The critical ingredient that remains missing from Pakistan's Covid response strategy

The focus in Pakistan must shift from policy to mass education, from analysis to practice.
Updated 25 Jun, 2020 10:44am

We drive cars but don’t venture to fly a plane. Why? Because we are not trained pilots.

That’s how it is. Managing our personal Covid realities is like driving a car; carrying a nation through a mercurial pandemic requires trained pilots. But when non-professionals try to fly planes, nations end up with confusion and chaos.

That’s what may have happened with Covid-19 in Pakistan where June 5, 2020 marked the 100th day of the outbreak. And during those 100-days, who educated the country about the disease? Politicians, anchors, doctors, bureaucrats, and others. And what was the focus of those communications? Policy debates, boilerplate analysis, and a potpourri of treatment plans. Our national discourse largely revolved around a single word: lockdowns.

This needs to change. The focus must shift from policy to mass education, from analysis to practice. This requires a panel of experts endorsed by the government and the local medical bodies. They should study the evolving science of this novel coronavirus, then communicate its symptoms, diagnosis, treatment, and preventive strategies to laypeople, daily. The goal is to train a nation on how to tackle this pandemic.

Also read: How our government's communication on Covid-19 has done more harm than good

Imagine if, during those first 100 days, a panel of experts answered questions from the general public every night on TV? Instead of fueling conspiracy theories or allowing folklore to muddle the conversation, imagine if these experts were regularly dispelling myths? How far along would Pakistan be?

That’s public health 101. Outbreak breed rumors. Having managed many outbreaks, I know why calm, honest, communication is vital. Sadly, on February 15, as the World Health Organisation (WHO) was warning the world about the risks of an "infodemic", Pakistan was veering into one.

Today, Covid-19 is going viral, literally. The total number of cases has crossed 120,000. And since our testing is almost 20 times less than many developed countries, it's plausible that the real number of cases might be manifold.

So, where do we go from here?

I believe a unified messaging about Covid-19 itself should be a top priority. Some may argue that it’s too late; the virus is already widespread. I disagree. According to the WHO, coronavirus might never go away — i.e., we don’t know how many 100-day cycles Pakistan will face. Others believe so many educational campaigns already exist, through apps, websites, TV ads, social media. I agree. But it's one-way communication. People don’t have a forum to ask their questions and see the experts. When armies attack countries, people find solace in hearing from their generals. Why shouldn’t Pakistanis hear from an expert medical panel during a pandemic?

More on this: With Covid-19, hope cannot be a strategy

Here is a suggested structure: based on competence, this three-person expert medical panel should constitute of specialists in epidemiology, infectious disease, and outbreak management. They should be coached in principals of mass communications and then provided with an hour on prime-time TV, across all channels, daily. TV channels should solicit questions from viewers ahead of time and allow the experts to give rapid-fire, data-driven answers. Be bold to reject urban legends. Be kind while listening to a difficult situation that may not have a solution. A good session should answer around 50 questions/hour. Let this panel become the face of Covid-19 defence in Pakistan. The idea is not to compete against the existing health structure but to complement it.

This system works. We implemented it in our hospitals after experiencing the first Covid-19 patient. Every day, we answered 30-40 questions from our team members on a 30-minute conference call. Despite being in an affluent country, we struggled with tests and supplies, but we never struggled with messaging. Witnessing our 3500+ strong team quickly adapted to a new reality was like watching a teenager quickly learn to drive.

And drive we must because nations cannot remain under lockdowns. Just like we learn the rules and risks of the road before getting our license, we should learn the rules and risks of driving through this pandemic. Accidents will happen, but they won’t paralyse us. With time we will become safe drivers. The panel should also be cognisant of four things: politics, trust, credibility, and expectations. Remain apolitical. Don’t lionise the government and/or criticise the opposition (or vice-e-versa). Earn people’s trust that the effort is sincere and not self-serving. Anchor your recommendations with WHO wherever possible. This will infuse discipline and credibility in the process. Yes, WHO has made some controversial decisions, but its core strategy has allowed many countries to contain the virus. Set the expectation that this panel will make errors, that they will backtrack some of their statements. That’s the nature of evolving science.

Gradually, this may shape a culture where mass communication practices deference to expertise. It costs very little. The government should opine on policy, economists should explain financial risks, and medical experts should talk about the virus itself.

Read further | Mental health: Pakistan’s Achilles heel during Covid-19

People say, "how can a large resource-limited country like Pakistan win against Covid-19?" I ask, how did Vietnam — a third world country of nearly 100 million people — stop the pandemic in its tracks by limiting the number of infections to 332? How come they had zero Covid-19 deaths? Because they trusted the science, effectively communicated, and mounted a unified defence against a unified virus.

Maintaining the status quo will breed more confusion in the coming days. Misinformation loves a vacuum. Fill it with expertise or accept chaos. Each case, each death will fuel further panic.

If this plan is executed correctly, the next 100-days may look like this: Millions become engaged and educated through a daily question-answer session on TV. Within 1-2 months, they learn the rules of this disease and start following policies, instead of debating them. Pakistan’s economy opens, and Pakistanis carefully drive through this pandemic until we reach the destination of mass vaccination.

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Dr Faheem Younus is the Chief Quality Officer and Chief of Infectious Diseases at the University of Maryland, Upper Chesapeake Health.


The views expressed by this writer and commenters below do not necessarily reflect the views and policies of the Dawn Media Group.

Comments (28) Closed

Yousuf47 London
Jun 13, 2020 08:32am
Brilliant analysis, it is where Government failed miserably, knowing fully well that a major proportion of the population have to repeatedly be told of social distancing, frequent washing of hands with soap and water and wear a mask, with strict penalties for disobeyance including sentencing for second time offenders of endangering lives.
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Naeem Sultan Butt
Jun 13, 2020 08:44am
I think the policy followed by the Indian state of Kerala needs to be given serious thinking."Kerala Health Minister K K Shailaja: ‘Our strategy is trace, quarantine, test, isolate and treat’
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Ali da Malanga
Jun 13, 2020 08:55am
The missing ingredient is common sense and the discipline to follow instructions.
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Kung fu khan
Jun 13, 2020 09:29am
Critical ingredient missing is commonsense
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Sal Khan
Jun 13, 2020 09:41am
@Ali da Malanga, very true. People keep complaining about not having enough resources, government isn't very different either: the driving forces are greed and being ungrateful. Pakistan has brilliant doctors but the supremacy and shortcomings complex is mind numbing .
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Salman
Jun 13, 2020 10:31am
We should follow what folks in US did. Right..great idea doc.
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TZaman
Jun 13, 2020 11:43am
Sir, you should have written the article at least 60 days ago. Brilliant.
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GM BUGHIO
Jun 13, 2020 11:47am
Impressed. Q&A Sessions are very important to dispel misunderstanding and formulate future strategy who an ordinary person can ensure health as well as his/her daily activities.
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Chrís Dăń
Jun 13, 2020 12:24pm
A very enlightening article. However the common man is successfully entraped by the mullahs of mohalla mosque in very early age and further ripened by free literature provided by these mullahs. It is too late now. The nation is brainwashed by mullahs since last 3 decades. It is sad. But this is how elite conspured with mullahs-made mullahs rich and piwerful to keep their thumb on neck of brainwashed mass. These mullahs need refresher courses.
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Marquis de Sade
Jun 13, 2020 12:46pm
Sorry, doctor, the ones listening have no authority, the ones with authority are not listening/don't have the brains or the inclination to understand...
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M. Saeed
Jun 13, 2020 01:01pm
It is unfortunate that, our quack pandemic experts are ruling the media. Every other person is posing experts and in the rush of pandemic advice, reality gets hidden deep in wilderness. There must be a law made about punishment for such quackery explosion.
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A. ALI
Jun 13, 2020 01:07pm
Our problem lies in our mindset as we don know when and what to say and where.
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Zulfiqar
Jun 13, 2020 01:35pm
Unfortunately most of the people of Pakistan do not believe the news and information coming from main stream media but they believe whatever they get from WhatsApp and Facebook..
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jssidhoo
Jun 13, 2020 01:38pm
The most successful country in dealing with Carona is Taiwan everyone knows the norms and follows them . They have had no lockdown and no casualties.
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Nick, NY
Jun 13, 2020 03:51pm
Right on the money...its a failure of leadership in all domains...no one gives importance to education...educating masses is key to overcome all challenges of the modern times. Empower masses with education!
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Sarfaraz Khan
Jun 13, 2020 04:19pm
Good analysis and suggestions - simple, straight forward, and doable. Put the public health experts - not the politicians - in the driving seat. Pakistan needs to get the public messaging right and we can significantly decrease the infection rate.
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atta rehman
Jun 13, 2020 06:18pm
These are all very good suggestions but in Pakistan historically committees had never solved any problems because there are already clear guidelines and steps that needs to be taken but there is no will and lack of understanding on level to implement such suggestions. In a nutshell problem is not with US, Pakistan, India or their people but unfortunately with mind set of Trump, Imran khan, and Modi. Problem is with the shepherd not with with the herd
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Prapur
Jun 13, 2020 08:26pm
@Salman, He is not talking about US government but hospital where he works. He has very good advise for all countries if want to live with such contagious deceases till effective vaccines are available and there after. Even common flue kills people anywhere 5K to 60K in any given season, in US alone even after vaccinated or not. New strain of flue comes out every year so prevention is must. Ayurveda is based on immunity development through discipline, control on habits, food and cure. Only cure or vaccine will not save lives for poor or rich.
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rafiq
Jun 13, 2020 10:03pm
@Ali da Malanga, You are quite right.
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Raza Haider
Jun 13, 2020 11:04pm
@Ali da malang , couldn't agree more. I have come across many many people who know what precautions they need to take against Covid-19, share lots of WhatsApp stuff on subject matter but sadly they themselves miserably fail to do it practically. Image inviting someone to your home for dinner who has tested positive for corona. Its really shocking
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Ibrahim S.
Jun 14, 2020 04:53am
It’s simple, any plan is a good plan if it’s implemented correctly . A best plan is a complete failure if not implemented correctly
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mangla
Jun 14, 2020 07:32am
thank you Dr.Faheem for sharing your thoughts for simple actions/strategy to be followed in these extra ordinary , difficult times in Pakistan as well as globally.
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MAH
Jun 14, 2020 09:08am
absolutely, spot on! our entire setup needs to change. the govt information ministry, instead of hurling taunts at opposition, should formulate mass communications and awareness strategy. no democracy can work when common people need herding and policing for every little thing. democracy can only work when people have the needed awareness of their rights but also responsibilities! And this is what leadership is expected to do.
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Laila
Jun 14, 2020 02:18pm
There has not been a response by our government to the Covid-19 issue. The strategy still ongoing is denial, blaming the public refusal to provide PPE to front line medical staff and misleading the citizens with misinformation.
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Dr.Sarmad
Jun 14, 2020 02:22pm
The devolved health structure (to the provinces) is posing major challenge to a desired and standard response. Provincial Govts are not much bothered to what federal Govt. plans and desires. Enhanced testing is totally misinterpreted and malpractised in this resource poor country and therefore clusters could not be identified by this irrational testing. There are many more reasons and areas to focus. Final note : Epidemiologists are not on board for community case response. Resultantly, curative health facilities are burning out of resources.
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Nizamuddin Ahmad Aali
Jun 14, 2020 06:48pm
The article highlight the right precaution and strategy . Precaution has not been practiced. The PM can be seen without mask most of the time even when the others were wearing masks. The strategy has failed. There is no team in place. The spokesman ( Asad Umar ) is neither a planner not an economist and has failed miserably in both of the assignments. Certainly he is no medical expert. Dr. Younis rightfulyrecommends for an experienced team be selected from medicine, infectious deseases and university theoretical researchers from well known institutions. The PM is surrounded by third raters, ignorant slick talkers and "know nothing " people. I will remind the PM that hundreds of Pakistani children, man & women are at risk of losing their lives because of wrong choice.
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Vman
Jun 14, 2020 09:51pm
A very basic analysis, which is just focused on implying that pakistani people are stupid and lack common sense. And lockdown are less important than education. Lockdown was necessary in countries like Australia, in the ealry days of coronavirus in Australia people were very relaxed with Covid resteictions, it was strict lockdown by governmwnt that forced people to stay at home. Australia which are considered first world countries, are you telling me they are not educated???? Moreover you mentioned vietnam, one of the reasons vietnam was able to combat coronavirus was because of their experiance with SARs. This article is not well researched.
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Spectator
Jun 14, 2020 10:54pm
Right man at the right place is the only option left for Pakistan. A team of medical experts must lead Pakistan's fight against corona.
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