FT Health: Holding governments to account for Covid-19 response

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Concerns grow around health procurement

Pitched against the substantial resources of the British government, a tiny non-profit organisation is challenging how a small company with no prior expertise in medical equipment supplies won a multimillion pound contract to provide life-saving coronavirus supplies to the NHS.

The Good Law Project, supported by crowdfunding and overseen by the barrister Jolyon Maugham, expects to hear later this month whether it has been granted judicial review over the terms of the award to supply personal protective equipment granted to PestFix, a pest control business with 16 staff and net assets of £19,000.

The scrutiny is part of a growing international drive to hold governments to account over the nature and costs of their responses to coronavirus, with concerns over opaque or allegedly inappropriate health procurement practices in countries from Bolivia to South Africa.

The Good Law Project has launched actions querying other awards including to Ayanda, a financial trading business controlled by an offshore company, to whom Andrew Mills, until recently a member of the government’s Board of Trade, is a senior adviser. Ayanda won a £252m contract for face masks, many of which could not be used because they were judged to not provide sufficient protection.

In conjunction with three opposition MPs, the project has also challenged the failure of government to publish details of these and other contracts within 30 days. Mr Maugham says: “In my own mind, the reason it is not publishing is because stuff has gone wrong with the contracts, and it doesn’t want us to know while there is still broad interest.”

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The companies concerned have defended their reputations and actions, while the government has called “wholly fanciful” the idea that it could have run a competitive tender as worldwide demand surged during March, tipping the balance of power to suppliers who raised prices and demanded upfront payments.

In response to queries last month, a government spokesperson told the FT: “There is a robust process in place to ensure orders are of high quality and meet strict safety standards, with the necessary due diligence undertaken on all government contracts.”

According to Mr Maugham, the authorities should have acted far more swiftly, fairly and openly in its procurement practices — something the European Commission did through joint tenders the UK refused to join. Whatever the outcome of his litigation, since his actions began the National Audit Office has also opened a probe and is due to report this autumn.

If nothing else, a determination to hold ministers to account could help ensure future pandemic preparations are improved and sustained even as memories of Covid-19 hopefully begin to fade. 

Three questions

Chikwe Ihekweazu, director of the Nigeria Centre for Disease Control.

What is your reaction to the news that wild polio has been eliminated in Africa?

It means a lot for Africa. For everyone working in the field, there is euphoria. I am excited that we have reached this milestone. It has been more than 20 years since we set the goal. It has drawn in substantial resources, some of which have supported the response to other infectious diseases. While polio eradication drew in resources for public health, over the years, many of our best people, best efforts, and best resources were focused on polio. This sometimes drew away attention from other important public health needs. Once you declare eradication of a single disease as a goal, it’s such a high bar that I hope we don’t do it for any other disease soon. It’s time to focus on systems, not diseases.

Are you worried about the continuing threat from vaccine-derived polio?

There is a lingering risk. For a mother, it’s really of no interest whether her child is paralysed from wild or vaccine-derived polio. Hopefully we can keep up the energy driving response activities till we get to the very end of the road. I don’t think anyone can rest on their laurels until we have a solution. A complete transition to relying only on the injectable polio vaccines delivered through routine immunisation is not sufficient to sustain immunity levels in Nigeria. As long as it is circulating somewhere in the world, given the opportunities for travel, we can’t relax anywhere. There is a risk with diminishing global leadership around public health and infectious diseases.

What is your view on the nationalistic response to Covid-19?

This is a global pandemic which requires a global response. But it quickly emerged that the more resources you had, the more you were able to access scarce commodities like personal protection equipment, masks and ventilators. The next big thing is access to vaccines and new therapeutics. We see countries negotiating their own terms and companies bypassing global alliances. There is constant pressure and countries we have looked up to for many years for equity and multilateralism are falling into the trap of fighting for their own best interests. The idea that you can protect yourself and ignore the rest of the world doesn’t make any rational sense. We have got to find a way of working together.  

News round-up

Focus on . . . coronavirus trajectory The milestones keep coming. As we approach the sixth-month anniversary of the declaration of the pandemic, the global total of cases has now passed 25m. The US has gone beyond 6m cases while record rises in India mean it will soon become the world’s second worst-affected country. WHO chief Tedros Adhanom Ghebreyesus said the pandemic could be over in under two years but warned yesterday that “no country can just pretend the pandemic is over”. Get the latest data from the FT’s free maps and tracking hub. (BBC, FT)

Vaccine nationalism The search for an effective coronavirus vaccine continues to be dogged by politics. The FT revealed today that the WHO is redesigning its Covax scheme — a project to ensure the fair global distribution of 2bn doses of effective vaccines by the end of 2021 — after rich countries were slow to sign up or simply refused, as the US has done.

Many fear poorer countries could lose out if their wealthy counterparts focus on their own bilateral contracts with manufacturers. Ngozi Okonjo-Iweala, of the Global Alliance for Vaccines and Immunisation, wrote in the FT that the world should avoid the experiences of swine flu in 2009 when rich nations bought up vaccine stocks. Here’s a good summary of the vaccine race since Chinese scientists first published the genome sequence of the virus in January. (FT, Washington Post, Reuters, Stat, Observer)

Risky business The FT revealed that vaccine makers were pushing the EU for legal protection against lawsuits if problems arose from their products. The Vaccines Europe lobby group said the speed at which trials were being pushed through created “inevitable” risks and called for “comprehensive no-fault and non-adversarial compensation system, and an exemption from civil liability”. The FT Editorial Board warned against political leaders’ rush to approve vaccines before they were ready as the paper revealed that President Trump was considering bypassing normal regulatory standards to fast-track an experimental vaccine from the UK, a move which would only boost the US “anti-vaxxer” movement.

Economic fallout Several of the world’s poorest countries may be pushed into debt distress because of Covid-19, the Paris Club group of creditor countries said on Tuesday, forcing official creditors and private-sector lenders to accept a reduction or restructuring of loan repayments. This would go beyond a current G20 initiative on debt suspension. Check the state of economic recovery with our global tracking hub. (FT)

Covid consequences The WHO’s Global Pulse survey, published on Monday, analysed the pandemic’s impact on health systems. Some 90 per cent of countries have experienced disruption to normal services including routine immunisation, diagnosis and treatment for non-communicable diseases, family planning and contraception, treatment for mental health disorders and cancer diagnosis and treatment. There are also fears that vector control for diseases from malaria to yellow fever could get less attention because of the focus on Covid-19. (WHO, PLoS)

Covid and China A WHO team investigating the disease’s origins in China was criticised by western governments for not visiting Wuhan, the city where the first cases of novel coronavirus were detected in December 2019. Chinese dissident artist Ai Weiwei released Coronation, a documentary filmed clandestinely in the city as the pandemic began. Three Chinese companies are at the forefront of finding a vaccine. (FT, Ai Weiwei, The Conversation)

Gasping for air An investigation found severe shortages of medical oxygen in sub-Saharan Africa, meaning potentially life-saving treatment is denied to patients suffering from severe Covid-19 and pneumonia. Some blame high prices from multinational gas suppliers. (Bureau of Investigative Journalism/The Guardian)

Focus on . . . India and Covid-19 India is key to the hunt for a vaccine not just because of its high rate of infection but because it is also “the pharmacy of the world” — the major supplier of medicines to the global south. Domestic repercussions of the pandemic include a drop in the numbers of women who breastfeed as misguided fears of infection lead to newborns being separated from mothers and formula milk promoted. Even as the rate of infection surges, authorities are pressing on with reopening the country’s severely damaged economy. Watch our video on the challenges ahead. (FT, The Conversation, BMJ)

Fake news flourishing An activist group hit out at Facebook for helping to spread pandemic misinformation and urged the platform to provide corrections and downgrade inaccurate posts. Another study documents the rise of fraudulent Covid-19 posts on Twitter and Instagram. However, the idea that we are suffering an ‘infodemic’ when it comes to coronavirus is attractive — but wrong, says one FT writer. (Avaaz, FT, Journal of Medical Internet Research Public Health and Surveillance)

Measles victory The Democratic Republic of Congo said the world’s largest measles epidemic was now over. Action against the disease, which has killed more than 7,000 children since the epidemic began 14 months ago, had been hobbled by civil war and the focus on curbing Ebola. (Reuters)

Dementia and Covid-19 People living with dementia are being disproportionately affected by the pandemic. One report says up to three-quarters of all Covid-19 care home deaths in some countries are of people with the disease. Alzheimer’s Disease International called for global action and for more detailed data from governments. (International Long-term Care Policy Network)

Focus on . . . Covid-19 in Africa Traditional African medicine, celebrated each year on August 31 and which has experience battling Ebola, Aids and cholera, is being mobilised in the fight against coronavirus by the WHO and the Africa Centres for Disease Control. Indigenous medicine can also help offset manpower shortages where there are very few conventionally trained healthcare workers. Accusations are flying across Africa that money meant for coronavirus purposes has been siphoned off by politicians. The re-elected head of the African Development Bank said the bank would pay increased attention to supporting African healthcare. (Liberian Observer, FT)

Environmental alarm Conservationists and biologists will tell a UN summit on biodiversity later this month that there is clear evidence of a link between environmental destruction and the increasing emergence of new diseases such as Covid-19. Deforestation, uncontrolled expansion of farming and mining and the eating of wild animals are creating a “perfect storm,” enabling diseases to jump from animal to human. (UN, Observer)

US election race heats up  With the presidential poll just two months away, here’s a guide to where the two hopefuls stand on health issues. President Trump has been criticised for “tarnishing the reputation” of two key public health organisations — the Centers for Disease Control and the Food and Drug Administration. Read the FT interview with the FDA chief. A political row is brewing over which parts of the community should benefit first from a coronavirus vaccine. (Kaiser, Washington Post, FT)

Heath workers in danger A Guardian/Kaiser Health News interactive project documents the US health workers who have died on the coronavirus frontline. A high proportion of infections among these workers appear to go undetected. (Guardian, CDC)

Wellcome photography prize This year’s winners captured everything from the joyful life of an 11-year-old with a brain tumour to the realities of female genital mutilation in Nigeria. A special focus this year was mental health. The overall winner was Arseniy Neskhodimov for his ‘Prozac’ series on living with depression. Here’s a video featuring the successful images.

Best from the journals

Slow progress on UHC The WHO target of 1bn more people benefiting from universal health coverage between 2019 and 2023 is unlikely to be met, says a new study, leaving some 3.1bn people without, a third of them in south Asia. Japan scores highest — evident in its successful approach to Covid-19. The Central African Republic, Somalia, Chad, Guinea, and Vanuatu fare worst. (The Lancet, The Diplomat)

Covid-19 and mental health Evidence is increasing of the pandemic’s effect on mental health, whether in older adults, the young or in families. There are fears that healthcare workers could suffer PTSD-like long-term effects. The situation is dire in poorer countries where upwards of 90 per cent of people with mental health conditions do not receive treatment. (Open Public Health, Journal of Gerontology, The Conversation, Pediatrics, Raconteur, The Lancet)

Covid-19 and obesity Action against obesity has taken on a new urgency as studies show it heightens the risk of contracting coronavirus. Pressure is growing for action in the US over junk food marketing but Mexican efforts face opposition from big companies. There are fears for UK plans to tackle the problem after the government dismantled Public Health England, a move criticised by the FT Editorial Board. Obesity and the illnesses it causes rarely appear as a cause on death certificates. (Obesity Reviews, Guardian, FT, Reuters, Medical Xpress)

Water security Nearly a quarter of households in poorer countries are unable to follow basic guidelines on handwashing. Solutions include more investment in infrastructure, promoting behavioural change and making alternatives such as hand sanitiser readily available. Sanitation workers across South Asia are in the frontline of the war against Covid-19. Improved handwashing habits could make a serious contribution to public health in Africa. (Nature, WaterAid, The Lancet)

Social distancing and masks Rigid safe-distancing rules are based on outdated science, says a new study: going to the beach or hiking are very safe even without a mask, but an evening in the pub is moderate or high risk. The FT’s Undercover Economist calculates the probability of contracting the virus but here’s why you shouldn’t panic too much about reinfection. Another report says that even the very best face masks have some degree of leakage — see video below — and distancing is still important. This interactive shows how the virus can spread in a subway car. (BMJ, FT, The Conversation, Physics of Fluids, NYT)

Pick of the pods

‘We are scientific fighters’ A WHO doctor and epidemiologist recounts her experiences on the front lines of Ebola and how she is now helping fight the spread of Covid-19 in the Central African Republic. (UN Awake at Night, 33m)

Covid in context A look into the history of pandemics and public health, from the bubonic plague to Aids. Where does Covid-19 fit in and how has the past shaped our response to the current crisis? (London School of Hygiene & Tropical Medicine, 72m)

Operation Warp Speed A discussion of the US government’s vaccine development strategy and the recent regulatory approval of convalescent plasma to treat Covid-19. (NEJM, 24m)

Kids and Covid-19 What do we know about the dangers of coronavirus to children and teenagers? (CDC Emerging infectious diseases, 19m)

Data privacy A critique of how the pandemic has given “data traffickers” the opportunity to suck up vast quantities of UK private patient data. (The Bunker, 26m)

The month ahead

Until Sep 4 European and International Congress on Obesity

Sep 3-5 FT Weekend Digital Festival. Sessions include How to deal with the next pandemic. The failures of the global response to Covid-19 — and a few successes — point to ways the world could handle the inevitable next pandemic more effectively. What lessons can we learn for public health?

Sep 10 World Suicide Prevention Day

Sep 15 UN General Assembly begins in New York

Sep 15 FT Special Report: Cell Therapy

Sep 17 World Patient Safety Day

Sep 17 Joint meeting of G20 finance and health ministers

Sep 21 World Alzheimer’s Day

Sep 26 World Contraception Day

Sep 28 World Rabies Day

Sep 29-30 FT US Pharma and Biotech Digital Summit

Sep 30 European Environment Agency annual report on air quality

End notes

Previous issue Pandemic exposes looming superbug crisis

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Final thought

Sharing: the key to longer life A new study says societies that successfully share resources have longer life expectancies. These can include private transfers, such as relatives helping out with a child’s education or public transfers such as retirement benefits supported by taxpayers. “Sharing generosity may reflect the strength of social connectedness, which itself benefits human health and wellbeing and indirectly raises survival,” say the report’s authors. (PNAS)