As of January 19th, the Kurdistan Regional Government (KRG) has documented more than 100,000 cases and 3,445 deaths from COVID-19. That is bad enough for the Kurdistan Region of Iraq (KRI) which has about 6 million inhabitants. Unfortunately, that’s not all, however. While the COVID-19 “natural disaster” has been unfolding in the region, a human-made one happened in parallel. The private health sector seized on the pandemic as a great opportunity to amass wealth in an unregulated and out-of-control market. KRG authorities either pretended unawareness or, worse, were sometimes involved in exploiting the pandemic for profit-making private business. In this short piece, we present examples of such exploitation in three COVID-19-related areas: prevention, investigation and treatment.
But first a word or two on the private sector in Kurdistan. It is difficult to assess the size of the private sector in KRI due to the lack of accurate information. However, the sector consists of an extensive network of private doctors’ clinics, laboratories and pharmacies. Doctors usually engage in dual practice both in the private and the public sector.
What has a substantial part of the private sector been up to, in their Covid-19 pandemic “response”?
As for prevention, private retailers increased the prices of masks, gloves and other essential equipment for prevention early on in the pandemic. Several herbal medicines were promoted as effective prophylaxis against COVID-19, and their prices went up. Private pharmacies also increased the prices of Vitamins, particularly Vitamin D, Vitamin C and Zinc. These substances are promoted as preventative medicines against COVID-19, and their prices escalated.
On the investigation/examination front (i.e. tests & diagnostics), the private sector in KRI also made significant profits over the last year. In a classic example of supply-induced demand, patients with even mild symptoms of COVID-19 were referred for CT scan tests of their lungs. Private hospitals didn’t hesitate much to increase the prices of doing such tests. Meanwhile, and rather mysteriously, the few CT scan machines available in the public sector suddenly “stopped” working. To make matters worse for patients, some hospitals require patients to have CT scans before admitting them in their COVID-19 units. But the exploitation was not only limited to radiological testing, also other COVID-19- related investigations were affected. All of a sudden, tests such as CRP, D dimer and Ferritin (all nonspecific markers of inflammation) became the ‘gold standard’ for almost every patient with suspected COVID-19. And guess what, the prices of those non-specific tests also went up. Some private laboratories intentionally abused the similarity between CRP and PCR to sell the former as diagnostics for COVID-19.
Finally, treatment. The most extensive exploitation of the COVID-19 outbreak arguably happened in this area (of medicines and presumed therapeutics). The prices of many medicines promoted as ‘treatment’ for COVID-19 went up substantially, in some cases even skyrocketing. These included medicines with no evidence for their effectiveness (such as Hydroxychloroquine, Azithromycin, Famotidine, Ivermectin) and ones where the evidence base is ambiguous or still in RCTs (like Tocilizumab, Favipiravir and Remdesivir). They all became part of an informal protocol that the majority of doctors treating COVID-19 prescribed. As for the prices, well, you know the pattern by now. For example, according to receipts from a private pharmacy, a single vial of Tocilizumab was sold for $3000. Awamedeica, a local pharmaceutical company, sold one box (containing 40 tablets) of Favipiravir for $200 to the Ministry of Health. And unsurprisingly, oxygen cylinders became another “commodity” with escalating prices for those who decided to treat their family members in their own homes.
In short, in an unregulated private health market like the one in KRI, the way in which some actors are ‘tackling’ the pandemic can be even worse than the natural disaster itself, certainly financially. The exploitation of the COVID-19 pandemic by the private market (in the KRI and many other LMIC settings with similar problems) highlights the need for strengthening the health system, legal frameworks and governance. It also underscores the need for the involvement of international organisations such as WHO in coordinating national efforts to help improve effective governance in the health sector, including regulation of the private health market towards Universal Health Coverage.