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

Interview with Dr. Ulana Suprun, Ukraine's former acting Minister of Health
© Yuliya Ovsyn­nikova /​/​ Imago-Images

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.

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