18/10/2020
As the Tunisian government takes the decision to remove its forced lockdown starting from 4 May 2020, it did so while it has still not committed to its promise to supply 30 million masks and 400,000 rapid test kits, made, as the virus reached Tunisia earlier this year. With the second wave of COVID-19 looming, this lack of commitment puts Tunisian citizens’ lives at risk.
In tracking the Tunisian government’s procurement of COVID-19 rapid test kits, ARIJ documented several discrepancies and found that the masks available in the market do not comply with standards recommended by the Tunisian government.
Dr. Nisaf Ben Alia, Director General of the National Observatory for New and Emerging Diseases, confirmed that Tunisia did not receive a shipment of rapid test kits from China, but clarified that the African Center for Disease Control provided a Chinese donation of RT/PCR tests, not the rapid tests.
Everything surrounding the shipment of 400,000 rapid test kits was ambiguous, from the companies that won the bid to the shipment’s expected arrival date.
Adding to the ambiguity, the results of the tender were never published on the Tunisian Central Pharmacy websites, nor the public procurement’s official websites. Hence, there is no published information about the suppliers or bid price, and nothing to back the statements made by Khalil Amous, Director General of the Central Pharmacy regarding the French-Swiss and South Korean suppliers.
The Prime Minister's Circular issued on March 31, 2020 stipulated "exceptional" measures regarding public procurement during the coronavirus, and emphasized that the bid tabulation must be made public –– whether on the Marsad website, TUNEPS - Tunisia On line E-Procurement System, or by any other means of public announcement.
When asked on June 5 whether the shipment of 400,000 rapid test kits had arrived or not, Dr. Yusra Qarqani responded on behalf of the Health Ministry that it “has almost arrived”, but did not offer dates on when it is expected.
She further clarified that the shipment consists of 200,000 “antigéniques tests” used to identify genes and antigens in human white blood cells, and 200,000 “anticorps tests” used to scan for the presence of virus antibodies. However, she refused to reveal the identity of the supplying companies.
The Tunisian Central Pharmacy published a call for an international bid for 400,000 COVID-19 rapid tests. The deadline for the call was March 31.
The deadline for the call, giving companies only four days to bid.
The Minister of Health in that period Abd al-Latif al-Makki announced that Tunisia is expecting to receive a shipment of 400,000 rapid tests from China.
He reported that the small number of test kits used were part of a donation.
Khalil Amous, Director General of the Central Pharmacy, announced instead, the procurement of 400,000 rapid tests from two companies: one European (Swiss-French) and the other South Korean.
[Due to the lack of accurate information, the journalist submitted an access to information request to both the central pharmacy and the National Public procurement agency. Because neither responded within the legal time period, she filed a lawsuit against both of the aforementioned institutions.]
In order to identify the type of rapid tests used, the reporter investigated samples of rapid tests at five public hospitals including the Military Hospital, Charles Nicole, Abderrahmane Mami in Tunis, Habib Bourguiba in Sfax and Farhat Hashad in Sousse.
According to photos shared with ARIJ by anonymous medical sources, the Ministry of Health was using PCR lab tests in its hospitals, not rapid tests as declared by former Minister of Health Al-Makki on April 3.
In the third week of lifting lockdown, ARIJ monitored a set of rapid tests that were used as high school students returned to school on May 26 and 27. The tests were used in schools in the Gafsa governorate (southwest of Tunisia) and Monastir (on the Tunisian northern coast). Interestingly, these tests are products by the Chinese company, Sinocare.
When asked about the Chinese tests identified by ARIJ, Nisaf Ben Alia responded that “they may be Chinese products,” but insisted that Tunisia did not receive them directly from China.
“They may have been received as donations from different countries," she said.
She added that the Chinese rapid test kits are from previous stock and not the 400,000 purchased test kits.
ARIJ’s reporter contacted Sinocare and enquired about the quantities of rapid tests provided to Tunisia and the dates of their arrival, but did not receive a response. She also contacted the South Korean company, NOBELEBIO, regarding the lab tests. A representative informed her that there were no direct dealings with Tunisia, and that the PCR tests may have been sold to the Tunisian government through an intermediary.
During the same period, ARIJ monitored another brand of rapid tests from the French company Biosynex. The tests were being used in the Kebili governorate, southwest of Tunisia, to test COVID-19 among students arriving at the Higher Institute for Technological Studies of Kebili.
On June 2, Télévision Tunisienne (state television) broadcasted a video report showing the use of Biosynex rapid tests for students and professors in the Tunisian capital.
Riad Zayan, General Manager of "GS Santé" — the official representative of Biosynex in Tunisia — in an interview on March 25 stated that after his company presented the product, the Tunisian state was impressed with it and made the initial decision to use it.
This statement was made only three days before the Tunisian Central Pharmacy’s public announcement regarding the call for bids to purchase 400,000 rapid tests on March 28.
Riad Zayan of "GS Santé" told ARIJ: “At first, we presented our product to the Ministry of Health and expressed our readiness to deal with them. Then, on March 20, we received an invitation from the Scientific Committee to Combat Coronavirus, during which Dr. Nisaf Ben Alia was present. We were asked to make a presentation about our product for rapid tests, and they posed some technical questions. The committee, which included more than 20 people, was impressed with our product and informed us that it could be a solution to the crisis.”
Following this, Biosynex participated in the call for bids announced by the Central Pharmacy. According to Zayan, "the number of applicants was 108 and we were the last of them, as our number was 108.” They submitted a tender offer for 200,000 rapid tests at a price of 15 dinars per test (approximately $5.25) and won the bid.
Zayan’s statement to ARIJ conflicts with the statement made by the Director General of the Central Pharmacy, who said that the number of applicants is 107, not 108. Did the Central Pharmacy purposefully conceal applicant number 108? If so, why?
The Director General of the Central Pharmacy did not respond to requests for comment.
Zayan denied that the agreement to purchase their product was made with the state prior to the call for bids was announced. He told ARIJ that after the initial order to supply 200,000 lab tests, the Tunisian state was willing to purchase another 500,000.
“The Ministry of Health contacted Mr. Thomas Lamy, General Manager of Biosynex and informed him that they needed an additional 500,000 tests, hoping to keep the same price of the first order [15 dinars per test]. The Ministry also said that it is likely to announce soon a call for bids for 500,000 rapid tests, so "prepare yourselves”,” Zayan added.
In the same context, on April 3, Thomas Lamy told the Moroccan newspaper L'Opinion that the Tunisian Ministry of Health had asked his company to manufacture 500,000 rapid tests. However, according to Zayan, this deal was cancelled due to tight delivery deadlines given to them compared to the great demand for their products from many countries in the world.
ARIJ also identified the origins of Biosynex through obtained documents and found that it is a French company registered in Strasbourg, with branches in Switzerland and Germany.
Commenting on Riad Zayan's statements, Sharaf al-Din al-Yaqoubi, an expert in government deals, said that since there are 108 applicants to the public tender for rapid tests, the choosing of Biosynex over others must be questioned.
"This important number indicates that rapid tests were available in the market at the time and were not scarce," he told ARIJ. Therefore, the only explanation for the Central Pharmacy’s choice of Biosynex over others is the comparison of the technical standards of the company's product with those of other companies, and if the standards set in the initial conditions are only available in the Biosynex product, then it can be assumed that the deal was tailored to the products of this particular company.
Al-Yaqoubi was surprised that the Tunisian Central Pharmacy concluded a deal in early April with a company that did not gain approval from the country in which it manufactures. Biosynex’s representative, Zayan, stated that Biosynex’s product for rapid tests was being sold in France in March, despite the French Ministry of Health not approving its promotion in France until May 22.
Suspicions of corruption surround this rapid tests deal, especially regarding the deadlines to acquire 400,000 rapid tests in the call for bids, and the Central Pharmacy’s management of the deal; neglecting to publish its results or identify the companies that won it.
On April 20, the National Anti-Corruption Commission was notified of suspicions of tampering in the purchase of the rapid tests deal.
Olfa al-Shahbi, Director General of the National Anti-Corruption Commission, informed ARIJ that, according to the notice, the four-day deadline for the international call for bids included two weekend days: Saturday and Sunday. Consequently, it was impossible for all companies to prepare the administrative and financial documents required for their offers, or to gain in-depth knowledge of the content of the bid.
Al-Shahbi indicated that the call for bids came as if directed to a specific company which had more information on the specifications of the deal than others. He added that on top of this, the results of the call for bids and the names of the winning companies were not published, which increases the suspicions.
Al-Yaqoubi informed ARIJ that calls for government bids usually concern small value procurement not exceeding 70,000 Tunisian dinars ($24,000). The aforementioned consultancy included a call for bids for 400,000 rapid tests. The large number (and its potential higher costs) raises several questions about the way the deal had been made.
The ambiguity surrounding the rapid tests and their arrival did not stop at the 400,000 tests deal, but was carried into a second deal, the full details of which were not released to the public. Former Minister of Health, Abd al-Latif al-Makki stated on April 19 that an order of two million rapid tests “will be in the possession of Tunisia in a matter of two days." Yet, they never arrived.
On May 1, and three days before the gradual lifting of lockdown, the Central Pharmacy announced a new call for bids to purchase an additional quantity of rapid tests without specifying the amount. It set its deadline to May 15.
The deadlines were impending and yet the results of the deal were not announced on the public procurement website. On the same date, the Presidency of the Tunisian government published information on the Central Pharmacy's protective equipment holdings during COVID-19. This information included approximately 32 million Tunisian dinars ($11 million) worth of bids for the purchase of 1,600,000 thousand rapid tests.
On June 5, ARIJ met with Dr. Yusra Garqni from the Ministry of Health to ask about the details of this new deal. She said that the Central Pharmacy announced the call for bids, but is “not in a hurry to review the offers, and has not opened them yet."
ARIJ also submitted information requests to the High Authority for Public Procurement and the Central Pharmacy regarding the details of the first and second calls for bids, but did not receive any answers. ARIJ subsequently filed lawsuits to the Access to Information Authority against the two aforementioned institutions, and has yet to hear back on the outcome.
Tunisia promised to provide sufficient masks before the gradual lifting of quarantine, but after identifying conflicts in statements about the available quantities of masks, their prices and the extent to which they comply with standards set by the state, ARIJ’s reporter found that this was not achieved in practice.
Khalil Amous, Director General of the Tunisian Central Pharmacy, stated that around 30 million masks will be manufactured before lockdown is lifted.
The Ministries of Health and Industry published a joint statement regarding the standards for manufacturing "protective masks intended for non-medical use by manufacturers and craftsmen."
Although the demand for masks increased with the gradual lifting of lockdown, they were not sufficiently available.
Three days before lockdown was lifted, vice president of the Tunisian Syndicate of Private Pharmacies Owners, Noufal Amira, denied that there are 30 million masks in the market, and ruled out their availability.
Lockdown was lifted, and former Health Minister Abd al-Latif al-Makki, confirmed that the state is subsidising 4 million disposable masks from China at a price of 500 millimes per mask (less than a quarter of a dollar). However, these did not reach most pharmacies in the capital.
surgical
3 hours
A quarter of a dollar
FFP2
up to 4 hours
Free
Cloth
Use up to 10 times
Dollar
On May 20, and 16 days after the lifting of the first lockdown period between May 4-24, ARIJ visited five pharmacies in the capital and its suburbs to inspect the availability of masks; both the subsidised Chinese type and the reusable, washable, unsubsidised type.
The five pharmacies responded that the subsidised quantities ran out during the first week lockdown was lifted, and that they “do not have a stock of the reusable cloth masks."
ARIJ revisited the same pharmacies the next day to see if they were supplied with both types of masks, but they said they are still waiting for the Central Pharmacy's agents or one of the private suppliers to “pass by", and that they may provide the masks "in their own way" — but did not specify how the process works.
For his part, the head of the Tunisian Syndicate of Private Pharmacies Owners, Mostafa al-Arousy, assured ARIJ that the disposable masks, priced at 500 millimes (less than a quarter of a dollar), had run out at wholesale suppliers and most pharmacies from May 22.
Until May 21, the process of producing masks and their distribution routes to private pharmacies were vague, as the Tunisian Central Pharmacy failed to supply them masks.
In the Mahrajan road area, in the heart of the Tunisian capital, “Dr. Alaa’s” pharmacy is only a few metres away from the headquarters of the Tunisian Central Pharmacy — but communication between the two is scarce. The pharmacist said that the Central Pharmacy has not contacted them since mid-April.
“All this time, we have been waiting on the basis that [the Central Pharmacy] is the entity who will provide us with the masks – as stated by its Director General – which didn’t happen,” he said. “Due to heavy demand, we had to deal with manufacturers directly, not even wholesale suppliers, and purchase masks from them.”
The "masks deal" scandal that stirred public opinion in Tunisia had eventual repercussions on the state's policies regarding mask management. The government’s original plan was that the Central Pharmacy would purchase multi-use masks from manufacturers who obtain approval for manufacturing, and exclusively distribute them to private pharmacies later. However, this plan was not executed, creating opportunities for private manufacturers to make and sell masks directly to pharmacies and shops. This caused confusion across the distribution networks.
On April 7, the Minister of Industry, Saleh Ben Yousef, called Member of Parliament for the National Reform Bloc, Jalal al-Zayati –– the owner of a company specialising in medical supplies –– asking him to manufacture 2 million masks that the government could buy to supply the Central Pharmacy which in turn will distribute to the high street pharmacies. The National Anti-Corruption Commission received 11 notices concerning this process which constitutes a conflict of interest and violates the law.
Olfa al-Shahbi, director general in the National Anti-Corruption Commission, informed ARIJ that the file referred to the judiciary has not yet been decided upon.
In this regard, the head of the Tunisian Syndicate of Private Pharmacies Owners, Mustafa al-Arousy, said that the government has withdrawn its previous agreements with the Syndicate of Pharmacists and Manufacturers.
He attributes this to the fact that the issue of the "masks deal" made everyone afraid to join a system that could compromise transparency and invite accusations of suspicions of corruption and favouritism, thus causing delays in manufacturing and distribution.
ARIJ also found that the masks being sold in pharmacies did not meet the specifications set by the Ministry of Industry.
ARIJ purchased three samples of masks from Alaa’s pharmacy. They appeared to partially meet the Ministry’s specifications, which stated that each mask must be wrapped in a plastic bag with a sticker bearing the name of the manufacturer. The bag must also bear product identification and a disclaimer that the mask is protective and not intended for medical use. Each bag must also display the composition of the mask’s components, the maximum daily use duration (four hours), the method of product care after each usage and the maximum number of authorised washings.
ARIJ noticed that the masks only had a label with the manufacturer's address and phone number. When we took these samples to Fahmi Sukkari, owner of Camelia, a company which manufactures masks, he informed us that these samples do not comply with the specifications regarding method of manufacture. He said that he plans to file a complaint to the Textile Technical Centre, which is responsible for producing certificates of compliance. The mask samples were sold in a pharmacy located only a few meters from the headquarters of the Tunisian Central Pharmacy.
"These masks do not comply with the specifications, and I doubt that they obtained a certificate of compliance from the Textile Technical Centre,” Sukkari told ARIJ.
“It is sufficient to compare them with the masks that we manufacture. It is unreasonable to have to compete with a manufacturer that does not comply with the specifications and sells their products in pharmacies in the same area in which my company is located. We have submitted a complaint to the centre in this regard," he added.
However, Director General of the Textile Technical Centre, Salim Jamousi, told us that the Centre’s mission is “limited to granting certificates that the mask samples match the specifications,” indicating that despite receiving many complaints in this regard, the Centre does not have authority over manufacturers or sellers — including pharmacies and shops.
Al-Jamousi said that the manufacturer must provide samples of the masks he wishes to manufacture, so that they are tested in the Centre’s laboratories and their compliance with the specifications can be verified. The response is given by providing them a report of compliance or non-compliance. In the second case, he said, the manufacturer is supposedly prevented from manufacturing.
On May 26, to ascertain how widespread non-adherence to manufacturing standards is, we visited five other pharmacies in the centre of the capital: on Avenue Alain Savari, Belvedere, Freedom Street and Palestine Road.
We documented the sale of masks that were not wrapped in plastic bags and touched without protection by pharmacy workers, along with others that were wrapped but without labels, name of the manufacturer, number of the compliance certificate, address of the manufacturer or phone number. ARIJ found that some multi-use masks are sold at the price of 2,300 millimes, significantly more than the 1,850 millimes stated by the Ministry of Trade in its announcement on April 28.
In response to requests for comment about the control process regarding compliance with manufacturing standards and the prices set by the state, the Director of Economic Research at the Ministry of Trade, Hussam al-Din al-Tuwayti told ARIJ that these enquiries do not fall under the functions of his ministry. Everything related to this topic, he said, is the responsibility of the Ministry of Health. However, Health Ministry officials also ignored ARIJ’s requests for comment.