects, TI Health Initiative