Holding politicians accountable for advancing pharmaceutical industry interests over public health concerns is a complex challenge, as the mechanisms for doing so are often fragmented, lack legal enforceability, or are themselves subject to political influence.

While formal and informal accountability mechanisms exist in the UK and EU, they are frequently insufficient to address the subtle and powerful influence of corporate lobbying.

1. The Role of Ethics and Standards Committees

Both the UK and the EU have bodies tasked with upholding ethical standards in public life. These committees are a primary formal mechanism for accountability.

• UK's Advisory Committee on Business Appointments (ACOBA) and the Committee on Standards in Public Life (CSPL): The UK's system for regulating the "revolving door" is centered on these bodies. ACOBA is tasked with advising on the new jobs of former ministers and senior civil servants, often recommending "cooling-off" periods. However, its advice is not legally binding, and there have been numerous instances where it has been ignored with no consequence. For example, a former minister could be hired by a pharmaceutical firm shortly after leaving office, and while ACOBA may advise against it, there is no power to stop them. The CSPL is an advisory body that promotes the "Seven Principles of Public Life" but has no enforcement powers.

• EU's Independent Ethical Committee: The EU has a similar system for former Commissioners, with an independent committee scrutinizing new employment for a two-year cooling-off period (three years for the Commission President). Like ACOBA, its power is limited to advice, and its decisions have been criticized for being too lenient. The effectiveness of these committees is a matter of public and political will, which can be inconsistent.

2. Parliamentary and Committee Oversight

Parliamentary bodies in both the UK and the EU are designed to scrutinize government policy and hold officials to account.

• UK Select Committees: The House of Commons Health and Social Care Committee, among others, can hold inquiries into specific policy areas, such as drug pricing or the role of the pharmaceutical industry. They can summon ministers, officials, and lobbyists to give evidence, and their reports can be highly critical. These proceedings are public and are often reported in the media, which can exert public pressure. However, a key limitation is that committee members themselves are not subject to a transparent register of their own meetings with lobbyists.

• European Parliament Committees: The European Parliament's committees, such as ENVI (Environment, Public Health and Food Safety), play a crucial role in scrutinizing EU legislation. During the legislative process, they can propose amendments to counter industry influence. They hold public hearings, and key rapporteurs are now required to publish meeting records with lobbyists. However, as with the UK's system, a great deal of informal lobbying happens out of view, and the committees have no legal power to sanction a politician for being swayed by corporate interests.

3. Civil Society and Non-Governmental Organizations (NGOs)

The most consistent and effective mechanism for holding politicians accountable is the work of civil society organizations, academics, and investigative journalists. These groups act as a crucial check on power.

• Investigative Journalism: Journalists and media outlets play a vital role in exposing conflicts of interest and the hidden influence of pharmaceutical lobbying. Their investigations, often based on leaked documents or analysis of limited public data, can generate public outrage and force politicians to address a scandal.

• Advocacy and Watchdog Groups: Organizations like Corporate Europe Observatory, Transparency International, and Global Justice Now actively monitor lobbying activities, analyze transparency registers, and publish reports exposing the links between politicians and the pharmaceutical industry. They conduct research on issues like the "revolving door" and the funding of All-Party Parliamentary Groups in the UK. Their work provides the evidence base for public health advocates and policymakers.

• Patient and Public Health Groups: While some patient groups are funded by the pharmaceutical industry, many are fiercely independent. They lobby governments directly to advocate for policies that prioritize patient needs over corporate profits. Their collective voice and direct engagement with the public can provide a powerful counterweight to industry pressure.

4. Legal and Judicial Review

In certain cases, legal mechanisms can be used to challenge government decisions that are perceived to be influenced by corporate interests.

• Judicial Review: Individuals or groups can seek a judicial review of a government decision if they believe it was made unlawfully or irrationally, or if a conflict of interest was not properly managed. While this is a lengthy and expensive process, it serves as a last resort to hold decision-makers accountable.

• Whistleblower Protections: Laws protecting whistleblowers can enable insiders to reveal information about corruption or conflicts of interest. The EU's Whistleblower Directive is a step towards providing a common standard for protecting individuals who report on breaches of EU law.

Conclusion: Gaps and a Call for Reform

While these mechanisms exist, they are often insufficient to provide effective accountability. The system is riddled with gaps and relies too heavily on voluntary compliance and a culture of good faith that is often absent when vast sums of money are at stake.

The most significant weaknesses in the accountability framework are:

• Lack of Enforcement Power: Ethics committees and advisory bodies often have no power to impose sanctions.

• Opacity of Influence: Most lobbying, particularly in the UK, happens outside the scope of official registers.

• Information Asymmetry: The industry has far greater resources to monitor policy and to influence decision-making than public health advocates.

To truly hold politicians accountable, a comprehensive reform is needed. This would include giving ethics committees legal powers, making all lobbying transparent, and strengthening the legal framework to address conflicts of interest. Ultimately, while the existing mechanisms are a starting point, it is the constant vigilance of civil society, journalists, and a demanding public that is the most effective tool for ensuring that politicians prioritize public health.