At East Legon in Ghana’s capital, Accra, a non-citizen of ECOWAS will have to pay only $16 for a Covid-19 antigen test, and it takes 30 minutes to get the results. At the Kotoka International Airport, less than six kilometres away, that service will cost the person $150. In the following report, The Fourth Estate’s Adwoa Adobea Owusu explores the Ghana government’s expensive mandatory antigen testing at the airport, which began with a shady contract, details of which six ministers of state could not disclose at their vetting.
On September 1, 2020, Ghana announced that it was charging every passenger arriving at the Kotoka International Airport (KIA) $150 for a mandatory antigen test. It left one of the country’s leading scientists, Dr. Joseph Humphrey Kofi Bonney, shocked.
“Averagely, it should cost between $10 and $20,” the virologist and research fellow at the Noguchi Memorial Institute for Medical Research told Joy News on September 1, 2020. This was on the day the government opened the airport to international flights, five months after Ghana’s air and land borders had been closed as measures to curb the COVID-19 pandemic.
Dr. Kofi Bonney explained that an antigen test was less accurate in detecting COVID-19 than the more sensitive PCR test. “But even PCR costs $50. I don’t know why we have to do an antigen test, which is less sensitive upon arrival,” he said.
The government refuted Dr. Kofi Bonney’s assertion. The Food and Drugs Authority (FDA) dismissed the virologist’s argument that an antigen test was less likely than a PCR test to detect a positive COVID-19 case.
In the midst of the pushback from the government, the Noguchi Memorial Institute for Medical Research released a press statement saying its employee, Dr. Kofi Bonney, did not speak for the organisation. It, however, did not deny or confirm the issues he raised.
The company handpicked to undertake the mandatory testing at the airport, Frontiers Healthcare Services Limited, went on to charge $150 for the antigen test for all arriving passengers. In early 2021, leaders of the 16 countries under the Economic Community of West African States (ECOWAS) raised issues with the charges.
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The government was compelled to reduce the cost of testing from $150 to $50. But this reduction was for only ECOWAS citizens.
People from other parts of Africa and the rest of the world continue to pay $150 for the mandatory antigen test at the arrival section of Ghana’s airport.
But it appears Dr. Kofi Bonney was not wrong. Less than six kilometres away from the Kotoka International Airport, the LEDing laboratory charges $16 (GHc100) for COVID-19 antigen test. One can get test results within 30 minutes of testing.
While Frontiers Healthcare Services charges $150 for the government’s mandatory antigen tests, the Omni Lab at the same airport charges $33 for the Covid-19 antigen test.
Outside the airport, The Fourth Estate visited 10 antigen testing centers. None of them charges above $41 for the antigen test. Below are the labs and their charges.
An antigen test in the UK ranges from £1($1.3) to £49 ($65). In Malawi, an antigen test costs $25; in Malaysia, $28; and in India, it cost $7.
In Ghana, however, it cost $150 at the airport where it is compulsory to use the services of Frontiers Healthcare Services Ltd.
However, at a laboratory at the Departure Section of the airport operated by Frontiers, antigen test costs $50 irrespective of nationality. This section of Frontiers does not undertake the mandatory testing of arriving passengers.
Even a PCR test costs $49 when it is done at Frontiers while its antigen tests cost $150 for all, except ECOWAS nationals.
Profiting from the Pandemic
Frontier’s test is mandatory. Passengers have no choice, and in the absence of options, The Fourth Estate has found evidence that suggests travellers into Ghana are being ripped off by the state and a private company in the midst of the pandemic.
When Frontiers began charging $150, it caused an uproar among travellers, who said it was a rip off. The uproar attracted the attention of the Economic Community of West Africa States (ECOWAS). In January, during its 58th ordinary session held in Ghana, ECOWAS prevailed on its own chairman, President Nana Akufo-Addo of Ghana to reduce Ghana’s antigen testing cost at the airport from $150 to $50.
In effect, only passport holders from the 16 West African countries have been paying $50 for mandatory antigen tests at the Kotoka International Airport since March 2021. All other passport holders of the remaining 177 countries pay $150.
Data from the Ghana Airport Company from January to November 2021 shows that an average of 2,000 passengers arrive in Ghana every day. The Fourth Estate does not know how many of these are ECOWAS nationals.
The Ghana Health Service said on November 28, 2021, that 600,000 people had arrived in Ghana since January 2021. If half of the figure is taken as citizens from ECOWAS and the rest is taken as the number arriving from the rest of the world, applying the charges of $50 and $150 would amount to a total of $63 million accruing to Frontiers Healthcare Services Limited.
December is projected to be the busiest month of the year when many people arrive home for the holidays.
From September to December 2020, the Ghana Health Service announced that Frontiers Healthcare Services Limited made $17.1 million from the mandatory testing at the airport. Out of this, Ghana’s share was $1.1million as fees for the space rented to the company at the airport.
Does Ghana have the world’s most expensive testing regime at the airport?
Ghana is among the few countries that make antigen testing mandatory at the airport on arrival.
South Africa, Africa’s worst-hit COVID-19 country, does not require any antigen test on arrival at the airport. In Europe where 1.64 million people have died of COVID-19 out of 71.5million cases, no airport requires an antigen test at the airport or recognizes antigen test on arrival.
According to a Principal Biomedical Scientist at the Korle Bu Teaching Hospital, Seth Agyemang, countries shun antigen tests because the results are limited in detecting COVID-19.
Mr. Agyemang explained that the antigen test has, at best, 85% chance of detecting the virus and as low as 70% (as compared to the PCR test which has a 95% detection rate).
Speaking on condition of anonymity, a leading scientist and immunologist at the University of Ghana said antigen tests detect the presence of COVID-19 in a positive patient only when the viral load is high.
According to him, when travellers show up at international airports and have PCR tests within the stipulated 72 hours, the results are considered more reliable and credible than antigen.
He said antigen tests could be produced within 20 minutes unlike the PCR, which could be produced in a minimum of two hours.
Commenting on the cost, the immunologist said even when PCR tests are conducted on to the masses over a period of time, it should not cost more than $30. “The more you do, the less the cost, if you factor in staff and administrative cost, it should still not be more than $20-$30, and the antigen test not more than $3, maximum $5.”
When asked about the reason for the high cost of antigen tests at the airport, he responded with a giggle, “That is a question for the Ghana Health Service.”
He explained that even if the equipment used by Frontiers were expensive, the company should have recouped its investments by now and should have reduced the cost of testing drastically.
In the UK, a traveller has to take an antigen test a day after arrival, while in Germany, travellers may take antigen tests if they feel any of the symptoms two days after arrival. Travellers, however, have several testing options to choose from. They are not bound to one company at the airport as in the case of Ghana.
Murky Procurement of Frontiers
On August 16, 2021, President Akufo-Addo addressed the nation and hinted at the re-opening of Ghana’s air borders to international flights.
“Under my instructions, the Ministry of Aviation, the Ghana Civil Aviation Authority and the Ghana Airports Co. Ltd., have been working with the Ministry of Health and its agencies to ascertain our readiness to reopen our airport. I want to ensure that we are in a position to test every single passenger that arrives in the country to avoid the spread of the virus,” President Akufo-Addo said.
Frontiers, the company that would conduct the mandatory tests, had been incorporated just three weeks before the president’s address.
Frontiers was handpicked through the single source procurement method. While the law allows the government to use single sourcing, this method must satisfy some conditions. According to the Public Procurement Act, it is used in emergency situations and when there is no other company or entity able to provide the services procured.
The government has said it had accredited 40 private laboratories to conduct PCR and antigen tests for COVID-19. But the government settled for an unlicensed company incorporated three weeks before the president’s announcement.
Although all new healthcare facilities are to be licensed before they start operating as stipulated in the Health Facilities Regulatory Authority (HeFRA) law, Mr Agyemang Manu told the Appointments Committee that he did not know that Frontiers did not fulfill that legal requirement before it became operational. He was, however, quick to add that it was remedied when he got to know.
The Frontiers Healthcare Services was eventually given a provisional license on November 3, 2020, two months and two days after the reopening of the airport
Some civil society organisations and individuals criticised the arrangement. They argued that Noguchi, which was Ghana’s saviour when the Covid-19 pandemic struck, should have been given the opportunity to test at a reduced cost and make some money to fund its operations. The government, however, thought otherwise.
With no competitive tendering, and with guaranteed exclusivity, Frontiers Healthcare Services Limited was empowered by the government to conduct the tests.
At the vetting of ministerial nominees in February 2021, all the ministers who were expected to know about Frontiers and its procurement denied knowledge of the details.
The minister of state in charge of procurement, Adwoa Safo, said she did not know the details about the selection of Frontiers.
The Deputy Minister of Justice and Attorney-General when the contract was signed, Godfred Yeboah Dame, also repeated the same lines to the Appointment Committee of Parliament during his vetting for the position of Minister of Justice and Attorney-General.
“Mr. Chairman, I am not in the position to tell whether indeed [Frontiers contract] was referred to the Office of the Attorney-General. I was deputy A-G at the time, I had no idea of the company behind the setting up of the company behind the testing,” Mr. Dame said.
At the time of the contract, Mr. Dame was a board member of the PPA. PPA board is responsible for approving all single-source procurement contracts awarded by the state.
The Minister of Transport, Kwaku Ofori Asiamah’s, response was terse.
“Mr. Chairman, per document before me, the contract was signed on September 1, 2020. I can’t remember when Frontiers started operations.”
Ghana’s Minister of Health since 2017, Kwaku Agyeman-Manu, continued the chain of denials. The Dormaa East lawmaker told his peers on the Appointments Committee, “It will be very difficult for me to answer this particular question? Why? Because there is a presidential task force that is supporting the ministry to do the Covid battle. This particular arrangement was put in place by the task force that reports to the President.”
“They actually did the procurement,” Mr. Agyemang-Manu said.
He is also a member of the COVID-19 Presidential Taskforce.
The Minister of Information, Kojo Oppong Nkrumah; and the Minister of Foreign Affairs, Shirley Ayorkor Botchwey; also did not have ample knowledge about the Frontiers contract when quizzed at their vetting.
It is unknown how long the mandatory Covid-19 testing for all arriving passengers to Ghana will continue.
What is, however, known is that while the test can be done as low as $16, the company that is given monopoly to undertake the mandatory testing at Ghana’s airport charges up to $150.