Transparency and accountability: Vital lessons from COVID-19 for leaders to act on now

When COVID-19 struck, not only were health systems woefully unprepared for a pandemic, but opacity and a lack of accountability hampered the ability to respond effectively at all stages, in wealthy and lower income countries alike. The WHO Director General, Dr. Tedros Adhanom Ghebreyesus, warned just this May that the next pandemic could be even deadlier than COVID-19, illustrating just how crucial it is that national and global health systems are strong enough to respond. Good governance, transparency and anti-corruption mechanisms are fundamental to this.  

Transparency International’s Global Health programme (TI-GH) has analysed findings from a whole series of research reports, which we have funded or assisted, in our report: ‘Navigating corruption and promoting transparency: Lessons from the COVID-19 pandemic for future health emergencies’. Drawing on this evidence, we looked at transparency and corruption risks across four vital areas and distilled learning to inform policy recommendations and solutions that will drive much-needed progress change in the coming months and years.  These include:    

1. The international financing of emergency responses.  
2. Public procurement during emergencies.
3. Purchasing of COVID vaccines. 
4. Deployment of vaccines. 

The (not so) hidden threat to health 

Whilst it is widely acknowledged that a lack of planning hampered the initial response, failures to incorporate anti-corruption or transparency regulation into emergency procurement procedures also had a major impact, not only risking vast amounts of public resource, but also potentially exposing the public to sub-standard equipment and treatments. In the UK, 14 companies incorporated in 2020 received contracts worth £620 million of which £255 million went to those less than 60 days old. Similar patterns were observed across the EU. Allegations of corruption in procurement in the UK were widespread. The Good Law Project, a non-profit organization, brought legal action against the government, accusing it of failing to disclose details of contracts awarded to private companies for the supply of PPE. It was later revealed that procurement had gone through a “VIP” lane where politicians from the ruling party could “fast-track” businesses, some of which were associated with government officials. The allegations raised concerns about conflicts of interest and lack of transparency in the procurement process. 

Even in the 18 months since our data began, European procurement systems remained at a higher risk of corruption than pre-pandemic levels, suggesting a sustained hit to corruption control. These heightened risks also routinely spread from the buying of COVID-19 specific goods to general health and even non-health buying. In Boliva, the Inter-American Development Bank raised concerns about purchase of inappropriate ventilators at inflated prices of USD $27,683 each, while the actual cost was a quarter of that amount. Whilst in Brazil, former President Jair Bolsonaro faced allegations of irregularities in a contract for the Covaxin vaccine developed by India’s Bharat Biotech. A Brazilian Health Ministry official claimed to have received pressure to expedite the deal, which rose significantly from the expected USD $1.34 per dose to USD $15 and which involved an intermediary company. 

Corruption also spread to bribery for COVID-19 vaccine access. Findings from a survey conducted in 2021 suggest that 10% of the Ugandan population paid a bribe to receive a vaccination.  

Despite some progress in integrating transparency and accountability measures into emergency financing measures from the IMF, the extraordinary circumstances of the pandemic, combined with the large, rapid disbursements to high-risk regions, escalated the potential for emergency fund misuse. According to Cameroonian media, an audit by Cameroon’s Chambres des Comptes exposed broad corruption and mismanagement of 180 billion CFA (USD $333 million) in IMF COVID-19 response funds. This led to recommendations of initiating 10 legal cases for suspected criminal breaches. 

Read the full report: ‘Navigating corruption and promoting transparency: Lessons from the COVID-19 pandemic for future health emergencies’

Lessons for the future 

With the COVID-19 pandemic still fresh in people’s minds, national and global leaders have a unique window of opportunity in the coming months to ensure learnings – including lessons on the global failure to get transparency and accountability right – are not forgotten and inform future plans.  On 17th July 2023 the Pandemic Accord Intergovernmental Negotiating Body will meet to continue to shape a global agreement on pandemic prevention, preparedness, and response. Whilst September brings UN High-Level Meetings on both pandemic preparedness and on Universal Health coverage.   

We want to see UN member states acknowledge the detrimental impact that corruption and opacity has on the effectiveness of health systems, in weakening trust in public services and on undermining progress towards Universal Health Coverage. Alongside this, we are calling for specific policy commitments which integrate anti-corruption and transparency solutions into both the global health architecture, and into national health systems. Doing so will help to ensure health systems that are not only resilient, transparent, and fair, but also inherently more effective and trustworthy.  

Over the next three months we want to see progress towards:  

• The Pandemic Preparedness Accord incorporating robust anti-corruption and transparency measures to ensure integrity in crisis response and reinforce public trust. With the Intergovernmental Negotiating body meeting again next week, we would like to see action taken to ensure that the Accord’s key principles of equity, transparency and accountability truly reflected in the accord itself; 

• • Incorporation of measures to ensure equitable global access to vaccines and medical products 
  • Measures for governments to publish information on public expenditure, and procurement should be included to increase public trust in emergency responses 
  • Limits made on confidentiality clauses in contracts for medical products, ensuring that confidentiality provisions are clearly marked with the reason for redaction. 
  • Recognise the need to strengthen the capacity of national and international regulatory authorities to effectively monitor medical supply chains 

• Upcoming UN High-Level Meeting resolutions on both Pandemic Preparedness and Universal Health Coverage should recognise the barrier that corruption poses to both global health security and Universal Health coverage. Resolutions should 

• • Recognise the need to embed anti-corruption and transparency provisions into health systems  
  • Commit to improving the transparency of financing for the health sector, both in emergencies, and in the delivery of routine care 
  • Recognise the need to strengthen the capacity of national and international regulatory authorities to effectively monitor medical supply chains 

In the longer term, it is vital that: 

• International Financial Institutions, including the IMF and World Bank, enforcing stringent anti-corruption provisions and governance mechanisms within their financing agreements and internal operations, particularly during health emergencies. 

• Nation states mainstream transparency and anti-corruption efforts in health to build a more sustainable and resilient system. This includes harnessing the power of digitisation for transparency and maintaining stringent monitoring of key goods and resources. 
• Private entities, especially pharmaceutical companies, should remove the veil of opacity in global emergencies, and take steps to ensure proactive contract disclosure, support collective action, and reducing resistance to transparency. 

Jonathan Cushing, Programme Director, Global Health