At the start of the pandemic, Germany was desperate for masks. Prices soared as authorities scrambled to secure planeloads of surgical supplies for the nation’s health workers. Two politicians from the CDU, Georg Nüßlein and Nikolas Löbel, were in on the take, earning a combined €910,000 for brokering sales contracts on behalf of the government.
To Sarah Steingrüber, a health expert who studies corruption in the global health sector, crooked deals like these are nothing new. On Friday, March 19, she’ll share her insights at Disruption Network Lab’s online panel Digging Deeper into Healthcare: The Vaccine Rollout, Pandemic Journalism & Corruption.
We caught up with Steingrüber ahead of her appearance to learn more about health corruption and scandal during the pandemic.
From a local to governmental level, there’s been a surprising amount of scandal around surgical masks. We all know about the CDU corruption, but lesser known is that, in March last year, Europol reported that 34,000 counterfeit surgical masks were seized globally. Where else have you seen corruption during the pandemic?
I think it’s important to differentiate between actual corruption that’s occurring and corruption risks. There are lots of dynamics that can increase the opportunities for corruption. At the service delivery level, where doctors interact with patients, you’re going to have the traditional forms of corruption that you would normally see: bribery, absenteeism, overcharging for services and fraudulent insurance claims, both for patients and providers. These are ongoing issues. What is happening more and more during the pandemic is the distribution of counterfeit and falsified products, because now there is a lot of scarcity for things that people either think they need and they actually do need.
You have a lot of individuals who have jumped on the opportunity to make a buck on the back of scarcity. There’s not a solid enough legislative toolkit to prosecute that kind of behaviour. You’ll often find people who were involved in narcotic drug trafficking moving over to falsified drugs because the penalties can be as low as six months in jail, as opposed to more dramatic consequences. If you are a pharmacist who is peddling falsified drugs, sometimes you won’t even have your licence taken away. That’s just a gap in the law that creates a window of opportunity.
How prevalent is this kind of corruption in Europe?
It happens a lot in all jurisdictions but we have less data for high-income countries. That’s just kind of the way the data goes. It’s not Covid-19-specific, but if you look into Italy, the Mafia has a lot to do with stealing drugs from hospitals and reselling them. Interpol’s Operation Pangea took place between March 3 and 10, 2020. It was a well-established international effort to disrupt the online sale of counterfeit and illicit health products. During that period, 121 arrests and €13 million in potentially dangerous pharmaceuticals were seized.
If you are a pharmacist who is peddling falsified drugs, sometimes you won’t even have your licence taken away. That’s just a gap in the law that creates a window of opportunity.
It’s an increasing problem because of the pandemic, which creates scarcity and opportunity. Regulatory authorities who monitor these things are typically very underfunded or funded by private enterprise, which has its own bag of problems. The weak surveillance system, a desperate population and a window of opportunity make for the perfect storm. The data might be slightly off for higher-income countries, but it’s still there.
Of 1,500 reports made to the WHO, only 12% of those were from healthcare professionals, which is kind of concerning that they are the last bastion to protect users. That shows that a lot of people at the frontline will not be so forthcoming in reporting something, as they’re not sure they have enough information. Did the patient die of other causes? Is the medication just not working on that patient? And so on.
What does that figure of 12% tell you?
Well, you wouldn’t want it to be 100%, but it should be a bit higher. What’s concerning is that they were worried that, if they did report something, it would reflect badly on their superiors. Even for just reporting, not whistleblowing, most in health are not keen to question the actions of their superiors in procuring the products. There are a lot of opportunities there to improve awareness and collective spirit. It’s not anyone’s fault, necessarily. The more we report, the more we can quarantine these products correctly out of the system and ensure that people aren’t taking poor-quality products.
In Neukölln last year, there was a scandal where fraudsters posed as health department employees and offered coronavirus tests. Within the German context, how common is it to see this low-level corruption and how can it be tackled?
If there is going to be some scandal, it’s going to be at high, decision-making levels, like we’ve seen with this mask scandal. It’s going to involve political leaders who are making bad judgements. With the bigger scandals, it takes time to find out information about them. Although it happened, it’s not typically going to be like the door-to-door knocking case in Berlin.
In Germany, there are two things linked to ownership. To have a mandated understanding of who’s making political decisions and what their beneficial ownership looks like, we need to know who owns what company and who has stakes in what company. Or do we have people in government who are connected to companies who get public procurement, if this is a benefit to them personally?
In Germany, there is a huge need for greater transparency and a more open procurement method. I think with Covid-19, there’s been an attempt to be a bit better. There’s so much scrutiny as people are pretty concerned about where their tax money is going. The recent mask scandal demonstrates that there are consequences for the individuals who thought they could get away with it. If you don’t have the methods to prevent it, at least have the ability to impose sanctions.
How difficult is it to report corruption or be a whistleblower within a grand-level corruption case? What challenges might they be faced with?
We need to increase safety for whistleblowers. In countries like the US, you do have protections, but then there is always the risk that people will start accusing the whistleblowers of having done something improper within the company. When there’s a grand-level of corruption, someone’s life can really be shaken up.
The recent mask scandal demonstrates that there are consequences for the individuals who thought they could get away with it.
With the whistleblowers who I’ve come into contact with, or investigative journalists who have written important pieces, their lives continue. But there’s typically a year or so where they will go through hell. Anything that will improve the conditions for people to come forward will help improve things overall.
Now that we’re in a period of mass Covid-19 vaccinations, do you see the potential for future corruption?
I think there are two things. Firstly, there’s a huge need to do a retrospective study into how everything has been handled. Everything happened so quickly and everyone had to move so quickly, so there will have been some people doing stupid things. But it is also likely that some people have done bad things intentionally. There is a strong need for retrospective audit.
Secondly, what do I see going forward? If the vaccines are redundant in a few years, we’re then back to square one and everything has to start fresh again. So I think there needs to be a lot of rigour around the quality of vaccines to ensure we don’t have falsified ones. There needs to be a lot more scrutiny of the vaccine rollout at all levels. Ensuring that all of the vials of the vaccines are returned so that people can’t get their hands on them and fill them up with water to resell.