NO government in the world had a primer to deal with the unprecedented pandemic which plunged countries into unmapped territory. However, several months into the global health emergency, lessons have emerged from across the world to show what worked to mitigate and contain Covid-19 — and what did not. It is never too late for a government to change course even in the midst of an uncharted and evolving crisis, especially as more evidence emerges about how best to tackle it.
By now, the most obvious and instructive lesson is that it is “rapid, decisive and collective action that can prevent the spread” — as an influential report from London’s Imperial College put it.
And this advice from the World Health Organisation remains imperative to fight the virus: “Countries must continue to find, test, isolate and treat every case and trace every contact”. And “If countries rush to lift restrictions too quickly, the virus could resurge and the economic impact could be even more severe and prolonged”.
Informed by this perspective, the prime minister might consider taking the following five steps: 1) send clear, coherent and consistent messages to the public; 2) act decisively; 3) lead a unified, multilayered, national effort with close coordination with all provinces; 4) stay a firm course on social distancing; and above all 5) be guided by the evolving medical science on the pandemic by giving a lead role to medical specialists who understand this, not generalist bureaucrats.
Like other countries, Pakistan is navigating a crisis that will test its leadership.
Why urge these steps? To answer this, consider what has happened so far. First, on messaging, the early weeks saw mixed signals, which did not convey the urgency or severity of the unfolding threat. Public communication veered between saying this was little more than a flu virus that would afflict the elderly to asserting that the virus had not hit the country as hard as other nations. If the aim was to calm and not panic the public, the (unintended) result was to underplay the threat when people needed to be persuaded to stay home to prevent the virus from spreading.
As the number of cases rose, the prime minister’s tone changed. But procrastination over measures aimed at social distancing continued to send conflicting messages. Getting mired in a prolonged public argument about lockdown vs no lockdown conveyed an impression of indecisiveness.
That brings up the second step — act decisively. If, as government leaders claim, they first “reviewed” the looming threat in mid-January, how did they act on this? How was an under-resourced healthcare system enabled to deal with the remorseless onset of cases? Did “rapid, decisive action” follow after the first infection was confirmed on Feb 26?
Missteps exacerbated the situation. Much has already been said about how zaireen (pilgrims) returning from Iran through the border crossing at Taftan were managed and cluster allowed into the mainland, which accelerated the spread of the virus. According to the latest official figures, over 30 per cent of current Covid-19 cases in Pakistan came via this route.
The centre’s unwillingness to move early to suspend air travel and restrict religious congregations had a similar deleterious effect, with scores of tableeghi members spreading the virus across Punjab and beyond. Official figures show almost 20pc of confirmed cases in the country today can be traced to the latter. Another 24pc have been tracked to people travelling back from countries other than Iran.
The federal government also did not take the lead on a lockdown, with officials debating its economic fallout rather than act. True, governments across the world struggled to find a balance between restrictive measures and economic activity. But as many international experts have pointed out, this is a false choice, because saving lives is necessary to save livelihoods. While the government’s economic packages and enhanced Ehsaas handouts are welcome steps to mitigate the economic fallout, the perpetual focus on this has fed the perception that the crisis is not being viewed through the prism of a public health emergency, but its economic repercussions.
While the federal government vacillated, the Sindh government led the way and implemented a lockdown, obliging Punjab to follow suit. Its effective communication campaign also offered a contrast to the media strategy pursued by Islamabad.
The third step is centre-province coordination. This was found wanting weeks into the crisis. The prime minister’s reluctance to reach out and consult provincial leaderships, especially of Sindh, prevented a unified policy from emerging. Provinces went their own way until a National Coordination Committee and a Command and Operations Centre were established in mid-March and early April respectively. But provincial approaches — for example, on a lockdown — are still not harmonised. This prompted a Supreme Court judge to urge the centre during a recent hearing to improve coordination with provincial governments.
Four, as the federal government mulls relaxing restrictions on economic activity, it remains important to meet clearly articulated health milestones, especially enhanced testing capability, before easing the lockdown. According to the government’s own projections, infections may reach 70,000 by end-April, as reportedly revealed to a cabinet meeting last week. If this projection is based on an assumption about a degree of compliance with social distancing, then that estimate can change if restrictions are relaxed early.
Last but not least, the determination of when to ease restrictions should be made on the advice of health professionals. Their counsel should guide the overall policy response to Covid-19. They should be represented in the top policy bodies established to address the crisis, not just subsidiary committees. Membership of these bodies should be dictated by the nature of the crisis, not ministerial status. Expertise is needed to interpret the evolving response of the global medical community. This critical gap should be filled as the NDMA is designed to deal with natural disasters and other aspects of the ongoing crisis, not a health emergency.
Like other countries, Pakistan has to navigate a crisis that will test its leadership. The prime minister has used the metaphor of war to describe the challenge of fighting Covid-19. He has a chance to emerge as an effective ‘wartime’ chief executive. Now is the time for him to live up to that challenge.
The writer is a former ambassador to the US, UK and UN.
Published in Dawn, April 13th, 2020