Conflicts of interest and Covid-19

Many of our leaders, from politicians to university administrators to business owners, face difficult trade-offs during the Covid-19 pandemic, which has created increasingly tense conflicts of interest. Across the globe, decision-makers grapple with dilemmas that weigh economic outcomes with responsibilities for public safety and health. Conflicts of interest impact decisions to close borders, implement quarantines, impose lockdowns, stagger reopenings, enforce social distancing and mandate mask-wearing.

What's striking is that many of these decision-makers believe, and sometimes explicitly state, that they are not at all influenced by financial incentives. The problem with these statements is that, if our leaders and decision-makers were influenced by their conflicts of interest, they would not necessarily be aware of it.

Decision-makers may think they are not biased by their conflict of interest, but that assumption is based on an inaccurate mental model of how such conflicts work. Research has repeatedly shown that conflicts of interest operate without our awareness and sometimes against our best intentions. Without external accountability, decision-makers will continue to fall prey to their biasing influence.

The science behind conflicts of interest

The public, professionals and policymakers alike appear to make the same assumptions regarding conflicts of interest: that those who succumb to their biasing influence are making a deliberate choice to place financial interests over their professional responsibilities. By extension, we consider those that do succumb to bias to be corrupt.

In reality, abundant evidence from social science research shows that influence from conflicts of interest often occurs on a subconscious and unintentional level. Even when decision-makers try to be objective, their judgments are influenced by financial incentives. And studies show that advisors routinely deny being influenced by financial inducements despite data demonstrating the opposite.

People are unable to remain objective, even when motivated to be impartial, which suggests an unintentional element to their decision-making. What’s more, people succumb to bias while denying they have done so, which suggests succumbing to bias is unconscious. The implication is that even decision-makers who are ethically engaged can make biased recommendations.

In medicine, for example, physicians typically report that their patients’ health and well-being comes first and that they would never be biased by financial incentives. A large body of evidence, however, suggests that physicians are indeed influenced by gifts and compensation from pharmaceutical companies and medical device manufacturers. Physicians who receive payment from industry are more likely to prescribe their sponsors’ drugs and request that specific drugs be added to a hospital formulary than physicians who are not paid by industry.

Many professionals, including physicians, take offense at the notion that they might be influenced by financial incentives. Their offense reveals, yet again, the robust belief that bias from conflicts of interest is within our conscious control. Although conflicts of interest can lead to deliberate corruption and bad decisions in managing the Covid-19 pandemic, the problem of unintentional and subconscious bias remains a pervasive problem that self-regulation cannot solve.

Ambiguity increases bias

Policy makers must consider many factors in the highly uncertain environment of the coronavirus pandemic, which makes their decisions complex. Under this ambiguity, the effect of conflicts of interest are amplified. It is not difficult to understand how certain anticipated financial fallouts can at times loom larger for decision-makers than uncertain but potentially catastrophic future public health consequences.

During the Covid pandemic, apparent failures such as the United Kingdom’s delay in implementing a lockdown, Sweden’s relatively loose restrictions, and Florida’s inability to mandate face masks likely have driven up the death toll from the coronavirus. The consequences of biasing influence from conflicts of interest can lead to reversals and confusing messaging. In the past few months, the UK government’s call for the public to “eat out to help out,” and decisions by US colleges and universities such as the University of Michigan and the University of North Carolina, Chapel Hill, to reopen their campuses to students have been reversed after they led to somewhat predictable surges of new Covid-19 cases.

With a new virus, uncertainty regarding its impact and danger cloud every decision. Even as we see mortality rates decrease, the long-term disability and morbidity effects from Covid-19 are yet to be identified. The trade-off between immediate economic outcomes and public safety may ultimately be moot as the lack of a clear strategy in managing the conflict decreases public trust and ultimately damages both the economy and public health. In fact, recent data show that those countries that prioritised protecting their population’s health from the start also ended up with greater protection to their economy.

Accountability can decrease bias

When conflicts of interest arise, attempts at self-regulation and statements of unbiased reasoning are woefully inadequate. They may even make matters worse, as advocating for a decision you’ve made can strengthen your belief that your decision was the right one, even if it is not.

The only effective way to manage conflicts of interest is through sincere attempts to eliminate, or at least mitigate, the conflict. When such conflicts cannot be eliminated, leaders must make their decision-making processes transparent and open to public scrutiny to increase accountability. If outcomes can be observed by others and expectations to be careful and accurate are strong, accountability may reduce displays of bias.

Decision-makers need to accept that if they are influenced by financial incentives, they are unlikely to recognise the bias themselves. This recognition can make leaders more open to dissenting opinions. Politicians, businesses and others who make decisions on our behalf must grant informed stakeholders voice, power and influence in managing the pandemic. People wrestling with conflicts of interest may not succumb intentionally to their biasing influence, but they nevertheless need to be held accountable for them.