Financial Conflicts of Interest on COVID-19 Vaccine Committees

After The BMJ uncovered experts with corporate ties advising the U.S. and U.K. governments, Dr. Joel Lexchin points to similar problems in Canada.

7 minute read

A recent investigation I published for The BMJ found that some members of committees in the U.S. and the U.K. that provide advice on COVID-19 vaccines have undisclosed financial ties to biopharma companies. I uncovered this by reading the minutes of committee meetings and then backgrounding these experts to see if corporate money had been reported in other venues such as publications, professional websites, or government databases.

Oddly enough, it does not appear that anyone broke the rules; rather, the rules just don’t seem stringent enough. Agencies in the U.S. and U.K. only require committee members to report financial links going back 12 months, while the International Committee of Medical Journal Editors calls for disclosure of relationships going back 36 months. 

In an accompanying essay, The BMJ Executive Editor Kamran Abassi wrote:

When people line their pockets in matters of patients’ and population health, the consequence is often that others pay by lining hospital beds and coffins. This is no lazy exaggeration or scare story: clinical and public health decisions distorted by financial conflicts do harm and do kill. Exhibit A: the pandemic response, from the UK to Japan.

Shortly after The BMJ published this investigation, I was contacted by Dr. Joel Lexchin, a professor emeritus at York University and an emergency physician with the University Health Network in Toronto.

Over the last 40 years, Lexchin has published around 20 papers on corporate influence in medicine, examining financial conflicts in the United States, European Union, Australia, and of course, in his native Canada. Dr. Lexchin recently analyzed financial disclosures filed by experts advising Canada’s COVID-19 Vaccine Task Force, and found similar problems in his country as The BMJ reported.

“Managing conflicts of interest really fails,” Lexchin told The DisInformation Chronicle. “We have to move away from just managing them to avoiding them.” This interview has been edited and condensed.

DICHRON: How many physicians really understand that companies are putting out money to buy influence? 

LEXCHIN: Companies have a commercial motivation whether that's paying for physician education or helping to fund research . . .  The majority of physicians will say that that they're smart enough to know when companies are trying to manipulate them and that they can avoid being manipulated. I don't think this is true. There’s research that shows the opposite.

Professors Ray Fisman and Michael Luca delved into the science explaining how companies use marketing to push higher prescribing rates by physicians.

DICHRON: What did you find about the committee that advised the Canadian government on the COVID vaccines?

LEXCHIN: The committee was set up around June of 2020 by the Canadian government to provide advice around vaccines—which companies’ vaccines should they order? Should they be providing assistance to companies to help them develop vaccines? Those kinds of issues. 

When the government set it up, they said that it was going to include people with conflicts of interest because the government wanted the best kind of scientific advice. There are groups that were not included on this committee—no indigenous voices or minority communities in Canada. 

At each meeting people have to declare what their conflicts are, then somebody—we don’t know who—decides whether or not those conflicts are relevant. And if they are, then these people get excluded. 

DICHRON: One guy had been the past president of Sanofi Pasteur, and they said that's not a material conflict. But then he recused himself out of an abundance of caution, which I thought was weird. If you’re the past CEO of a company, that seems an obvious conflict. 

LEXCHIN: He was the president of the Canadian branch of the company until 2016 and my guess is that the government position was that this ended more than three years ago, therefore the conflict wasn’t relevant. But there had been publicity in some of the newspapers about this committee, and I think he recused himself for public relations purposes. 

DICHRON: You found many instances of academics who, maybe had no ties to a company, but their university did.

LEXCHIN: Universities get money from companies to do research. But if the universities are going to be critical of a company, they would risk not getting further research money. There's an implicit bias.

DICHRON: That’s exactly what tobacco did in the fifties to buy acquiescence from academics. They funded them and their research institutes. 

LEXCHIN: In the case of Joanne Langley, who was one of the co-chairs, the number of companies that have been associated with Dalhousie University, and sometimes her role with those companies, should have disqualified her in a number of cases. In fact, I think that she and Mark Lievonen should both not have been the co-chairs of the committee. 

DICHRON: Dr. Joanne Langley holds the Canadian Institutes of Health Research – GlaxoSmithKline Chair in Pediatric Vaccinology at Dalhousie. Multiple companies fund trials at her university which was not considered a conflict. But in one case she recused herself from a meeting because she planned to work with a company in the future.

Again, it seems the panelists are being more cautious than the government by recusing themselves. 

LEXCHIN: We don't know who actually is making these decisions about whether or not conflicts are relevant. It could be the co-chairs, the committee itself, or a government bureaucrat.

I think in some instances people are trying to cover their ass by stepping back, because they're worried about the publicity that would be generated if they didn’t recuse themselves. 

DICHRON: Here’s one that I thought was really odd. Dr. Benjamin Rovinski worked for Sanofi over 20 years ago. And yet he seems to have recused himself, although this was not a conflict of interest. There were journalists reporting on this committee who weren’t even in high school when he worked there. Twenty years seems like a long time.

LEXCHIN: This is all the detail that we get. We don’t know who made the decision. It could be that he’s just an upstanding guy. But the other possible interpretation is that he worked for the company 20 years ago, but he's still friends with a bunch of people at Sanofi. They still have informal meetings where they talk about projects. And because of that, he thinks that he shouldn't be involved in the decision making. But we don't know.

MedPage Today story on The BMJ investigation of US and British vaccine advisory committees on COVID-19 vaccines.

DICHRON: Right. Basically, they fill out government forms, but we never see the forms. The government decides what they want to make public. 

LEXCHIN: Maybe. The actual forms are not revealed. I think they have a meeting with somebody recording the minutes, and people disclose financial ties in the meetings. And these public statements get revealed.  

DICHRON: There’s a Dr. Sylvia van Drunen Littel‐van den Hurk who 10 years ago had a small contract with Sanofi Pasteur. They deemed that no recusal was necessary. 

I can't imagine something 10 years ago would come up in a discussion in the United States at the FDA. 

LEXCHIN: My assumption is she stood up at the meeting and said, “I had this contract 10 years ago.” I don’t know if she put that on the form she signed. And the government is likely not going back and searching people’s CVs. It’s what people choose to disclose. 

DICHRON: It appears that people are possibly disclosing more than what the government is asking. 

LEXCHIN: True. To that extent, what people are doing is good. But we should not be relying on an individual’s moral compass to find out what their conflicts are. The government process needs to be much more rigorous. 

It wouldn't take an awful lot to go through publication records for the past three or four years and look at their websites before allowing people to serve on a committee. But we don't know if the government does that or just relies on the personal integrity of these people.

DICHRON: How does Canada differ from the United States? There is an American perception that Canada is a kinder, gentler version of America when it comes to corporate influence. Canada is a little bit more cautious, a little less pro industry, and a little bit more collectivist than America. But also, maybe corporate influence in medicine is just more studied in America?

LEXCHIN: Probably 80 percent of the what's published about conflicts of interest comes out of the U.S. First, the media is much better funded in the U.S. to report on this. 

Second there's a lot more pharma money that's floating around in the U.S., which draw the attention of public interest groups that don't exist in other countries. There's no equivalent of Public Citizen in Canada, Australia, or the U.K. 

The main thing is that pharma’s financial influence has not been investigated in Canada to the same degree as in the U.S. I would guess that 80 percent of the patient groups in Canada get money from drug companies. And there’s little disclosure of this money.  

It's a mistake to think that industry involvement in Canadian drug policy is less than in the U.S. We just haven’t looked.

DICHRON: If you look back historically, the National Academies passed the first conflict of interest policy in 1971. Scientists were very upset and argued that their financial ties to corporations gave them expertise, not a conflict. You can see this today, where academics argue that only a doctor who has been paid by a company to run a clinical trial has the expertise to judge clinical trials.

LEXCHIN: This is a complex issue. Content experts are the cardiologists who know how different drugs may affect the heart and how different heart conditions play out in in patients. The process experts, who design the trials to avoid bias, are less likely to have conflicts than the content experts, because the companies just don't get the same kind of value from them.

But some people who get money from drug companies for research also give talks for the companies, or hold shares in the companies, get licensing fees, are flown to conferences . . . that kind of stuff. Those conflicts clearly should disqualify people serving on government committees. 

In the current world that we live in, I don't think we can do away with company money to do research. I would certainly like to see a different model, but I don't think that I'm going to live long enough to see that. 

DICHRON: Conflicts of interest are often discussed as an abstraction. You hear people arguing, “Well, can you prove that a particular payment caused someone to change their mind and vote to approve a drug?”

LEXCHIN: One matter is to declare what your conflicts are, and somebody makes a decision if they're really bad, and that you can't participate. The other way of looking at conflicts is just avoiding conflicts of interest.

Managing conflicts of interest doesn’t work. First, people don't declare everything. They say, “I didn't think that that was a conflict, so I didn't need to declare that.” 

Secondly, conflicts of interest affect decision making at a subconscious level. They operate like gifts, like Christmas cards. If you didn't bother sending a card to someone because you don't like them that much, or you just don't feel that close to them, but you got one from them, you'll probably send one to that person next year, even though your feelings for that person have not changed. It’s a gift relationship.

And getting money to speak for companies or getting flown to somewhere warm in the middle of winter is a gift relationship. 

If I declare before a talk that I got money from Merck, Sanofi, Pfizer, yada, yada . . . people listening are not necessarily experts in my area. How can they judge if I was influenced by all that money? 

They can spend hours hunting through everything that I said to see if it reflects general medical opinion. Nobody is going to do that. Second, they can say, “He was honest and declared his conflicts, therefore we should believe him.” Finally, they can say, “He has all these conflicts and none of what he said is true.” 

So managing conflicts of interest really fails. And we have to move away from just managing them to avoiding them. 

DICHRON: It's been shown through documents that have become public in lawsuits that companies will explicitly fund people to buy allegiance. 

LEXCHIN: Sometimes companies will identify people who have the kind of viewpoint around medications that the company is pushing—a respiratory expert who believes that a particular drug is better for asthma than anything else. Drug companies fund these people because it's much harder to accuse them of being bought.

DICHRON: Are there enough experts in biomedicine in the great nation of Canada to find people without conflicts and put them on these panels to advise on drugs, devices, and vaccines? 

LEXCHIN: I think so. It would be harder, because a lot of people do get money from drug companies. I think that there are enough independent people in the country who have the expertise to advise officials. 

And not everybody has to be pure. If you got down to 25 percent of people on committees who had conflicts, you know, that would certainly be better than 75 or 80 percent of people.