What can we do to salvage Pakistan’s Covid-19 response?

Published November 23, 2020
It is likely that the dreaded second surge of Covid-19 is upon us and if the evidence from elsewhere and the great flu pandemic from 1918 is anything to go by, this will be both severe and sustained. — AFP/File
It is likely that the dreaded second surge of Covid-19 is upon us and if the evidence from elsewhere and the great flu pandemic from 1918 is anything to go by, this will be both severe and sustained. — AFP/File

THERE is something unreal about public discourse and response in Pakistan these days, akin to watching a crash landing in slow motion. One watched in abject horror the blunt refusal by mainstream politicians to reconsider their plans for mass rallies and protests. This was topped by scenes from a mass gathering on Friday for a person who from available descriptions, almost certainly, succumbed to an acute illness eerily similar to Covid-19. Of the several hundred thousand people who assembled at the gathering from all over the country, available images show that fewer than five per cent wore masks and physical distancing was non-existent.

It is likely that the dreaded second surge of Covid-19 is upon us and if the evidence from elsewhere and the great flu pandemic from 1918 is anything to go by, this will be both severe and sustained. Fortunately, while many of the earlier doomsday models of Covid-19 burden and deaths in Pakistan failed to materialise, a major factor was the excellent work and oversight by agencies and the National Command Operations Centre. This may now all be undone. Premature celebrations and accolades have helped feed a false sense of security that somehow Pakistanis are immune and hence resistant to the effects of a virus that has to date infected over 58 million people and killed close to 1.4m globally.

Premature joy over lower epidemic burden fed a false sense of security that somehow Pakistanis are immune

Despite occasional exhortation, there has been a visible decline in the use of face masks, physical distancing and precautions culminating with the politicians repeatedly encouraging and leading mass rallies and meetings in all major cities. While the prime minister warned people of the need for care, he himself led mass meetings in Islamabad and more recently in Gilgit-Baltistan, thus making it difficult to selectively ban the opposition’s meetings and political assemblies.

We now face a situation where once again the current limited small-scale “lockdown” measures could well escalate to larger scale closures. A decision on closing schools for an extended winter break might be taken on November 23. If implemented, this will be an abject tragedy. Children have just returned to schools after a prolonged closure and this will now be tantamount to the potential loss of a full academic year for many and an irremediable learning gap for young children at a very sensitive part of their development. There could also be an increase in school dropout rates for adolescent girls, some of whom may end up in early marriages. This will be a national tragedy with major long-term consequences. As a nation if we have to choose between keeping our schools open or politicians in the streets, most of us would make a clear choice to do the former.

What can be done immediately to address the potential crisis that confronts us and salvage Pakistan’s gains to date in responding to Covid-19?

First and foremost, we must debunk the widespread misperception that Covid-19 is a relatively harmless disease and will somehow spare Pakistan. It is a potentially lethal virus and is now also known to be associated with significant long-term consequences even among those infected with negligible or mild symptoms. It would be wonderful if the electronic media could replace the interminable political squabbles in their prime-time programmes with real information and discussion on the virus and the risks it poses. Our media currently gets a D minus for its inability to lead with examples of appropriate mask use and public education. Meaningful discussions of issues at hand such as equitable deployment of limited supplies of appropriate Covid-19 vaccines when they do become available, or myths and misperceptions would have helped reduce some of the widespread disinformation about the disease.

The potential second wave of the virus should be treated as a national emergency. There is still time to stem its exponential increase, but this will mean putting politics aside and broker an urgent moratorium on public congregations, and complete ban on large political rallies. Strict imposition of section 144 in all cities should be a starting point and will likely need stronger non-partisan measures for implementation.

Protective measures such as the use of masks, hand hygiene and physical distancing must be universal with no exceptions. Even if a vaccine were to somehow arrive and become available, the virus will be among us for much of 2021. With rich nations of the world racing to procure and deploy the limited supplies of effective vaccines as they come on line, the likely scenario for Pakistan is that between 20-40 million doses of the vaccine might be made available by mid-2021 with support from the global vaccine alliance and open market purchasing. That is barely sufficient for less than a fifth of our population and likely to go to first line health workers and those who have power and access to claim first right. I predict that most politicians will be first in queue touting their indispensability to the nation. Notwithstanding the vaccine, protective measures will be needed for another 1-2 years at least and this should be the key message to all. Measures such as the use of face masks and shields in markets, assemblies and communal prayers should be mandatory.

Rebuilding the economy requires getting our institutions and businesses working safely. So far there is little evidence that there is systematic implementation and monitoring of key responses and most measures seem sporadic and reactive. In addition to well-designed regular sero-surveillance studies, few of which have been made public, a regular situational assessment of schools, day-care facilities, businesses and factories would help ascertain what is needed to reduce the risk of infections.

Finally, we need a national discourse on how best to prepare ourselves for future emergencies of this nature. Investments in our scientific research institutions related to basic immunological research and vaccine development a few decades ago could have placed us in a much better position than we find ourselves today. At the very least the current crisis should help us think through on what structural investments and measures are needed to prevent and address the next pandemic.

The writer is founding director of Institute for Global Health & Development, Aga Khan University

Published in Dawn, November 23rd, 2020

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