From the earliest days of the COVID-19 pandemic, activists and analysts have called attention to the significant corruption risks associated with the response to both the public health crisis itself and the economic disruption it has caused. Anticorruption advocates have highlighted, for example, the corruption risks associated with the distribution of relief funds and personal protective equipment, and have emphasized the need for reforms like enhancing transparency, requiring audits, and ensuring protections for whistleblowers. (For samples of the discussion of the need for anticorruption measures in coronavirus response, see here, here, here, and here.) Yet there has been surprisingly little sustained discussion or planning concerning a specific issue which, while still prospective, is of pressing global importance: the inevitable corruption risks that will be associated with the distribution of a COVID-19 vaccine, if and when such a vaccine becomes available.
This is not to say that there has been no exploration of the subject. Commentators have discussed the difficulties of ensuring that a vaccine is distributed equitably, as opposed to simply being given to the most affluent, and have called attention to the problems of black markets and price gouging that are likely to emerge once vaccines are available. There has also been some general, abstract discussion of the fact that the distribution of a COVID-19 vaccine, once one exists, has significant potential for both grand and petty corruption. Absent from the discussion, though, has been the development of concrete plans for incorporating anticorruption measures in vaccine distribution—plans that take into account the inherent logistical challenges. The World Health Organization (WHO), to its credit, has released a seventeen-page plan for fair allocation of a COVID vaccine, which discusses detailed measures to ensure that vaccines are distributed fairly. However, the WHO plan devotes little more than a page to promises of “strong accountability mechanisms” in the governing bodies to “ensure protection against undue influence.” The WHO does note that the primary role of its own Independent Allocation Validation Group is to ensure that proposals from the vaccine Allocation Taskforce remain “transparent and free from conflicts of interest,” but while this sort of internal monitoring is laudable, the WHO plan conspicuously lacks any further guidance or recommendations on appropriate anticorruption measures once the vaccines are handed over to their allocated countries.
Although the timeline for a vaccine remains uncertain—and there’s no guarantee that a vaccine will be available any time soon—it would make sense for both international organizations and national governments to identify the most likely corruption risks associated with vaccine distribution and to begin developing safeguards to mitigate those risks. While there are many possible corruption risks associated with vaccine distribution, the two most significant are diversion of vaccines and extortion. Let’s examine each in turn:
- Diversion of vaccines: Once a vaccine becomes available, the highest priority for governments will be vaccinating front-line health care providers and the most vulnerable populations, such as the elderly and those with pre-existing conditions associated with greater risk of severe illness. But demand will likely outstrip supply, and it’s easy to imagine that politicians, government officials, or others with influence over vaccine distribution might divert vaccines to friends and family, or to those with strong political connections or the ability to pay or offer favors in exchange for early access. It’s also possible that corrupt officials could misappropriate and sell vaccines on the black market. While we of course do not yet have a COVID-19 vaccine, there’s empirical evidence from other contexts that corrupt diversion of vaccines is indeed a genuine problem. For example, a 2007 study in the Philippines found evidence that rates of local corruption were negatively correlated with vaccination rates among the most disadvantaged households, a finding that suggests that corrupt officials gave the wealthy preferential access to scarce vaccines. According to the study, “the odds of completing vaccination [in an individual] can decrease 4.2 times as a result of a one standard deviation increase in corruption.”
- Extortion: The high demand for a COVID-19 vaccine also creates the opportunity for those who have the power to control access to the vaccine to use this power as leverage to extort favors from those who need it. Again, while we do not have direct evidence regarding this sort of corruption with respect to the as-yet-nonexistent COVID-19 vaccine, research on other vaccines suggests that this sort of extortion may be a substantial problem. For example, a 2005 study on tetanus vaccinations near Lagos, Nigeria found that health care workers extorted bribes from mothers in exchange for vaccinations for their children. Distribution of a COVID-19 vaccine would likely offer similar opportunities.
Fortunately, there are a number of familiar steps that might be taken to reduce the risks and effects of corruption in the COVID-19 vaccine distribution process. The United Nations Development Programme (UNDP) authored a report in 2011 describing tools and best practices to combat corruption in health, including specific recommendations for distributing drugs and equipment supplies. These practices include, among others, tracking shipments in real time throughout the distribution process, creating electronic systems to monitor transport vehicles and inventory, mandating separation of workforce functions, and creating health boards charged with distribution and monitoring of stocks at the facility level. The WHO would do well to commit to implementing some, if not all, of these recommendations.
The UNDP report also recommends coordinating with non-governmental organizations (NGOs) in monitoring drug delivery systems. This suggestion is well-founded. NGOs have long been involved in vaccine distribution and the anticorruption measures that come with the territory. Perhaps most prominently, the Gates Foundation is quite practiced in monitoring what happens to vaccines after they are delivered. “If you get corruption, your measurement system is going to show that,” Gates said in a 2014 interview. “If we pay for health improvement, we can see that that the vaccines got delivered, we can measure the coverage. In fact, there are a few diseases like measles that, if you’re not getting your vaccine coverage, you’ll see measles deaths go up.” COVID-19, with its high infection rate and rapidly developing symptoms, could be just such a disease. The Gates Foundation developed its efforts in this area in years since: as recently as October 2019, the Foundation partnered with Global Integrity to create anticorruption solutions in service-delivery sectors. The WHO’s plan already shows they are open to working with NGOs on vaccine production and distribution. Why not anticorruption monitoring as well?
While no step is likely to be 100% effective, even incremental safeguards could save money, time, and lives. These goals are achievable, should the preparation be put into them. But those plans have to be developed now, rather than once a corruption crisis is already in full swing.