Compounding Effects of Corruption on COVID-19
The COVID-19 pandemic has brought on challenges for communities around the world, including virus surveillance and containment, economic disruption, and unprecedented stress on healthcare systems. Communities have suffered extraordinary loss, and though the end may now be in sight with the development and administration of viable vaccines, the impacts and demands of this pandemic continue to evolve at unmanageable rates. This mass instability has forced governments and organizations to make decisions based on limited evidence and take immediate action to reduce the spread of the virus and protect their populations. Though such rapid responses are necessary to save as many lives as possible, urgency and uncertainty often creates the perfect opportunity for another crisis to occur: a crisis of corruption.
Original illustration by Cassandra Seal.
Corruption is commonly defined in international fora as “the abuse of entrusted power for private gain” [1]. It can happen in businesses, government, media, health systems, and civil society, and can take many forms including but not limited to: bribery, fraud, and exploitation.
Though corruption can occur at any level, in any institution, it has disastrous effects within the health sector. In 2013, Transparency International, a global anti-corruption agency, found that in 42 out of the 107 countries who were included in their survey, more than 50% of their citizens viewed the health institutions in their country as corrupt or extremely corrupt [2]. The impact of this widespread corruption is averaged to account for a loss of approximately $455 billion of the $7.35 trillion spent on healthcare globally each year [3]. What’s more, the health impacts of corruption are devastating. It has been estimated that more than 140,000 deaths of children under the age of five are either directly or indirectly attributed to corruption [3,4]. This disturbing impact is largely due to the barriers to accessing health services created when, for example, funds earmarked for public health and sanitation services are misused, or a bribe is needed to secure access. Such forms of corruption, and many others result in the denial of quality health and sanitation services to millions of people [4]. Furthermore, the health impacts of corruption are not distributed equitably. Corruption has a more detrimental impact on lower-income countries and people of lower socioeconomic status [5].
Beyond financial, health, and equity impacts, corruption has long-term deleterious effects on health systems. Not only does it decrease the accessibility of healthcare services, it also distorts national and international-level health investments through the diversion, misallocation, and embezzlement of funds [5]. Funds can be misused at all levels including by funding agencies, government officials, program managers, and frontline workers. This corruption within health sectors creates uncertainty and mistrust between citizens and public officials, leading to a lack of compliance with public health policies [6, 7]. One major threat borne out of this mistrust is the recent global surge in vaccine hesitancy which the World Health Organization (WHO) has deemed a top ten threat to global health [8]. This threat has already resulted in the resurgence of measles, a deadly virus, in many countries including Poland, Germany, Ukraine, and the United States [9]. Now, in light of the COVID-19 pandemic, which has resulted in almost 5 million deaths worldwide [10], the risks associated with vaccine-hesitancy are higher than ever.
Beyond financial, health, and equity impacts, corruption has long-term deleterious effects on health systems
As we move through the phases of the COVID-19 pandemic, health systems globally are facing unprecedented and unpredictable demands. Governments and international organizations are rushing to reduce the spread and minimize the virus’s harm. This urgency has resulted in the rapid flow of large amounts of funding to respond to both health and economic crises. Additionally, with the urgent need for action, procurement protocols which govern the acquisition of goods and services have been simplified, meaning that many corruption prevention and enforcement mechanisms have been suspended. While these measures were necessary to facilitate the rapid mobilization of health, social, and economic aid, they have created conditions conducive to corruption.
What’s more, in our digital era, the threat and harms of corruption are amplified by the spread of misinformation. The spread of misinformation, increasingly referred to as “fake news,” is commonly deployed to undermine and discredit accurate news reporting [11]. While the landscape of information dissemination is ever-evolving, specifically in relation to social media, anti-corruption movements rely heavily on independent media outlets as well as social media as means of communication, making the spread of misinformation and its resulting mistrust a legitimate threat to anti-corruption efforts.
While [COVID-19] measures were necessary to facilitate the rapid mobilization of health, social, and economic aid, they have created conditions conducive to corruption
Over the course of the pandemic, corruption and fraud have revealed themselves in the form of price gouging, flawed goods, and fake and counterfeit medicines and Personal Protective Equipment (PPE). Such forms of corruption can cause varying degrees of harm including increasing exposure to COVID-19, poisoning from counterfeit medicines, and the inaccessibility of life-saving medications and equipment. Price-gouging, while not always illicit, is skewing the costs of essential goods and denying people life-saving treatments. This issue has caused countries around the world to launch investigations into online and in-person sales of products such as hand sanitizers, masks, and other PPE [12,13]. A survey by a German anti-fraud consulting company found that the majority of 58 countries they surveyed experienced corruption related to purchasing and accessing PPE [14]. The survey, conducted in April 2020, aimed to estimate the impacts of fraud and corruption on health systems during the COVID-19 pandemic. The most widespread issue reported by 81% of the countries was PPE being stolen, sold at exceedingly high prices, or bought and never delivered. An example of this issue includes a shipment of 500,000 misbranded and defective ‘N95 masks’ from China to the United States [15]. The survey concluded with the finding that 80% of respondents rated issues of fraud and corruption on healthcare systems as important or very important [14]. In another example, the Democratic Republic of Congo and Cameroon have found massive quantities of fake chloroquine, a drug unjustifiably promoted by former US President Donald Trump, being widely circulated [16]. In April 2020, this same drug was responsible for French police removing over 70 fraudulent websites that falsely claimed to sell chloroquine [17].
With this marked increase in corruption, we are led to ask the question: how can we prevent and address corruption while still responding to the changing demands of the pandemic?
As a result of the advocacy work of anti-corruption agencies, governments and international organizations, including the World Health Organization and the World Bank Group, are beginning to publicly address corruption in their own operations and in their funded programs. Responses have taken many forms including citizen reporting portals, fact-checking databases, and audits and investigations.
The Ontario provincial government, for example, has set up an online portal where citizens can report any price gouging that they’ve encountered since March 17, 2020 [18]. On a global scale, Transparency International has created Advocacy and Legal Advice Centres (ALACs) that aid citizens in more than 60 countries to report corruption issues related to COVID-19 [19]. These centres assist people in accessing information, safely reporting offenses, and advocating for government transparency and accountability. Since January 2020, the ALACs have supported more than 1,800 people in seeking support and reporting COVID-19-related corruption [19].
Another innovation borne out of the COVID-19 pandemic is the #CoronaVirusFacts Alliance led by the International Fact-Checking Network at the Poynter Institute that unites more than 100 fact-checking organizations around the world [20]. This alliance provides a platform where people can verify information surrounding the COVID-19 virus, which aids in reducing the spread of misinformation [21].
These solutions are just a few of the measures in place to combat the existing and future incidents of corruption incited by the COVID-19 pandemic. Corruption during this time has the potential to create negative impacts that long outlast the pandemic itself. As stated by the United Nations Secretary General, “corruption is the ultimate betrayal of public trust” [22]. Corruption has the potential to severely hinder the achievement of the 2030 Sustainable Development Goals (SDG) including, but not limited to SDG 3 Good Health and Well-Being, and SDG 16 Peace, Justice, and Strong Institutions [22]. In order to combat this issue, the global health community needs to increase transparency and accountability within our systems and continue to support and empower anti-corruption organizations. COVID-19 has already had devastating international impacts, and in order to reduce the lasting harm caused by this pandemic, we need to ensure that anti-corruption, accountability, and transparency efforts remain a central part of the COVID-19 response.
Andrea Bowra (she/her) is a PhD student in Social and Behavioural Health Sciences at the Dalla Lana School of Public Heath, University of Toronto. She is a member of the Collaborative Specialization in Global Health and a research assistant with the World Health Organization Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector. Andrea's doctoral research focuses on corruption in multinational pharmaceutical companies, and specifically how and why criminal justice systems are failing to hold companies accountable for their actions.
References
[1] Transparency International. (2020, December 16). What is corruption? https://www.transparency.org/en/what-is-corruption
[2] Transparency International. (n.d.). Global corruption barometer. Retrieved December 16, 2020, from https://www.transparency.org/en/gcb
[3] National Academies of Sciences, Engineering, and Medicine. (2018). The critical health impacts of corruption. In Crossing the Global Quality Chasm: Improving Health Care Worldwide. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK535646/
[4] Hanf, M., Van-Melle, A., Fraisse, F., Roger, A., Carme, B., & Nacher, M. (2011). Corruption kills: Estimating the global impact of corruption on children deaths. PLoS ONE 6(11), e26990. 10.1371/journal.pone.0026990
[5] Witvliet, M. I., Kunst, A. E., Arah, O. A., & Stronks, K. (2013). Sick regimes and sick people: a multilevel investigation of the population health consequences of perceived national corruption. Tropical Medicine & International Health, 18(10), 1240-1247. https://doi.org/10.1111/tmi.12177
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[9] Kelland, K. (2019, November 5). Corruption and suspicion brought measles back into Europe. Irish Examiner. https://www.irishexaminer.com/opinion/commentanalysis/arid-30962006.html.
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[16] World Health Organization. (2020, April 9). Medical Product Alert N. 4/2020: Falsified chloroquine products circulation in the WHO region of Africa. https://www.who.int/news/item/09-04-2020-medical-product-alert-n4-2020.
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[18] Ontario Government. (n.d.). Report price gouging related to COVID-19. https://www.ontario.ca/form/report-price-gouging-related-covid-19.
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