Boxes containing the Pfizer-BioNTech Covid-19 vaccine are prepared to be shipped from Pfizer's US manufacturing plant. The World Health Organization’s Covax facility aims to ensure the vaccine is procured smoothly across the globe

Felicity Hawksley, journalist

After months facing down a global pandemic, the next challenge for health services around the globe is the procurement and distribution of the Covid-19 vaccine.

At ACCA’s 10th Public Sector Conference – held virtually for the first time – Patrick Osewe, chief of the health sector group at the Asian Development Bank, described critical geographic differences in bargaining power and delivery infrastructure, and the importance of the World Health Organization’s Covax facility, which aims to enable the smooth procurement of the vaccine globally.

‘There is a concern that rich countries will grab the vaccine and we will have a situation like the Aids crisis all over again,’ he said. ‘That’s why the Covax facility is so important; it will help us ensure low- and middle-income countries get the progressive quantities of vaccine they need.’

‘There is a concern that rich countries will grab the vaccine and we will have a situation like the Aids crisis all over again’

Conference hot topics

ACCA’s global public sector conference took place in December 2020 and looked at a range of topics affecting professional accountants in the public sector, including

  • the role of the public sector finance professional in the Covid-19 recovery
  • new models of public procurement
  • combating corruption in the digital provision of public services
  • good practice in financial management and implementing international standards
  • Supreme Audit Institutions and the Sustainable Development Goals
  • developing a future-ready finance function.

All the sessions are available on demand.

Infrastructure challenges

Osewe also described the infrastructure challenges in both distribution and vaccination. ‘Some of these vaccines need ultra-cold storage,’ he noted. ‘That is clearly going to be a coordination problem for some countries, and many don’t have enough healthcare workers to administer the vaccine, so there are operational challenges, too. Can you re-hire retired workers? Can you train others?’

Information around the vaccine is one of the areas that needs addressing very quickly. ‘Social media is a very powerful tool and we can leverage it to spread information about the vaccine,’ Osewe said. ‘But equally it is a very dangerous tool for misinformation. We have to get the balance right.’

Future pressure

While mass vaccination against Covid-19 is a new challenge, old ones remain. Simon Currie, director of financial planning and delivery at NHS England, praised his team for its ultra-fast emergency budget as Covid-19 turned into the main event in February.

‘It’s amazing what you can achieve when money is taken out of the equation,’ he said, pointing to NHS England’s new emergency-capacity Nightingale hospitals, its rapid resolution of previously delayed discharges and emerging signs that the population is taking better care of itself than it did pre-pandemic.

But he also cautioned that there would be knock-on effects. ‘People have missed diagnoses and missed operations,’ he said. ‘This will mean more pressure later.’

Currie also voiced concerns that free spending during this period could ‘ironically reduce the focus on money’. After a decade of cost-cutting, such an approach would prove unaffordable.

The discussions raised significant questions around how health services play catch-up, and how their emergency response will have changed attitudes to healthcare spending

Focus on outcomes

Meanwhile, the NHS in Wales believes that post-pandemic health financing should be outcome-focused. ‘The UK has some of the poorest healthcare outcomes among developed countries,’ said Professor Alan Brace, director of finance, health and social care for the Welsh Government.

He pointed to the pursuit of volume within a context of increasingly scarce resources, and the poor health of the wider UK population as causes. Too many of the resources put into healthcare, Brace said, are targeted at the ‘rescue’ stage where hospital beds are required for emergency care.

His colleague Sally Lewis, national clinical lead for value-based care, described the new approach at NHS Wales: ‘We need to understand the total cost of care across the care cycle, in the context of the patient outcome,’ she said.

It is clear that even with the advent of a vaccine, health finance leaders are considering the continuing impact of Covid-19. The conference discussions raised significant questions around how health services play catch-up, how they might vaccinate the most vulnerable, and how their emergency response will have changed both internal and external attitudes to spending on healthcare.

Digital corruption is damaging public services

Corruption in the provision of public services has existed as long as public services have. But as governments across the world spend massive amounts of public money on tackling Covid-19, the problem seems bigger than ever. Digital services are partly to blame.

Attendees of the conference session ‘Combatting corruption in the digital provision of public services’ heard how this is the first global crisis where, in many cases, financial relief has been applied for, calculated and delivered digitally.

Opportunities for identity theft, phishing and procurement abuse are greatly enhanced, and with many governments’ greater tolerance of risk, pressure on the public purse from bad actors has never been higher. With global corruption already costing US$2.6 trillion annually pre-pandemic, that figure is now likely to be higher, delegates were told.

Claire Jenkins FCCA, a forensic accountant at UK executive agency Companies House, noted that the ‘automatic assumption that everyone is honest’ won’t work any more and that the infrastructure to combat corruption needs improving radically. ‘We need to think like fraudsters,’ she said.

Julio Bacio Terracino, acting head of the OECD’s public sector integrity division, agreed: ‘We need better risk models and assessments if we’re going to strike the balance between releasing much-needed funds quickly.’