Revolving doors and conflicts of interest in health regulatory agencies in Brazil

Abstract

Regulatory health agencies exist in most public health systems (PHS) and play a crucial role in enacting regulation and overseeing economic activities in order to ensure the quality of health systems, goods and services.1 Multiple practices of corruption such as bribery or fraud have been reported in health policy and systems.2 Public health agencies are particularly susceptible to ‘regulatory capture’,3 4 a process by which an agency advances the special interests of the industries and of other actors it is entrusted with regulating. One of the mechanisms that can potentially lead to an agency capture is the so-called ‘revolving door’,5 the situation where an exchange of roles between public regulators and regulated institutions may result in health policy decisions which are biased in favour of industry interests. Revolving doors have previously been described in the USA and Europe, with an emphasis on legislative, energy, financial and patent agencies. However, there is little empirical evidence on the scale and scope of this problem in PHS. In this commentary, we explore the extent of the revolving doors phenomenon in Brazil by analysing the professional trajectories of public agents who held high positions at the two key health regulatory agencies in the country between 1999 and 2018.