Authors: Alfred Zylyftari, Elsa Dautaj, Seth Facey
There are many things that Albanians are aware of regarding the impact of the pandemic on their country.
Albania was one of the first countries in Europe – in March 2020 – to impose strict isolation measures, blocking transport, citizen movements and closing businesses.
According to the data of the Ministry of Health, until July of this year there have been more than 290.000 positive cases of Covid 19 that have resulted in more than 3500 deaths since the beginning of the pandemic.
The sheer number of cases nearly led to the collapse of the hospital system. Many citizens chose to be treated at home and in private hospitals, often using drugs not found in the protocols of state hospitals. In some cases, they received drugs trafficked from neighboring countries.
AH, who asked to remain anonymous, says he was forced to deal with COVID at home because he didn't trust state hospitals.
“I suffered a severe bout of Covid and the treatment at home cost me about $7000.00. I had to find and use contraband drugs because they were not available in local pharmacies. The doctor who came to my house to supervise my treatment cost me about $2000,00. I could afford it but what about people who can't afford it?!” said AH
EK from Tirana, who lost his grandfather, decided to send him to a private hospital believing that the conditions and service were better.
"I can't say for sure that the hospital didn't give him the right help, but unfortunately my grandfather passed away. At the moment when we family members were suffering because my grandfather passed away, someone came to us from the reception and informed us that we cannot take the dead body out of the hospital without paying the bill, which was 87.000.00 euros. In those moments I realized how worthless a man's life was in that hospital", said EK.
But there are many things Albanians do not know and may never know about their government's response to COVID.
Contracts for the COVID vaccine and the lack of public information
Vaccine supply contracts, signed by the Albanian government with various pharmaceutical companies, are considered a state secret. Deputies who voted on these contracts, through special laws, were provided with only minimal information before voting.
Compared to many other countries that have made public contracts related to fighting COVID, Albania continues to keep those contracts confidential, and there is little public information about what the government has paid for the vaccines or medical equipment needed to fight COVID.
Myslym Murrizi, who was the deputy speaker of the Assembly when the government signed a contract with Pfizer for the purchase of vaccines, told ACQj that he only voted for the first contract with Pfizer after the detailed terms of the contract were made available to him.
"I saw the terms of the contract as discriminatory for the Albanian government, but this happened in emergency conditions as it was the first vaccine company that came to the country, with a price of 12 euros per vaccine," he said.
The Albanian government bought vaccines from a number of international companies and in some cases the amount paid is known.
For example, Albania spent $20 million or 2 billion lek on vaccines from “Keymen Ilac Sanayi ticaret anonym sirket (Sinovac)”, based on VKM no. 174 and VKM no. 357 , with two payments for the Chinese vaccine made in March and June 2021.
The government paid "Gavi Alliance" 4.1 million dollars or 430 million ALL for the vaccines.
Albanians became much more aware of the government's contract in January 2021 with Pfizer because it was revealed by a number of portals. However, these data are not official.
The contract was signed between Pfizer Export BV in the Netherlands and the Ministry of Health and Social Welfare and the Ministry of Reconstruction and the Institute of Public Health. The leaked 52-page draft contract shows the amount, costs and conditions that the Albanian government must meet. The Albanian government is said to have signed the contract to purchase 499,590 doses for a cost of about $6 million.
According to an article on biospace.com published in June of last year, average vaccine prices per dose worldwide range from $19.50 for the Pfizer-BioNTech vaccine, $5.25 for AstraZeneca, $10 for Sputnik V, and $29.75, the most expensive, the Chinese Sinovac vaccine. All of these types of vaccines have been used in Albania.
In response to a request for information from ACQJ, the Institute of Public Health disclosed that the doses administered domestically from January 11, 2021 to March 13, 2022, totaled 2,646,59. However, no information was made available on the cost per dose of each type of vaccine.
Government Contracts in the Time of COVID
In February 2020, the Albanian government decided that public institutions can contract companies without a public tender if these companies can provide the Services and goods required in case of urgent need . Specifically, this concerns situations, such as the pandemic, which are “caused by extraordinary circumstances beyond the control of the contracting authority and the time available to resolve the urgent need is not sufficient for the normal development of the procedures”.
Since the announcement of this decision, the Albanian government has signed 15 secret contracts and around 200 contracts directly related to COVID, totaling $40 million, excluding VAT. None of the contracts involved an open competitive procedure. According to the legislation in force, none of these contracts, even if there is corruption or favoritism, can be investigated by the Prosecutor's Office, due to the collective decision-making nature of these acts.
Aranita Brahaj, Executive Director of the Albanian Institute of Sciences, a local NGO focused on monitoring government contracts through its programs such as OpenData Albania, sees the situation as very problematic.
"The situation with secret tenders or tenders for essential interests of the state, was applied to several contracts in April 2020, by decision of the Albanian Government (not only the Ministry of Health). This type of procedure was abandoned very quickly, the reasons were several: the main one was that the government failed to provide the goods in real time as the Selected Contractors (businesses) did not have the capacity to provide goods for which there was a shortage at the national and international level. regional markets. The other reason is also the attitudes of civil society against this process".
Fatos Çoçoli, an economic expert, agrees that there was no need for secret contracts to secure COVID-related goods.
"I believe that full transparency should be done. It is a big risk not to follow the usual form of open tender", adds Cocoli.
Murrizi links these tendering procedures with patronage in the government.
"Each tender classified as a "secret" tender was conducted solely for profit purposes, awarded to predetermined companies without actual competition. The procurement law clearly defines which procurements must be kept secret, procurements for national security, technological equipment for intelligence Services, prosecution, some specific military equipment and some operational equipment needed by structures fighting organized crime and terrorism. Murrizi adds.
Murrizi said that masks, gloves, food, vaccines, etc. should not be bought with secret tenders.
"Albania has a special law that breaks down in detail what is classified as secret, top secret, confidential and sensitive information. Any other reason is just to steal. Of the secret tenders that have been signed over the years by this government, there are over 600 procurements, of which the largest number is occupied by AKSHI and the Ministry of Health, followed by the Ministry of Defense. Any tender classified as "secret" is a dangerous precedent for major abuses of public money. It is the most corrupt way of stealing public money", said Murrizi.
During the pandemic, the Albanian government has awarded about 200 medical tenders, with a total cost of about 40 million dollars excluding VAT. Fourteen special procedures, developed with special laws, cost 416,617,248 ALL with VAT (about 4 million dollars), while in total, the Ministry of Health and Social Protection has spent 1,383,707,749 ALL without VAT.
In second place, according to the OpenData tender database , is the “Mother Teresa” University Hospital Center, with a figure of 1,383,615,012 lek excluding VAT (about 13 million USD). The “Shefqet Ndroqi” Hospital, otherwise known as the Sanatorium, has spent 624,620,800 lek excluding VAT (about 6 million USD) on tenders during the pandemic.
During this period, the Ministry of Defense was also included in the umbrella of secret/confidential tenders, spending 141 Lek excluding VAT (about 585 million USD).
Asked about these secret tenders and future ventures in these procedures, Endri Fuga, spokesman for the Prime Minister's Office, emphasized that now that the emergency is over and the situation is almost completely back to normal, it is easy to forget the obstacles and problems of the weeks and months of first of the pandemic.
"Governments in various countries, including EU member states, had one goal: to do their best to provide as much medical equipment as possible, including respirators and tests, personal protective equipment, including masks and gloves, as well as oxygen and medication. This was also the goal of the Albanian government. All this in the conditions when the demand in the market was at its maximum, while the supply was almost non-existent. "Borders were closed and governments of various countries confiscated goods from neighboring countries as if it were wartime, completely ignoring the existence of contracts for the purchase and sale of goods," he said.
Fuga added that "Albania was in an extraordinary situation and the essential interest of the state was to save as many lives as possible in the face of a war with an unknown virus with fatal consequences."
Fuga insisted that any interested party can access these contracts and information from relevant institutions through simple information requests.
However, ACQJ submitted requests for information to all agencies that executed secret and centralized contracts. Only a few responded by referring the Center to other agencies and, in the case of the Ministry of Defence, giving only a minimal response and a reference to a broken link to the government's website.
ACQJ has asked the Ministry of Health why the contracts have not gone to public tender, but the Ministry has not provided this information until the publication of this article.
On the other hand, Fuga vowed that now that the situation has stabilized, the government will switch to standard procurement procedures for future tenders and not to secret emergency procedures.
Another problem that is noticed in the database of published tenders is that for some companies the real value of the contracts is not shown, where only the unit value of the drugs is public. This has made it almost impossible to extract the total value of the contracts.
The main companies that have won most of the contracts in the health sector are MEGAPHARMA LLC, INTERMED LLC, Rejsi FARMA LLC, MESSER ALBAGAZ LLC, EUROMED LLC, TRIMED LLC, INCOMED LLC, all major local companies have won contracts of considerable value.
"The negative impact of these tenders has been that the contracts have been very close to the limit fund and this constitutes a loss for the state budget, because holding public tenders ensures competition, reduction of offers and protection of the state budget", said Cocoli. "This attitude of the ministry is a cover-up because now, even though we are in the conditions of the presence of the virus, we are not in the conditions of an extreme emergency, therefore this information must be given", he added.
Cocoli believes that the Ministry is hiding behind unnecessary artificial rules.
"We don't know if there is something behind this kind of protection or they [the Ministry] don't want to get into trouble by not giving any kind of information, but I think it could be the former," Cocoli said.
According to Open Data Albania, these contractual procedures of the Government are unconstitutional, illegal, unjustified and contrary to the basic principles of good governance, which are accountability and transparency.
Asked about the process of holding these tenders and signing these contracts, Tritan Shehu, former Minister of Health, said that he sees them as very problematic, damaging competition, violating equality and reducing the quality of products that come as a result of the elections. arbitrary.
"Any procedure that becomes non-transparent, not in accordance with the rules, clearly damages the quality of Services and damages the state budget, creating distrust among citizens towards state legislation", said Shehu.
ACQJ sent a list of questions to the Ministry of Health and Social Protection, but the Ministry initially refused to provide the information. Following a decision of the Commissioner for the Right to Information, the Ministry has provided partial information on some questions, but not on all.
How were the contracts for COVID handled in the US?
Access to COVID-related expenses in the United States is much easier.
In the US, there is a routine procedure for how the government handles medical contracts for vaccines and medical equipment needed for a virus like COVID-19. However, due to the pandemic emergency, the price negotiations were changed.
Zain Rizvi, director of research for the advocacy group Public Citizen, who is listed on the organization’s website as “an expert on pharmaceutical innovation and access to medicines,” said the process begins when the U.S. government goes to a provider of medical equipment or vaccines, such as Pfizer, and tells the company how many doses the government wants to buy. The company and the government negotiate the price and eventually reach an agreement.
Rizvi said Pfizer initially wanted to charge the government $100 per dose, but the government was able to negotiate that number down to $19,50 per dose, the price stated in the original contract. The government then instructed Pfizer where to distribute.
Derek Willis, a news application developer for the nonprofit news outlet ProPublica and a reporter since 1995, is concerned about how the contracts signed for the US were executed.
"The data shows the large number of sole-source, no-bid contracts. We had people telling us, 'It's unusual, but it's an emergency so it could happen,'" Willis said.
"Sometimes we have struggled to get additional information about the contracting process in a timely manner. For example, if we wanted to see what kind of bids people submitted or what kind of documentation within a particular agency related to a specific contract, we would have to use the Freedom of Information Act, and it would almost always take unimaginable to get information. But in terms of the information itself, it's very good and quite useful,” added Willis.
Willis also spoke about the general accessibility of these medical contracts to the public.
“There were definitely some things we had to read, some manuals and talk to people to understand the individual nuances in the data. But in terms of getting the data myself, no, it wasn't terribly difficult,” Willis said, “Compared to other scenarios I've been in, in terms of getting government data, this was very easily".
The quantity of vaccine doses purchased and the prices are publicly available on the website MedicalCountermeasures.gov . Also included are medical contracts between the US government and companies that provide equipment such as COVID-19 tests.
In addition, the U.S. Department of Health and Human Services ’ website publishes some, but not all, medical contracts, and ProPublica has built a database containing information on all medical contracts related to the COVID-19 virus. According to that database, the U.S. government executed 18,243 contracts worth $39.9 billion to combat the virus.
The database from ProPublica also contains information about which government agencies are spending the money, how much they are spending and how many contracts they have completed.
Also, there is information about the vendors that received the most government money and their location, the largest contracts and their specific price, the type of vendors that receive contracts, and how much was spent on different categories.
For example, ProPublica shows that $7.07 billion was spent on "Medical and surgical instruments, equipment, and supplies" and $1.63 billion on "Laboratory equipment and supplies."
But there are limits to transparency.
The most common redacted information concerns an exemption in the Federal Freedom of Information Act (FOIA) which “ protects ‘trade secrets and commercial or financial information obtained from a person [that is] privileged or confidential.’ This exemption is intended to protect the interests of the government and the submitters of the information.”
The US government and the company must agree to allow the information to be made publicly available. Experts say the government often allows the company to redact whatever it wants to maintain a good relationship for future negotiations.
"Quantity pricing, unit pricing, clinical trial cost information" are some other examples of things that are often redacted from these medical contracts," said Kathryn Ardizzone, an attorney for a nonprofit called Knowledge Ecology International, which describes himself as looking for the best results. including new knowledge resource management solutions.
Ardizzone says there are specific commercial reasons for the edits.
“Contractors want their product to look as profitable as possible. So if there were rights that the government could exercise that could create uncertainty about companies' ownership of their intellectual property or the rights that the government could use in the resulting products, then that could be something that companies or the government would like to keep it confidential,” she said.
It is the government's duty to protect these redactions when dealing with Freedom of Information Act requests. However, Ardizzone pointed to a possible explanation for the number of redactions seen in COVID-19 medical contracts.
"The government has reason to be very careful and inclined to protect [information] because if the government releases information that the contractor wants to withhold, the contractor can sue the government, so there's a risk," she said.
Willis agrees with this position.
"I don't think Pfizer or any contractor has 100% editorial control over those edits that are made, but I think they can assert some claim that this is proprietary, trade secret business information, and I think the government should accept that assertion." .
