Times of social, political, and economic stress present opportunities for corrupt actors to act corruptly—and the crisis caused by the novel coronavirus will be no exception. As the vast majority of Americans pull together to protect the country’s most vulnerable and ensure that medical and financial resources go where they can do the most good, it is hard to imagine that a few fellow citizens would take advantage of their public roles to facilitate their private gain. But alas, prior pandemics demonstrate that this will be the case.
Dangers of Health Care Corruption
As the United States ramps up its health-related procurement, lessons learned in health-sector corruption elsewhere show that procurement and contracting malfeasance could lead to deadly consequences—inflated prices or poor-quality goods, perhaps in exchange for bribes. In prior epidemics, corruption compromised containment efforts, such as when corrupt actors used petty bribes and other favors to avoid quarantines, roadblocks, and safe body collection procedures. Even ventilators and other medical oxygen-related equipment have been the subject of bribes and kickbacks, sometimes leading to the tragic deaths of patients. These examples demonstrate the worst case of what can happen without resilient anti-corruption policies.
The U.S. medical establishment is the frontline of this fight, and an overwhelming majority of medical personnel are dedicated, ethical individuals doing the best they can in trying circumstances. But corruption in U.S. health care is a reality. A study published in the Journal of the American Medical Association estimated that $98 billion were lost to fraud and abuse in Medicare and Medicaid in 2011 alone.
Pharmaceutical supply chains are also very susceptible to corruption. The coronavirus crisis comes at a time when U.S. citizens are already wary that the pharmaceutical industry may not have patients’ best interests at heart. The United States is still in the midst of an opioid crisis, with ongoing lawsuits by states and localities over the role opioid producers, such as Purdue Pharma and Johnson & Johnson, and medical suppliers, such as Walgreens, CVS, and Walmart, played in exacerbating the opioid crisis. Further undermining public trust in pharmaceuticals, the cost of insulin tripled between 2002 and 2013, leading the Minnesota attorney general to sue three insulin makers in 2018 for deceptively raising prices. Corrupt actors can use these fears for personal gain. For example, counterfeit malaria medicines are estimated to lead to 450,000 preventable deaths worldwide each year, and the incentives for creating such fake pharmaceuticals in the coronavirus crisis will be immense. Thus, the U.S. pharmaceutical industry will be under intense pressure to prove they can respond responsibly and ethically to the coronavirus.
Medical supply chains highlight another concern over corruption as the coronavirus spreads: federal, state, and local authorities—along with U.S. citizens—will find it harder to provide effective accountability and oversight over them. With new federal disbursements expected to top $1 trillion, oversight and accountability would be a challenge even in the best of times. But the coronavirus’s unique challenges make oversight even more difficult. Officials may be unavailable for public duties due to quarantine requirements, their loved ones falling ill, or falling ill themselves. Meanwhile, quarantine requirements also make it more difficult for regulators to physically inspect supply chains, visit pharmacies and public health providers, or conduct detailed investigations. Likewise, inspectors general, tax officials, and other oversight officials will have difficulty following the disbursement of funds and other resources as part of the coronavirus response. Law enforcement agencies have their hands full with demands to assist their fellow citizens, so crime and corruption cases may drop in priority.
Meanwhile, the media and civil society will also find it more difficult to hold their public officials to account. Local newspapers including the Monterey County Weekly, the Portland Mercury, the Sacramento News and Review, and the Chico News and Review are undergoing layoffs as a result of the virus; this is especially troubling because the U.S. West Coast has been so hard hit by the coronavirus. On March 18, journalists at the Military Times and Navy Times announced they were being furloughed. As two U.S. Navy hospital ships deploy and as pressure continues for the Department of Defense to expand support to civilian officials, losing the investigative journalism expertise in this vital sector will make oversight more difficult. Why does this matter? Because as Washington Post columnist Margaret Sullivan notes, “One problem with losing local coverage is that we never know what we don’t know. Corruption can flourish, taxes can rise, public officials can indulge in their worst impulses.” As money flows to communities to combat the coronavirus, this lack of local media is all the more troubling.
At the same time as media faces staff shortages and their own quarantine and health issues, Americans face new challenges in getting information from their government. For example, on March 17, the city Council of the District of Colombia unanimously approved a provision in their emergency response plan that would allow the D.C. city government to delay responding to records requests. The day before that, the Federal Bureau of Investigation announced that it has stopped accepting Freedom of Information/Privacy Act (FOIPA) requests and sending out electronic responses; only FOIPA requests sent by standard mail would be accepted. Given that many of these employees should be working from home, it is unclear who would be available to accept and process that mail in a timely manner. This is occurring at the same time as some business regulations are being relaxed, often at the request of business interests. The U.S. Chamber of Commerce, for instance, is advocating that portions of the 2017 tax law associated with offshore profits be lifted, which could facilitate tax avoidance and evasion just when those tax dollars are most needed.
Meanwhile, the ability of citizens to hold their local, state, and federal elected officials to account will be strained due to the necessary cancellations of institutions like city council meetings and state legislative hearings and while Congressional offices are closed to visitors.
There are a number of top-down and bottom-up transparency, accountability, and good governance (TACCGG) measures that can help limit coronavirus–associated corruption. First and foremost, TACCGG measures should be an integral part of the legislative bills flowing through Congress. The flow of money and the contracts associated with this new funding should have the highest levels of transparency. This includes making contracts publicly accessible. The use of anonymous companies in any contracting or subcontracting should be expressly forbidden as the lack of beneficial ownership information already facilitates crime and corruption. Contractors should be required to include anti-corruption clauses in their contracts (examples of these can be found here) and clawback clauses so that money already doled out to firms can be more easily returned to taxpayers in the event of malfeasance.
Information is an essential aspect of anti-corruption. For that reason, FOIAP requests should be considered essential services. Likewise, to ensure accountability, the work the Government Accountability Office, agency inspectors general, and other accountability institutions should be considered critical functions and their personnel prioritized accordingly. To protect those workers, secure communications systems that allow accountability personnel to work from home while protecting sensitive information should be prioritized for these workers. Additionally, whistleblower laws should also be strengthened to help ensure that those who see corruption have strong incentives to report it and to help limit retaliation against them.
There is a great deal that citizens can do to hold the government to account as well, even while on quarantine. First, citizens can support their local newspaper. To afford to do their jobs, local media need subscriptions and donations. Likewise, charitable foundations should consider expanding their funding of independent local media. Those stuck at home can also learn the skills to become their own citizen journalists. Organizations like Bellingcat have reems of information on how to become a citizen journalist, along with opportunities to help in crowdsourcing for fact-checking and investigations.
Second, citizens should demand that state and local hearings, town hall meetings, school board meetings, and so on be held virtually. Citizens should attend virtually, ask tough questions, and demand information on how coronavirus responses are being rolled out.
And finally, citizens should monitor and demand the highest level of TACCGG from their state and federal politicians and public servants. The Coalition for Integrity publishes the States With Anti-Corruption Measures for Public Officials Index, grading all fifty states and the District of Columbia on regulations governing transparency and ethics. In their index, which is on a scale of zero to one hundred where higher numbers indicate more stringent anti-corruption measures, no state even scored an eighty, and North Dakota scored an abysmal perfect zero. Being stuck at home on quarantine is a great time to find out how one’s state ranks and advocate with one’s state representatives for better financial disclosure and conflict of interest regulations. Likewise, citizens can call their Congressional representatives to demand good oversight and accountability protections in the series of coronavirus bills making their way through Congress.
Putting good TACCGG legislation and regulations in now will save lives from the coronavirus. As prior crises have shown, jailing wrongdoers will not bring back the lives lost to misappropriated tests or ventilators nor recreate the bankrupted small businesses who did not receive the government assistance they should have. It is thus imperative that government agencies and citizens work together now to fill oversight and accountability gaps that will inevitably emerge.