ONE of the few positive outcomes of the Covid-19 crisis is the forced triumph of public health priorities that were buried beneath the pile of national priorities starting with defence, industry, energy, budget deficit etc. The reality is that without huge investments in public health, countries like Pakistan are highly vulnerable to great crises such as the one we are facing today. Health and human security trump other efforts focused on protection of state security.
The second positive outcome is the discovery of how critical data and evidence are for guiding us in times of crisis. In the absence of accurate data it is difficult to gauge an epidemic, leave alone predict it or mark its future trajectory. We do not collect data on births or deaths systematically, we do not have reliable data to assess birth and death rates for the last 10 years. We put on hold for 13 years the Pakistan demographic survey, we did not include fertility, mortality or migration in any of the regular surveys of the Pakistan Bureau of Statistics (PBS) because we awaited a dicennial Population and Housing Census since 2011!
Every day, if not by the hour, the numbers of those who are contracting the virus, and dying from it, are alarming. While we are collecting real time data on infections and deaths, these numbers do not tell us much about how the coronavirus is spreading, its contours, our vulnerability, how to distribute relief, how to test etc, etc. The lack of data is producing multiple speculations; as an expert in the US said, it is like “driving without having a fuel gauge”.
The lack of data is producing multiple speculations.
Important decisions have to be made in the next few days if we are serious about smart lockdowns. We need to decide which population needs to be put under quarantine, when to move from testing symptomatic cases or those self-presenting to random sampling in the community in order to discern who is at greater risk and who can be allowed to go back to work. To answer these questions, we need population data to assess the universe and to have reliable numbers to use as the denominator. We need data to sample and test systematically — otherwise the results of antibody or other testing will simply have no statistical validity.
For this we are sitting on a goldmine of data in the Population and Housing Census 2017. The main motivation for the census and the Supreme Court ruling was because we desperately required the numbers to form constituencies for the 2018 election. Unfortunately, most did not care for the numbers beyond their significance for constituency counts and vote banks. The results of the 2017 census broke into controversy over a couple of constituencies and all the data worth 18 billion precious rupees was suppressed.
This is a strong plea to the prime minister, the National Command and Control Centre and the chief ministers to liberate this data and please use this now to make important national decisions. The data from the census is lying with the PBS. It would give us the district, tehsil and union council population numbers, housing structures, people living there and characteristics in terms of education and employment, etc.
The district reports should be handed over to the district administrations who are on the front line of the battle against the Covid-19 outbreak. Furthermore, union councils can use the numbers to deal with all the issues associated with the spread of the disease, carrying out relief efforts, and distributing food. The 2017 census data may be more updated than the 2010 National Socioeconomic Registry that is being mainly used by the Benazir Income Support Programme today to distribute additional cash transfers. We should use GPS coordinates that, reflected in maps, would be especially useful for smart lockdowns.
In the last 20 or 30 years, we have witnessed beyond belief a progressive weakening of demographic and health data. We have not paid attention to quality of data, standardisation, pooling and collating data sets. We have ignored and not invested in building the capacity of our data analysts. Today, we lag far behind other countries in our ability to do risk modelling and use big data sets to predict the future spread of the virus.
Unfortunately, we have not appointed a qualified chief statistician at the PBS who should be using this data to lead a group of epidemiologists in order to assess trends in disease rather than make wild predictions based on anecdotal evidence and basic wishful thinking. This function is what federal institutions are meant for. I wish we could have someone like America’s Dr Fauci, Korea’s Dr Kim Woo Joo or Singapore’s Dr Chuan to lead us out of the pandemic by giving us clear predictions of where we stand with regard to it at present. Then we would be on surer ground when we make statements that we expect a few thousand, and not several hundred thousand, to perish.
The release of the census numbers will also help us in relief efforts as we can target households based on characteristics that define poverty and vulnerability. This will give teeth to our efforts to count and identify the truly vulnerable population that will most likely fall into poverty, the areas where six to nine persons are packed into one- or two-room dwellings and cannot self-isolate, and where those who have no drinking water, let alone water to wash their hands.
Above all, the rapid spread of the virus is concentrated in our largest and fastest-growing urban centres of Karachi, Lahore, Peshawar and Quetta. We should focus on containing the spread, but also question the major reasons why these numbers are so frightening. Rapid population growth rates especially in urban areas and growing concentrations are no longer something to be left ignored. It is ironical that a deadly disease may make us realise the worth of the valuable lives of all our citizens. Life beyond the numbers is what we should care about.
The writer is country director, Population Council, Islamabad.
Published in Dawn, May 2nd, 2020