Covid-19 & the political unrest

WITH few cases and no deaths from Covid-19 in Pakistan in recent weeks, the pandemic seems to have taken a back seat while political chaos is taking centre stage. The federal government has changed and the Punjab Assembly, at the time of writing, has become a literal battleground and is in limbo. We are seeing massive political rallies by the ousted kaptaan. Divisiveness in society has never been so deep and sharp. Politically, it is an unstable time and the future looks uncertain. There is talk of an early election, a new ‘freedom movement’ and, God forbid, a civil war.

With all that’s going on, nobody is talking, let alone caring anymore about the global pandemic, which is still not over and can flare up anytime, anywhere.

In the meanwhile, the National Command and Operation Centre was wound up on March 31, 2022, and the “baton has been passed on to the health ministry” which is now managing it through the Public Health Emergency Operations Centre (PHEOC) at the National Institute of Health which itself is undergoing major restructuring as a result of NIH (Reorganisation) Act, 2021.

The combination of ongoing political instability, institutional change in the command and operation of Covid-19 management and the pandemic still being a pandemic — all this does not augur well for the future.

The new rulers need to pay attention to our state of preparedness for a recurrence of Covid-19.

The only relief is that the technical leadership continues to be the same. The national coordinator of the PHEOC Maj Gen Aamer Ikram and the federal director general of health Dr Rana Safdar have been the technical leaders in this national response. They along with their teams have worked tirelessly since the beginning of the pandemic and deserve the nation’s gratitude for effective technical management of the pandemic.

The average number of new cases in the last seven days in Pakistan is less than 100 — to be exact 97. Nevertheless, nobody can predict when this dip starts climbing. It may never do so but it may yet happen, sooner or later. We cannot predict but we can plan, and we must, so that we are better prepared for any next wave. Given our healthcare infrastructure limitations and the state of emergency preparedness, Pakistan has done extremely well in effectively responding to the pandemic and quickly building our capacity to test, trace, treat and vaccinate. Without producing any vaccine of our own we have been able to fully vaccinate more than 120 million Pakistanis which is a great achievement and will serve as our main protection in the future.

Indeed, the pandemic has been receding around the world but it has not yet run its course. There have been small-scale spikes here and there. Globally, new cases reported two days ago, ie on April 19, 2022, are 868,131, with 3,360 deaths from the disease in the same period. In our neighbourhood, cases started piling up again in China despite very strict infection prevention and control measures in place. At the end of March, 14 large Chinese cities had very strict lockdowns, and the share of China’s economic output represented by those cities shrank to eight per cent from 14pc. Likewise, in the US, cases have begun to rise again after a precipitous fall from their January peak. The rise is largely driven by the cases on the East Coast. In Rhode Island and Washington, D.C., cases have more than doubled since the start of this month.

The virus is at work and constantly mutating. Until now, Omicron’s sub-variant BA.2 was dominant, but experts in the US believe that two new subvariants may be contributing to the recent rise in cases. Both subvariants seem to have evolved from the BA.2.

With all this going on, back home the NCOC has been closed and PHEOC has taken over in a newly formed Centre for Disease Control at the restructured NIH. The restructuring of NIH is a major undertaking and, understandably, it will take time to reset the organisation. Some key positions have been difficult to fill. Not only has it been a major shift in Covid-19 management but reportedly, the level of participation at PHEOC’s daily meetings has also gone down.

The most important role the NCOC played was through its authoritative convening of all public and private stakeholders and immaculate national coordination as a civil-military constellation. Decisions were made and implemented in a highly efficient manner and this made all the difference. Now, with the move to PHEOC, the coordination with the provinces has also reportedly become weaker. Disease surveillance continues to be based primarily on manual reporting, while differentiated data analysis, as we saw during the NCOC days, is also losing granularity.

All this, and now the continued political turbulence and a new leadership at the ministry of health has made us quite vulnerable and we should be anxious. The new political rulers need to pay immediate and sustained attention to our state of preparedness for detecting any early signs of Covid-19 ripples before they turn into a wave.

Pakistan is not seizing the proverbial opportunity in the challenge. Here is my proposal for the new government: set up an independent national commission to carefully study the national response to Covid-19, our strengths and weaknesses and suggest actions that we must take to prepare ourselves better for any future public health emergency. The commission should also make recommendations for resource allocation for emergency preparedness and response in the light of the Covid-19 experience and in the context of the International Health Regulations, 2005, and the comprehensive report produced by the Joint External Evaluation Mission in 2016 that looked into each aspect of emergency preparedness in Pakistan.

We need to move from a position of vulnerability to a position of strength. This is only possible if we systematically analyse and learn our lessons from Covid-19.

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.