Ulana Suprun: Government Agencies Are Using the Quarantine to Become Much Less Transparent

An interview with Dr. Ulana Suprun, former acting minister of Health of Ukraine (2016–2019) on the government’s response to COVID-19, including an erratic commu­ni­cation strategy, a lack of trans­parency and corruption risks. The interview was conducted by Mattia Nelles.

As of now the COVID-19 infection rate in Ukraine, compared with other countries, is relatively low. Are the figures realistic? And the broader question is, where does Ukraine stand now against its fight against COVID-19?

Regarding the number of tests performed in Ukraine: we do not know the number of people that have been tested for COVID-19. We only know the number of tests that have been done and how many were positive. That’s different than in many other countries, where they are reporting on how many people have been tested. Since we don´t have these numbers, it is problematic to be able to do any kind of modeling, and it is difficult to tell what’s really going on.

In the beginning, there was a problem with the avail­ability of tests and it has only been in the last week and a half that there has been an increase in their avail­ability. The second part of this is the ability of the labora­tories to perform the steps necessary to get a result for the test.  No planning was done. Ukraine ended up being at the tail end of trying to find the equipment, find the tests, find the PPE, find the venti­lators after most of the world has already bought up most of those resources. Ukraine still has not reached its peak. Every day over the last week we have seen an increase in the number of cases. That’s expected because once we started testing, we started confirming that the people in hospitals on venti­lators or with pneumonia have tested positive for the SARS-COV‑2 virus.  We also will have an increase in cases, which I think will happen in the next week, because of Easter, as Orthodox Easter was just this past Sunday, and the Russian Orthodox Church acted irrespon­sibly, allowing people to gather at the churches.

But when did you expect that peak to happen?

The ministry of health has estimated that it will be in early May. However until we can get enough infor­mation and enough data to see what the doubling time is, the number of positive tests as well as the number of people that have symptoms, it is difficult to tell. One of the biggest issues is again, there is a lack of trans­parency and sharing of infor­mation.  We don´t have the number of how many people are on venti­lators and there isn´t even a hard number on how many venti­lators are available. It’s difficult to make those assump­tions unless you actually go yourself into the hospital and check each one of the machines and count them yourself. And what is happening is that civil society rather than government officials are doing just that.

How would you evaluate the crisis commu­ni­cation of the government and of health profes­sionals. Is it effective or what is missing?

It’s been ineffective from the very beginning, when over 80.000 Ukrainians returned from outside of Ukraine, crossed the border and entered the country. They were not given any infor­mation on what they should do. They were told to self-isolate, but they weren´t given specific instruc­tions on what that means.  The lack of commu­ni­cation from the beginning was quite severe. Then as time moved forward, to compensate for that, the government ended up having too many headquarters that were giving out infor­mation.  People were getting mixed messages from different places. That is something that creates confusion and people don´t know who they should be listening to.  The lack of provision of coordi­nated and accurate infor­mation to the people caused the government to force Ukrainians to go into such a strict author­i­tarian quarantine which has basically decimated our economy.

The ZPK, the Anti-Corruption Action Center, recently warned of possible corruption risk in the ministry of health procurement plans for medical equipment. So how do you view the corruption risks in procurement and in the crises and beyond?

The risks are high because the ministry of health and other government agencies are using the quarantine to become much less trans­parent on what they are doing.  There are two problems that are happening right now. Number one is that the procurement of medicine and medical devices by inter­na­tional organi­za­tions not related to COVID-19, the routine procurement that has to be done every year for the 1,5 million Ukrainians that need the medicines procured by the government to stay alive, has not been started. So there has been no procurement done yet for medicines for people who have cancer, HIV, orphan illnesses, for other people who need medicines. And this is a big problem. Let’s say HIV: there are enough medicines in Ukraine for patients until September. After September there will be a deficit. And the procurement process is relatively long. What will end up happening if procurement is not done through inter­na­tional organi­za­tions the way that it is planned? The Ministry will not adhere to the proper proce­dures and start buying them from anybody they can find, and that leads to corruption.

The second problem that’s happening is that all procurement for COVID-19 desig­nated equipment and medicines is outside of the regular rules of procurement. For example, the procurement of medical gowns as ordered by the Ministry of Health was initiated by the new Medical Procurement Agency. The equipment was priced by the medical procurement agency in Ukraine at 245 UAH. The new Minister of Health Stepanov initiated a second tender from within the ministry and bought from South Korea at 488 UAH, almost twice the price. Another issue that hap­pened with the new min­is­ter of health is the day before he got appointed when he already knew he would be appointed min­is­ter, his wife reg­is­tered a company that sells medical devices in Odesa. This company has not yet partic­i­pated in the tendering process, but obviously it is the potential con­flict of interest.

The admin­is­tration itself has taken great efforts to enroll the private sector including some oligarchs in this pandemic response. So how do you see that and how are the results of this engagement with the private sector?

No oligarch is a good oligarch. Its closer to a mafia-like structure where the say “you ask for our help, we give it to you, but then you have to pay us back with interest”. Ukraine has a Reserve Fund and Ukraine’s government as well as legit­imate businesses could cooperate with civil society to help. That is what happened when the war started in 2014. A similar situation happened at the beginning of the COVID-19 pandemic. Ukrainian civil society and business have come together and are now pretty effec­tively helping not through government channels, but through their own donor or charity channels. And it seems that at least when looking at the reporting of what’s been done, the grass­roots efforts have done far more than the government or these supposed oligarchic headquarters have done. Another one of the issues is that we hear from the president that there is X number of planes coming from China every week deliv­ering some kind of equipment, but there is no reporting on what actually arrived, where it’s gone, and what it is being used for. We don´t know what has been brought in. At this point, a lot of the equipment was procured from China, not given as a donation. There is a suspicion it was of poor quality, not useful, and that the money was not well spent because the first thing that came available was bought, rather than having a plan or strategy of what we actually need to be put in place.

You already said that there is not enough testing. But how do you envision Ukraine’s exit strategy, or hammer and dance approach, in coping with the pandemic in the absence of many tests and antibody tests?

We do need to test more people and we need to have more avail­ability of those tests. But trans­parency and the reporting of the truth are much more important for us to be able to react properly and until we do that, we will be never able to confi­dently come out of this quarantine, because we won´t know what’s really happening. This morning I read that according to the American Medical Associ­ation in the United States, there are four essen­tials that must be in place before they can stop the quarantine. Number one — is to have a minimal risk of community trans­mission based on sustained evidence of a downward trend in new cases and fatal­ities. Secondly is a robust coordi­nated and well-supplied testing network. The third is a well-resourced public health system for surveil­lance and contact-tracing. And fourth is fully resourced hospitals and the health care workforce. We are far from any one of those. We need to address the fact this is what needs to get done and not only speak about it. At the level at the cabinet of ministers you need to have these four things in place, then talk about what can be opened and what cannot be opened. If we can´t do that, when the quarantine ends, we will have a huge increase in infec­tions and disease and also of deaths. We need to have a testing network in place with clear guidance for physi­cians and for hospitals on who they should test and how they should test and how they should report this. We need a public health system for surveil­lance and contact-tracing.  And our hospitals need to be fully resourced and our health care workers need to be both trained on how to use PPE and have access to PPE so that they are safe.

How long do you think it will take until a vaccine is developed and how long it would take to widely distribute in Ukraine?

US: Most of the inter­na­tional research community is saying that it will probably be a year before the vaccine is developed and produced to the point that it can be widely available. Ukraine often does not come into the first line of those countries that buy new vaccines because of both financial reasons as well as not neces­sarily being in the top countries that are producing the vaccines or have ties to the companies that will be producing the vaccines. And there is a strong anti-vacci­nation movement in Ukraine. But I would certainly antic­ipate that as soon as vaccines are in production, Ukraine will place an order and have the financing available to pay for that vaccine.

What do you think about the coron­avirus situation in Russian occupied terri­tories. Should Ukraine help these terri­tories and if yes, how?

First of all, there has been an accusation by Russian disin­for­mation sites that the OSCE brought in Coron­avirus into the Russian occupied terri­tories, that the Mission actually “seeded” the occupied terri­tories. There was a strong reaction by both the OSCE and those countries that are part of the Mission denying...but it not really denying... telling the truth about the fact that it is not what happened at all. The accusation was being used as a reason to attempt to ban the OSCE Mission from the Russian occupied terri­tories by saying that they were seeding the disease. And that is not true at all. Otherwise, we only hear about some reported cases in the Russian-occupied terri­tories through human­i­tarian organi­za­tions. And our state security service does monitoring of the so-called media that’s in the occupied terri­tories, so they gather infor­mation. We see some numbers, but we don´t know really how accurate they are and if they are true or not. I think the most important thing that can be done is providing infor­mation because in the Russian occupied terri­tories they do watch Ukrainian television, or they do listen to Ukrainian radio and they do have some access to infor­mation from Ukraine whether it is on the internet or social media. Accurate infor­mation, what to do or how to protect yourself, what sorts of programs or proce­dures the government is providing, can help to decrease the number of infec­tions there and to help people that have been infected. I think at this point this is an important thing which the Ukrainian government is able to do to help. And they are doing that.

Dr. Ulana Suprun was Minister of Health in Ukraine from 27 July 2016 to 29 August 2019. She was born in the USA and emigrated to Ukraine in 2013. During the Maidan she made a name for herself as a doctor who helped the injured. She founded the NGO Patriot Defence, a school for rehabil­i­tation medicine at the Ukrainian Catholic University in Lviv and the NGO Arc.UA.