BY now, it is clear that the federal government’s position on handling the fallout from the virus is based on its understanding of a trade-off between subsistence and disease-burden. At various points in the preceding couple of weeks, government representatives have stated (often very clearly) that they cannot cater to the population’s welfare needs that emerge from a shuttered economy.
The gradual ease-up in restrictions on businesses is therefore the government’s way of finding welfare solutions through the private sector, or more generally, through the workings of the market. It is also, unfortunately, an admission of binding constraints — that the state cannot expand its capacity at such short notice; that it does not have the institutionalised linkages with civil society which would allow it to reach vast swathes of the population through voluntary efforts; that it does not have the fiscal resources (or cannot reallocate the ones that it does have) any more than what has been committed already.
Pandemics or disasters of any kind are both a litmus test for a state’s capacity, and a catalyst for rapid expansion in what states are capable of. We’ve seen both aspects already — the rapid and admirable expansion of a cash transfer programme, which one hopes is here to stay; and the admission that subsistence will have to come through the market.
None of this changes the fact that a public health crisis still exists. The disease hasn’t gone away, and neither has its potency. Easing restrictions on some sectors and allowing the return of economic normalcy in some form only (partly) helps out with one issue; it does nothing for the other.
This crisis has triggered an upsurge in intellectual work from academia, civil society, and professionals from other domains.
Thankfully, this crisis has also triggered an upsurge in intellectual work from academia, civil society, and professionals from other domains who are providing research, data analysis, and policy advice on Pakistan’s options, while keeping in mind its significant capacity and fiscal constraints.
Much of this work is predicated on the logic that the options utilised by better-resourced countries to control the virus might not be available to Pakistan. At the same time, this should not be taken as an excuse to do nothing at all. There are smarter, less resource-intensive solutions available, which can be piloted and scaled up depending on their relative success.
Two contributions oriented towards Pakistan’s case in this regard are worth highlighting. The first comes as part of the excellent work done by the Pakistan Institute of Development Economics (PIDE), who have produced a range of analytical products detailing both the socioeconomic impact of the virus and proposed measures for how it can be curtailed. PIDE was one of the first, if not the first, organisations to put out vulnerability assessments for the geography of urban settlements and the economy as well, highlighting in particular the risks posed by poor urban planning and informalisation through high levels of own-account and other informal workers.
PIDE’s proposed solutions highlight the centrality of testing, given the spatial constraints placed by densely populated and overcrowded localities within Pakistan’s urban centres. Supplementing this should be a scale-up of aggressive contact tracing using geo-tracking and cellular data, which the government is already utilising (though in a relatively patchy state). The idea is to catch infected patients relatively early, propose adequate quarantine solutions, and reduce the rate of transmission.
The second important contribution comes from the Centre for Economic Research in Pakistan. CERP’s approach has been drafted by a team of economists, policy specialists, and medical professionals both domestically and abroad. As mentioned earlier, it too draws on the constraints and context-specific particularities of Pakistan’s case (high levels of informality, poverty, weak supply chains), and crafts a dynamic system that incorporates continuous learning to refine interventions.
In a recent piece for Dawn’s online platform, Prism, CERP’s Anum Malkani and Maroof Syed outline their team’s theory and their proposals for a smart containment strategy. The logic here is simple — virus transmission, prevalence, and impact will differ from place to place due to underlying socioeconomic and demographic realities.
Using the district-tier as the focal node for decision-making and implementation, diffused containment strategies can be utilised at an appropriate scale (neighbourhood/village/settlement), so as to both reduce the burden on healthcare systems, and mitigate against disruptions in essential worker mobility and food/welfare supply chains. Their proposal bases lockdown strategies on the scale of infection, with extreme cases resulting in full-scale closures.
However, the important thing that they stress is that any such decision-making must be based on continuous data collection, which would also help identify the level of risk that particular district faces. This means health data collected through disease screening and testing of at-risk populations, and sentinel testing of sewage systems in potentially impacted localities; as well as using data that draws on economic vulnerability, health demographic (age profile and population density), and mobility profiles collected through phone surveys, contact tracing and other forms of cellular records.
Complementing the health side would be public outreach campaigns and community-based interventions designed to encourage appropriate behavioural change and ensure compliance with distancing and quarantine measures.
Some of what’s proposed here is already being piloted out by provincial governments in at least three of the four provinces. But as CERP’s plan proposes, each tier of government should be delineated with differential responsibilities: provincial governments playing a resource provision and coordination role, while the district tier becomes the most important in localised decision-making and implementation.
Times of crises require states to swap standard models of behaviour and governance for those that enable capacity enhancement to directly address the problem. Simply saying that a country is too poor to do anything is insufficient; on the other hand drawing on the proposals and analytical work being developed elsewhere doesn’t cost as much and would be one key way to quickly address capacity shortcomings and mitigate further fallout.
The writer teaches politics and sociology at Lums.
Published in Dawn, April 20th, 2020