Health emergencies, whether natural or man-made, significantly disrupt public health systems. They can cause the collapse of critical health infrastructure, reduce health workers’ capacities, and limit health systems’ operational capacity. In these contexts, any form of corruption will contribute to protracted health crises. This puts people’s rights to life and the enjoyment of physical and mental health at risk.

Corruption thrives in emergencies. The need for rapid action often leads to governments bypassing standard protocols and procedures. This can result in reduced oversight, compromising traditional systems that ensure transparency and accountability.

While embezzlement, fraudulent contracting, and bribery do happen in normal times, corrupt practices can become more frequent during emergencies and have a far greater impact on public health and trust. For example, when personal protective equipment (PPE), vaccines, and ventilators are diverted due to corruption, health systems are unable to manage the crisis effectively. This can lead to unchecked spread of disease, higher mortality rates, and a severe erosion of public trust in institutions. Beyond the immediate crisis, such failures pose a broader threat to global health security. Infectious diseases spread more easily across borders, while weakened health systems struggle to contain them.

This guide presents the latest literature and research surrounding what drives corruption during health emergencies. It outlines lessons learned from different emergencies, including Covid‑19; those most impacted; and the latest anti-corruption efforts and recommendations in such contexts.

What drives corruption during health emergencies

Health systems are complex and unique. Some have specific weaknesses in their efforts to prevent and manage corruption. These gaps can include lack of and/or poor internal whistleblowing frameworks; anti-competitive market dynamics (eg monopolies in the private sector); and overall weak rule of law where acts of corruption go unpunished. Emergencies exploit these vulnerabilities, which worsens existing weaknesses and exposes gaps in anti-corruption efforts. As a result, the capacity of anti-corruption mechanisms is tested during an emergency.

Health emergencies magnify other key vulnerabilities to corruption, such as:

• Complex processes and procedures to ensure transparency and accountability are usually delayed or deferred for quick action.
  Using data from a three-year window before and after natural disasters, a regression analysis revealed that disasters significantly increased the risk of corruption in public procurement in affected areas in Italy. There was a higher likelihood of contract awards through non-open procedures – such as single bidding – and shortened advertising periods.
  
• Countries receive increased financing, but their health systems have limited absorption capacity.
  The sudden influx of funding and lack of clear emergency response plans force many governments to relax safeguards that protect against conflicts of interest, collusion, and fraud. During the Covid‑19 pandemic, failure to absorb the increased funding enabled opportunities for undue influence, bribery, price gouging, and the proliferation of substandard and falsified medical products.
  
• There is an increased requirement for medical supplies, but supply chains are not always equipped for the sudden demand.
  The Covid‑19 vaccine supply chain faced significant challenges. For example: not enough manufacturers, poor coordination among organisations, weak monitoring systems, difficulties in temperature control, high costs, and lack of financial support. This made vaccine distribution inefficient, complicated the rollout process for many countries, and created opportunities for corruption.
  
• There is no – or poor – preparedness and planning for the response.
  The outbreak of communicable diseases like Ebola and Covid-19 have exposed health systems’ poor capacity to control disease outbreaks. A 2023 study on West African countries’ levels of preparedness for Ebola found that most countries had “poor capacity for testing and treatment, inadequate health facilities, poor incentives for health care workers, poor governance systems, poor border control, and awareness and research capacities impacted negatively on the capacity to control disease outbreaks.”
  
• Previous corruption weakens health system governance and leads to more corruption and a prolonged crisis.
  In countries with poor financial transparency or where monitoring is interrupted because of the emergency, those responsible for managing the additional funds may see opportunities for embezzlement. During the Ebola outbreak in 2013–2014, an estimated US$1 billion of international aid went to Sierra Leone, Liberia, Nigeria, and Guinea-Conakry. However, corruption in the preceding years had already weakened their health systems. This limited their response capacity. Weakened governance also incentivised fund diversion from the health systems’ emergency response.

Corruption threatens global health security

Corruption during health emergencies undermines global health security by weakening the ability of health systems to respond effectively. During the Ebola outbreak, the diversion and mismanagement of funds and supplies by government officials and private actors delayed the delivery of essential medical supplies and services. Containment measures such as roadblocks, quarantines, and body collection and burial procedures were easily circumvented by bribing the police and military tasked with the new rules. These corrupt acts likely contributed to a higher death toll and the cross-border transmission of the virus.

Corruption also undermined health systems’ response capacities during the Covid‑19 pandemic. In Argentina and Peru, high-level government officials and elite groups were allegedly involved in vaccine queue-jumping. This contributed to unequal access to lifesaving vaccines at critical points of the emergency.

Queue-jumping and nepotistic practices to access vaccines distort the demand and supply of these products, enabling black markets to proliferate. This increases the likelihood of more substandard and falsified vaccines entering the market and putting people’s lives at risk. In Venezuela, at least 2,000 people were inoculated with boiled water, antibiotics, and painkillers – under the pretence of being Covid‑19 vaccines. Corruption not only prolonged the crisis but also deepened inequalities, fostered instability, and eroded public trust in institutions on a global scale.

Poor governance and corruption also contribute to long-term global health threats, such as the rise of antimicrobial resistance (AMR). Weak oversight and lax enforcement of regulations in healthcare and related sectors (such as food and water safety) enables the spread of resistant pathogens. In the case of multidrug-resistant tuberculosis, corruption in the supply chain leads to the distribution of inadequate or poor-quality drugs. This fuels the spread of resistant strains and exacerbates the public health crisis.

The resurgence of polio, tuberculosis, and AMR – along with the potential cross-border spread of both known and unknown pathogens – further threatens fragile and unprepared health systems. Corruption compromises global health security by amplifying national health systems’ weaknesses. This leaves those systems less prepared and able to safeguard public health.

Actors in health emergencies and potential corruption risks

An emergency response includes a range of stakeholders. Each has varying levels of decision-making power and influence on their nation’s response.

Government

The government sets the legal and financial frameworks for emergency response and leads coordination. While these efforts are crucial for emergency preparedness and response, they are also highly vulnerable to abuse – especially when there is significant discretion among high-level decision makers in resource allocation. Grand corruption can occur and, in a domino effect, generate the conditions for more corruption at lower levels and a protracted health crisis.

During the Ebola outbreak, Sierra Leonean government officials misappropriated donor funds from the Gavi Vaccine Alliance. This reduced the resources available for frontline responders. The health system was already struggling with staffing shortages and paying regular salaries before the outbreak. Unsurprisingly, informal payments for free services continued to persist during the outbreak. Many of these payments were for ‘unpaid volunteers’ who were informally hired to make up for the staff shortages.

Thus, the emergency response was sandwiched between corrupt state officials and frontline healthcare workers trying to survive. This reduced access to healthcare services and likely increased the spread of the virus. Similar stories were discovered during the Covid‑19 pandemic. In one case, the Minister of Health of the Democratic Republic of Congo was placed under provisional arrest over alleged embezzlement of more than US$7 million destined for the pandemic response in 2020.

Military and police

The military and police are often deployed during emergencies for logistical support, maintaining public order, and securing health infrastructure. However, their increased power in such situations can increase existing corruption risks.

During the Covid‑19 pandemic, there were reports of police officers demanding bribes at roadblocks and from pregnant women and sick individuals going to the hospital. Cases of police officers abusing their power by sexually extorting women or detaining and extorting people for minor breaches of mask mandates and curfew laws became widespread. These abuses illustrate how emergencies can heighten opportunities for corruption and exploitation, particularly when oversight is already weakened.

Healthcare workers

Frontline responders responsible for delivering care are often at risk of exploitation during a health emergency. In Kenya, healthcare workers protested after the government mismanaged US$70.4 million intended to protect them against Covid‑19. In Nigeria, health workers were promised resources which never reached the hospitals. This prompted many doctors to avoid treating Covid patients.

In other cases, health workers engaged in functional corruption, such as stealing PPE or demanding bribes from patients to protect themselves or supplement their income. Health workers in Rwanda were arrested for stealing Covid‑19 testing-kits and vaccines. In Ghana, hospital staff stole and sold PPE for personal profit. The role of healthcare workers is paramount to any successful emergency response. However, corruption left unaddressed can reduce the quality of care, demotivate workers, and contribute to an increase in corrupt practices.

Private sector

The private sector plays a crucial role in procurement and supply chains, particularly in managing large contracts for medical equipment and services. During health emergencies, the pharmaceutical industry is a key player. It provides essential medicines and vaccines to help health systems meet surging demand. However, these crises can also create incentives for some private actors to engage in corrupt practices. In the UK, nearly two‑thirds of PPE contracts were awarded to companies through a special ‘VIP lane’ without proper due diligence. Transparency International Global Health flagged £15.3 billion worth of contracts as needing further investigation.

Media

The role of media and investigative journalism in health emergencies is to expose corruption cases. During the Covid-19 pandemic, journalists in Romania revealed how contracts funded by the EU recovery plan were given to politically connected companies with little experience in providing ventilators and PCR tests to hospitals. In Zimbabwe, journalists exposed how a two-week-old company with direct ties to the president had received Covid-19 tenders at higher prices. This revelation resulted in the arrests of the Minister of Health and the owner of the company. They were later released on bail with reduced sentences. Although impunity trends may happen, these examples showcase the importance of free and independent media to expose corruption and push for accountability, especially in times of crises.

Civil society organisations

Civil society supports the emergency response and aids vulnerable groups. It also has a significant role in reporting corruption and mismanagement of resources – either human or financial. The Transparency International (TI) chapter in Argentina launched a successful public procurement observatory in response to the Covid‑19 pandemic. The initiative monitored the procurement of vaccines. This helped prevent power abuse by making the information available to the public. They worked with other civil society organisations to monitor the distribution of vaccines. They publicised how many vaccines were available, where they had been sent, and who had been vaccinated. These measures helped reduce the risk of corruption in the procurement and distribution of vaccines. While evidence points towards the benefits of an active and progressive civil society involvement in health emergencies – such as pandemics – they are yet to be systematically utilised to help prevent and mitigate corruption in emergency responses.

Experiences of corruption during Covid‑19

During the pandemic, the high demand for essential medicines and health supplies – in conjunction with global shortages – exacerbated corruption risks globally. U4 conducted a review of the literature and found corruption in all six building blocks of a health system: service delivery, human resources, health financing, health governance, medicines and technologies, and health information systems. Here are a few critical examples of key manifestations of corruption:

Public procurement

Corrupt practices such as bid rigging, kickbacks, embezzlement of funds, nepotism, favouritism, theft, and fraud affected the public procurement of PPE for healthcare workers’ protection and the distribution of vaccines. In Italy, two out of six tenders that manufactured 32 million masks, totalling over 12 million euros, were granted by the government to an agriculture and forestry company. In Slovenia, the government granted 80 million euros for the manufacturing of medical supplies to companies involved in gambling and with no prior experience in healthcare.

Grand corruption and state capture

Grand and political corruption in the form of state capture was rampant during the Covid‑19 pandemic. It was found that 17 million afghanis (approx. US$231,000) – from a budget of 150 million (approx. US$ 2 million) – designated for the pandemic response was embezzled. The Attorney General’s Office closed the investigation into the matter. The Russian Direct Investment Fund was accused of pricing gouging and corruption during the marketing and distribution of the Sputnik-V vaccination. This included exclusive resale rights to five countries at inflated prices.

Service delivery

A report by Transparency International identified informal payments, embezzlement and theft of medical supplies, absenteeism of health workers, overcharging and false treatment reimbursement claims, favouritism in care, and manipulation of data during the first year of the pandemic. Corruption at the point of service delivery severely impacted vulnerable groups reliant on public health services – such as women, the poor, and ethnic minorities.

Clinical trials, vaccine manufacturing, and distribution

There were challenges regarding transparency and accountability in the development of clinical trials and in vaccine manufacturing and distribution. Corruption included falsification of data, misallocation of resources allocated for clinical trials, supply-chain mismanagement, substandard vaccine production, diversion of supplies, fake certification production, vaccine queue-jumping, and price gouging. In Peru, an investigation found that 487 non-healthcare workers had been inoculated with Sinopharm vaccines that were part of a clinical trial study.

Global governance

In 2021, in light of the Covid‑19 crisis, world leaders proposed a pandemic accord. This was an agreement for countries to work together to prepare for, prevent, and respond to future pandemics. The accord claims to address governance by recommending oversight mechanisms designed to increase trust, transparency, and accountability in future responses. However, it is unclear whether its scope is enough. As of the beginning of 2025,the process is ongoing and has not been straightforward.

The challenges around the accord negotiations have been: individual country domestic opposition; misinformation; disputes between high- and low- to middle-income countries surrounding intellectual property rights and resource distribution and sharing; and a general lack of trust between states. If endorsed, this legally binding document could serve as an important anti-corruption mechanism in future global health emergencies.

Corruption’s impact on vulnerable groups

Corruption during health emergencies exacerbates inequalities. A U4 literature review of corruption experiences during Covid‑19 found that marginalised groups – such as women, the poor, rural populations, people with disabilities, and children – were more vulnerable to corruption.

Because of their specific health needs and gender roles, women are more likely to seek health services for themselves and their family members. This continuous contact with providers means they are more likely to be victims of bribery, overcharges, and sexual corruption. They also have more limited access to quality medicines and are more prone to using substandard or falsified medicines or products. Research on the gender-related response to both Ebola and Zika emergencies found a lack of consideration for the rights and needs of women when allocating resources and delivering care. This omission in the response further exacerbated gender inequities in health service delivery.

Anti-corruption efforts and recommendations

Covid‑19 and other health emergencies offer lessons for how to mitigate corruption in future emergencies:

Enhance transparency in decision-making

Providing timely and continuous information to the public about decisions being made during an emergency can increase transparency in decision-making. This can include anti-money laundering approaches and public finance management. The World Bank recommended strategies to improve financial management systems after the Ebola outbreak. For example, building systems to track which activities were funded by whom and through what source. WHO also recommends strengthening public management systems in preparation for future health emergencies, including focusing on budget allocation, execution, and oversight.

Integrate a gender perspective

The inclusion of a gender perspective in anti-corruption responses would help combat the inequities faced by some vulnerable groups during health emergencies. Women should be involved in the design of anti-corruption efforts to ensure their needs are being met. Data reporting should also be sex disaggregated to understand the full impact of the emergency. Research demonstrates that applying a gender lens in emergency preparedness helps to mitigate the vulnerabilities experienced by women and girls during health emergencies, including corruption.

Invest in data governance

Investment in data governance would help technology realise its potential in preventing corruption, and mitigate its potential in driving corruption. As a preventive tool, technology such as health information systems (HIS) can enhance transparency in public health services, and make it easier for civil society to monitor resource usage and advocate for improved service delivery. Having a well-functioning HIS is especially important during a health emergency, where things change rapidly and access to high-quality data is fundamental.

Similarly, blockchain technology could potentially help reduce corruption risks and deficiencies in vaccine supply-chain management. It could do this by increasing transparency, safety, and trust of the supply-chain data. This would reduce the risk of falsified medical products entering the market or diversion of lifesaving vaccines. Nonetheless, while the potential is there, so is the risk of corruption in the form of data manipulation and data misuse. These two types of corruption risks thrive in contexts where data governance is weak, resources scarce, and political incentives are lacking.

Coordinate cross-sector collaboration

Public health emergency responses require coordination and collaboration across sectors, including government, military, police, healthcare workers, the private sector, media, civil society organisations, and philanthropies. WHO’s Covid‑19 Strategic Preparedness and Response Plan outlines ten pillars to guide coordinated health action. Although it does not explicitly address anti-corruption, its emphasis on transparency, accountability, and stakeholder engagement aligns with key anti-corruption principles.

Emergencies disrupt ‘business as usual,’ making it essential to engage multiple sectors and partners – especially non-governmental and civil society organisations – in the planning phase. Their involvement can improve response equity and help mitigate corruption risks, such as the embezzlement of funds and equipment. Logistics in health emergencies further illustrate this need, as nearly all health system actors are involved to some degree.

Supply chains require expertise from both the public and private sectors, with medical and supply-chain professionals collaborating on procurement, manufacturing, packaging, transportation, storage, and distribution. Ensuring coordinated action at each stage is crucial – not only to improve understanding of risks along the health supply chain but also to establish systems to mitigate them.

Strengthening cross-sector collaboration and coordination in health emergencies is essential to protecting health systems and improving patient outcomes. Recent health crises highlight their devastating impact and demonstrate how weak coordination can exacerbate corruption risks. By fostering collaboration among involved actors and integrating anti-corruption measures into national emergency preparedness plans, health systems can become more resilient and better equipped to respond to future crises.