COVID-19 drive-thru testing rollout blurs lines between public, private sectors
 
 

Ahmed al-Geidi, the technical director of Prime Speed Medical, which offers a drive-through coronavirus testing service, says the company’s prospects look bright.

“There’s a lot of demand for the service,” Geidi tells Mada Masr. “We opened a branch in the North Coast at Alamein. So now we have four branches: two at public universities — Ain Shams and Banha — and a third at the American University in Cairo.”

Geidi has reason to be optimistic: the prime minister visited the company’s first drive-through site the day it opened, on June 15, accompanied by the ministers of health and higher education, who have been heavily involved in Egypt’s pandemic response, and the secretary general of Egypt’s sovereign wealth fund. 

The visit prompted questions about the discrepancies in the government’s coronavirus testing plan. Why did the Health Ministry prohibit the private sector from selling PCR tests to citizens? Why did it only bless one private sector company, which offered the service at double the price of its central laboratories?

The visit marked a public reversal of the Health Ministry’s previous ban on private sector testing. The ministry had designated its central laboratories as the sole PCR test providers, charging LE1,050 per test. Then testing shortages helped foster a black market for tests, a Health Ministry official told Mada Masr. But the government has endorsed just one private company to provide testing: Prime Speed Medical, in which Tamer Wagih, a former executive of President Abdel Fattah al-Sisi’s 2014 election campaign, is a major investor. The state-affiliated reference laboratory that oversees the company’s testing, which has provided paid testing services since March, has ties to the minister of higher education through the university hospital council he chairs. And because the government does not recognize the reference lab’s results, its positive results are not included in Egypt’s official coronavirus numbers.

When the virus first appeared in Egypt in February, and public demand for testing began to grow, the Health Ministry announced that it would not allow the private sector to conduct tests for “national security” reasons. As the virus spread across the country and the number of infections spiked, demand for testing also increased. The Health Ministry then limited free testing only to patients who suffer severe symptoms. This created a black market for testing, which hospitals and private laboratories exploited by selling the service to citizens for up to five times the price of the ministry’s central laboratories and then sending the samples to be tested for free. 

Prime Speed charges LE2,000 for PCR tests with results within 24 hours and LE400 for the more rapid antibody tests with results in minutes, according to Geidi.

“Our role is only diagnostic,” Geidi says. “We take samples from people, then we tell them if their tests came back positive or negative for coronavirus. We’re not responsible for whether or not they get treatment.”

In mid-June, the Cabinet’s official Facebook page said the aim of establishing a drive-through testing service was to avoid the overcrowding of patients at laboratories and limit the spread of infection. The Cabinet explained in its statement that patients obtain the service by paying in advance — either by credit card through the service’s application or the electronic payment portal Fawry for those who do not have credit cards — without including the price of the service. It also mentioned that the service is a collaboration between Prime Speed Medical and the Ministry of Higher Education — represented by the Supreme Council of University Hospitals and the reference laboratory affiliated with it. 

The statement did not explain the government’s relationship to the service or mention any details of its contract with the company — whether Prime Speed won the contract through an open bid or not. Instead, the statement emphasized the government’s moral support of the service by using the phrase “the prime minister visited” instead of “the prime minister inaugurated.”

 

The private sector: Prime Speed

On February 16 — just one day after Egypt recorded its first coronavirus case — the private company Speed Medical announced that it would be among the first private sector laboratories to offer PCR testing for coronavirus by the end of the month.

On March 30, the same company signed an investment agreement with a group of businesspeople. Chief among them was Tamer Wagih, a former member of the executive committee of President Abdel Fattah al-Sisi’s 2014 presidential campaign. The agreement created a new company under the name Prime Speed, with Speed Medical contributing 30 percent of the capital. The new company’s stated aim was to “find solutions to help the Egyptian state in its ongoing efforts, enter into strategic partnerships for the purpose of expansion, and deliver outstanding medical services to clients all over the country.”

On April 4, TV anchor Amr Adib hosted Wagih on his show Al-Hekaya to promote drive-through testing. At the time, eight countries around the world, including the United Arab Emirates, had adopted some form of drive-through testing. Wagih emphasized the need to expand coronavirus testing capacity through private sector companies that would offer it to all citizens. He also emphasized the need to test people without symptoms, as the Health Ministry has done with hepatitis C. .

On April 7, Speed Medical announced it had reached a preliminary agreement with Prime Speed for four million tests. It had already started delivering the tests and was set to continue over the weeks to come.

Speed Medical was not content with selling detectors only to Prime Speed. In fact, it announced on April 22 that its subsidiary had won a bid to become the exclusive agent and distributor for Cellex Incorporated in Egypt. The US-based company was the first to receive the Food and Drug Administration’s approval for a COVID-19 antibody test.

 

The public sector: The laboratory affiliated with the Supreme Council of University Hospitals

The Ministry of Higher Education got approval from the prime minister to allow a laboratory affiliated with the Supreme Council of University Hospitals to offer testing services for a fee. Since the beginning of March, the laboratory has offered tests for LE2,600 and has signed contracts with public and private entities to test their employees.

Then, the Higher Education Ministry-affiliated laboratory contracted Prime Speed to offer drive-through testing to people for LE2,000, which is double the price determined by the Health Ministry.

Ghada Abdel Wahed, the director of the reference laboratory affiliated with the Supreme Council of University Hospitals, says that the laboratory is responsible for the actual testing, while Prime Speed’s role includes “setting up a tent, a caravan, computer connections and a bathroom for employees and providing the staff and management.”

Abdel Wahed adds that her lab is the only coronavirus reference laboratory affiliated with the Supreme Council of University Hospitals. It supervises all drive-through testing branches in Cairo and other governorates overseeing training and  the swabbing operations as well as the transfer of samples. “The lab does everything; it delivers results to the drive-through within 24 hours and collects statistics on the rate of positive cases,” she says.

Abdel Wahed says that aside from drive-through testing, the laboratory has been offering a number of paid services since the beginning of the coronavirus crisis. It conducted coronavirus tests at various hospitals, and took swabs from some employees at the National Cancer Institute and Helwan University. The lab also has a home testing service that sends a representative to a patient’s home to take the sample. “We also provide the service to private laboratories, medical centers and hospitals, as well as to anyone who has come into contact with a positive case,” Abdel Wahed says.

An official source at the Health Ministry’s central laboratories who spoke to Mada Masr on condition of anonymity says that, at the beginning of March, the ministers of health and higher education agreed to select Ain Shams University’s Demerdash Hospital, Cairo University’s Qasr al-Aini Hospital and others to receive suspected coronavirus cases and test them free of charge alongside the Health Ministry’s hospitals. This came up in a statement released by the Health Ministry on March 25. The minister emphasized that “the test for the novel coronavirus is prohibited unless it is through the ministry’s central laboratories or university hospital labs that the ministry coordinates with in one network.”

Yet at the same time, the reference laboratory offered coronavirus detection tests — both PCR swabs and antibody tests — for a fee to anyone who wanted them. As a result, the health minister directed the Central Department for Free Treatment and Medical Licenses to send an inspection committee in a lead up to closing it down. This indeed happened as the committee prepared a report on the laboratory’s violation of the health ministry’s decisions and presented it to the minister. But according to the source, the health minister refrained from making a decision because the minister of higher education objected to the inspection of the lab since it is affiliated with the Supreme Council of University Hospitals, which he chairs. He also demanded the prime minister grant him the authority to determine which university hospitals are to receive suspected cases of coronavirus, which the prime minister approved. This move kept the operations of the reference laboratory — which is affiliated with the minister of higher education — immune from oversight by the health ministry. An expansion in the lab’s operations soon followed by creating memberships for governmental agencies and institutions, judicial bodies, private oil companies, and elsewhere to test their employees.

The source adds that the lab billed each of these entities at a different price. Meanwhile, the health ministry’s central laboratories were keen on offering the service to individuals and private labs and hospitals at the same price of LE1,000.

According to the source, the Health Ministry did not recognize the reference lab’s test results and did not rely on positive coronavirus results issued by the reference lab in admitting patients to isolation hospitals or hospitals affiliated with the ministry.

 

The private and public sectors come together

“We were struck by the deal announced between the reference laboratory and Prime Speed — and that the health minister even attended in person to inaugurate it,” the official at the Health Ministry’s central laboratories says. “So, we realized that it had been agreed upon from the beginning, especially since neither the private company nor the governmental lab can provide the equipment and material used in tests without the approval of the Unified Medical Procurement Authority.”

Unlike the immunity from oversight the reference laboratory enjoys, given its affiliation with the Ministry of Higher Education, private labs are subject to the authority of the Health Ministry’s Central Department for Free Treatment. According to the same source, the department closed two of Speed Medical’s labs before the drive-through service was launched because they violated the Health Ministry’s decisions by conducting tests.

The source says that Prime Speed took advantage of the contradiction between different ministerial policies. On the one hand, the Ministry of Higher Education has a laboratory that offers tests for a price without restrictions. On the other, the Health Ministry limits free testing to its hospitals and central laboratories and prohibits the private sector from conducting patient tests.

Hours after the first drive-through unit opened at Ain Shams University, the head of the Egyptian Society of Laboratory Medicine, Suheir Helal, submitted a complaint to the head of the Medical Syndicate. Mada Masr obtained a copy of the complaint in which she expressed her reservations over the Supreme Council of Universities contracting Prime Speed. She asked the president of the syndicate to intervene to stop the project and outlined three reasons for her reservations. First, it violates the Constitution, which stipulates that the state is required to provide health services in the form of health insurance or otherwise to all citizens for all diseases without trying to make a profit, particularly during a pandemic.

The president of the Egyptian Society of Laboratory Medicine, which includes in its membership professors of medicine from Egyptian universities throughout the country, noted that the drive-through service is for profit and only available to those who can afford it. She believes that the service “squanders public funds and allows others to profit from public funds.” Secondly, Helal points to the fact that Prime Speed was awarded the contract directly, which contravenes legal measures related to codes of practice and bidding. Finally, personal information, such as the tallies and names of patients who test positive for COVID-19, are a matter of “national security.” A private company should not gather such information, the complaint letter states.

Asked whether Prime Speed sends information on patients whose coronavirus tests come back positive to the Health Ministry, an official at the drive-through service says that his company does not deal with the ministry, nor does it provide it with any information. Yet he also emphasized that they coordinate operations with all relevant bodies, without specifying which ones.

The director of the reference laboratory, Ghada Abdel Wahed, says the aim of the drive-through service, along with other services the lab provides, is to meet increasing demand for testing by those who can afford it in order to relieve the state and limit free testing provided by the Health Ministry hospitals to those who cannot afford to pay. She stressed that not recognizing her lab’s results is “arbitrary” and that the ministry “wants to expropriate the service.” She adds: “They’re fighting all labs and don’t allow anyone to do testing even though they’re unable to cover everyone who needs a test and refuse to test a lot of people.”

The Health Ministry official says that the ministry objects to the private sector conducting coronavirus tests because it wants to centralize the process of tallying new cases, as Helal mentioned in her letter to the Medical Syndicate.

A source at the Health Ministry acknowledges that the state’s policies have contributed to creating a black market for testing. The ministry has been unable to compel private laboratories to offer testing at a specific price. “There were large hospitals that brought us samples and paid LE1,050 per sample, then sold them to patients for LE4,500 and 5,000,” the source says. “There were senior doctors who would strike deals with government hospitals, like the fever hospital and others, to send them samples to test at central laboratories for free, then turn around and charge patients large fees.” 

Even though the source admits that the Health Ministry’s policy of rationing PCR tests contributed to the creation of a black market, they stress that the solution is not the exploitation of the pandemic and allowing businesspeople to multiply profits. Instead, the testing operation should be assigned to the Health Ministry or to laboratories affiliated with established university hospitals, such as the Demerdash and Qasr al-Aini labs. 

The public and private sectors overlap in coronavirus testing and various state bodies handle drive-through testing. This led the Doctors Syndicate board, headed by Hussein Khairy, to excuse itself from intervening in this issue, telling Mada Masr that the matter is instead the responsibility of “monitoring bodies” over which the syndicate has no authority. Khairy explained that the drive-through testing project is a result of a contract between the reference laboratory affiliated with the Ministry of Higher Education and Prime Speed’s lab, which falls under the supervision of the Health Ministry’s Central Department for Free Treatment. Additionally, the Accountability State Authority has a role in monitoring the contract and the expenses and revenues related to the reference lab’s earnings given that it is a government body affiliated with the Ministry of Higher Education, Khairy said. In a letter, which Mada Masr obtained a copy of, the syndicate asked the head of the Egyptian Society of Laboratory Medicine to contact the prime minister directly and attach any available documents.

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