THE day the coronavirus vaccination campaign began, a friend called as he waited at one of the inoculation centres in Islamabad. It was a mess, he said. Too many people had been called in and the hospital administration was unprepared. There was no system in place and neither was there any seating arrangement for those who waited, who consisted mostly of the elderly and frail. And it was overcrowded. He returned rather than wait and risk getting infected. By then the news channels had begun reporting on the disorganisation, a story that echoed the entire day.

By the next day, a turnaround was witnessed. The friend, who was hopeful enough to venture another trip, was back after his vaccine shot within an hour and was all praise for the arrangements — all that was wrong 24 hours earlier had been fixed.

And so, it has been since. Most of those who have gone have spoken of a pleasant experience. My mother and aunts who went to the Expo Centre were even driven back to their car in a golf cart. In fact, in social and mainstream media, those who have been to the Expo Centre in Lahore have been generous with their praise of the arrangements made there and appreciative of those in charge. Just yesterday (Monday), a famous Urdu columnist quoted a friend as saying that the service being provided at Lahore’s Expo Centre could perhaps not even be matched by Canada.

The discussions reminded me of an incident a few years ago when I had to venture to a government hospital in Islamabad for polio drops — the good old days when international travel was easy and airlines were doing well. On one such trip, I got the drops and the person issuing the certificates was missing. I was sent off in search for him through the hallways teeming with patients, relatives and health staff. I ended up in a small office. Its occupant, an administrative officer, was missing but the room was quiet and provided respite from the halls. I was soon joined by other seekers of the grail (certificate). The wait turned into hours but the relevant official remained busy in some mysterious meeting. However by then, one of the fellow seekers turned out to be known to a colleague and he promised to retrieve the certificate and have it sent to me. Jaan pehchaan (acquaintance) had come to the rescue and I was able to escape.

How will the vaccination centres fare once the rich and powerful no longer go there for their jab?

But while we sat in relative comfort, those who had come to the hospital for treatment roamed around helplessly and used the floor of the hallways for rest. Many women came into the room more than once to ask for help and direction; they were confused not just by the red tape but also the language. Many could not read the signs or were not well versed in Urdu.

Since then, it has struck me more than once that I took it for granted that I could wait in the office, as did those allowing me to do so. Not all of those who were wandering around or waiting would have been allowed the privilege, even though I too was availing a service the state was providing at its expense.

But generally speaking, the process for the administration of polio drops worked rather smoothly. On other occasions, the desks were always manned and the certificate handed over within minutes. Perhaps because like the vaccination centres, those using it were not those who could be treated as indifferently.

International travel before the pandemic was hardly a luxury. Nonetheless, it was used heavily by the more well-off, just as the initial vaccination drive has attracted the more affluent. And this is why the administration of the polio drugs — like the vaccination campaign at present — is serving those who are not the powerless or the voiceless. Their opinion matters and it can be heard, loudly. Perhaps this is what ensures the state acts efficiently. For if it doesn’t, criticism creates pressure. And the general criticism of the creaky health structure, which is covered extensively, can be ignored. Because it usually impacts the vulnerable and the poor and hence the state can afford to offer poor services and get away with it.

Or is it also because the state has limited resources for the health sector which allows it to offer very little to begin with? And within this, if one or two services have to be offered (because to do so otherwise would invite far too much pressure), well, it can do so.

I don’t have the answers. Perhaps those who study and understand the health sector would have them. I just wonder how these vaccination centres will fare once the more powerful are no longer interested in the vaccination, either because they have been inoculated or because the private sector is in a position to take care of their needs.

Will they still function so efficiently or will they resemble the larger public health sector they are part of?

Aside from the vaccination campaign, the pandemic did force many of us to pay considerable attention to the health sector and the state’s role. When we complained about the state of the isolation centres travellers were being forced into, we were unwilling to realise that the problem was not what was being provided but what we expected. Or when during the first or third wave we complained of hospitals running out of space, only to be told by the governments that space was still available at less well-known hospitals which we didn’t want to go to. But little of this, unfortunately, has led to any introspection. Our debate has remained limited to criticising the governments or officials in charge rather than understanding the larger, systemic issues, which are at play whether it is a pandemic or the absence of the rabies vaccine in rural areas.

When the pandemic began and the Spanish flu became more than just a vague event in history, it was interesting to read about its impact on public health matters long after it ended. I had assumed Covid-19 will have a similar impact. But a year later, I am not so sure.

The writer is a journalist.

Published in Dawn, March 23rd, 2021