What is corruption?
What image comes to mind when you see the word corruption? I was born and raised in Nigeria and I associate corruption with Ghana must go bags, agbada, bullion vans, and animals swallowing money before vanishing. Lobbying never comes to mind. Lobbying conjures images of placards, campaigns for social issues and suited professionals in the corridor of legislative buildings chanting for justice. Quite limited when compared to reality.
The World Bank defines corruption as the abuse of public office for private gain. Nepotism, bribery, embezzlement, extortion and fraud are all forms of corruption. Conversely, lobbying is a tool adopted by stakeholders to influence government policies or decisions regarding a cause or outcome. Award of contracts is one of the likely outcomes.
Lobbying for and against public health
Lobbying has been instrumental for addressing complex issues in health systems ranging from calls for increased domestic health financing to bills that are eventually passed into law, to regulate industries that contribute to the burden of noncommunicable diseases. The improved access to affordable antiretroviral medicines globally from the initial cost of about US$14,000 was a product of lobbying and other advocacy strategies. This same tool has equally become a nightmare for countries where industries yield enormous economic and political power.
Several LMICs have increased efforts to regulate the food, tobacco and alcohol industries in response to the rising burden of noncommunicable diseases. Studies have shown that these industries lobby aggressively to resist laws, policies and regulations and push for self-regulation. Retired public officials and well-connected power brokers are recruited to influence NCD prevention policies and laws. This practice is influence-peddling; using one’s influence to get favors in exchange for money. However, you would find that in several countries, influence peddling is not necessarily illegal and even when it is illegal, enforcement is lax.
The rising cost of drugs is another issue that seems unresolvable, largely because of the lobbying activities of profit-driven stakeholders. These stakeholders engage in aggressive lobbying to frustrate the efforts to reform drug prices. Unfortunately, patients suffer.
During the pandemic, some companies made an unreasonable profit from COVID-19 related contracts secured through lobbying. The impact of such contracts was damning as companies charged ridiculous prices for essential services like COVID-19 testing. Again, the people suffered until the government reviewed the prices.
Clearly, lobbyists engaged in health advocacy have vested interests that are not always in the interest of public health. Often, these interests overshadow public health interests because of the intensity of lobbying activities and robust funding sources unmatched by stakeholders’ lobbying for public health interests. The concerning part that makes monitoring and transparency challenging is the blurry line between questionable lobbying activities that undermine public health and corruption. In different jurisdictions, the legality of corrupt practices compounds this blurriness because not all corrupt practices are illegal. Corrupt practices only become illegal when laws, codes or regulations make them unlawful.
Lobbying to influence decision making on health deserves extra attention because public health concerns are a matter of life and death. It is risky to leave public health outcomes in the hands of public officials who may or may not do the right thing because the internal factors that motivate decision making are difficult to decipher. For instance, when a public official has a conflict of interest, it provides a fertile ground for corruption, however, having conflict of interest is not corruption in several jurisdictions. Of course, having a disclosure requirement is a remedy, but then discovering and managing interest concerns is challenging.
Some lobbying activities are glaringly corrupt and undermine public health interests with no consequences. There has been little or no transparency, accountability and repercussions for lobbyists that made unreasonable profits from COVID-19 contracts awarded during a global pandemic. No consequences for the lobbying activities of countries to stockpile COVID-19 vaccines that defied transparency requirements and compromised the public’s trust in the vaccine development process. Consequently, transparency is vital for enabling the public to take part in scrutinizing lobbying activities that eventually affect them. Countries where industries yield enormous power in politics and policymaking should establish frameworks and regulations that clearly outline the ambits of lobbying activities and measures to ensure compliance with transparency requirements. Ultimately, the cost of corruption regardless of its form, on health and healthcare, is too expensive to gloss over.
About the author: Chiamaka P. Ojiako is a lawyer and health policy professional with diverse work experience in the public, nonprofit and international development sectors. She has an MPA in Health Policy and Management from New York University Wagner. Her work is at the intersection of law, research, policy analysis and advocacy, with a focus on addressing health governance gaps and fostering health equity.
Competing interests: None
Handling Editor: Neha Faruqui