Thanks to the Chinese donation, Pakistan will hopefully kick-start a Covid-19 vaccination drive this week, administering half a million doses to public healthcare workers, signalling the beginning of the end of the deadly virus a year after the first case was reported in the country.

A deal to source 10m more doses from China has also been reported. Citing dangers of corruption and a lengthy public procurement process, the government has granted licences to half a dozen private companies to import vaccines. But in the absence of clear pricing policies, confusion clouds the path ahead.

Commenting on the issue Special Assistant to PM on health Dr Faisal Sultan said in a message: “We intend to allow private sector to import but deployment will have to be via the official system. This condition is to ensure capture of data and creation of vaccine certificates. Minor details are left to be sorted out”.

Insiders told Dawn the government is hoping to secure enough free vaccines from China, Covax and other sources to vaccinate 20 per cent of the population that it believes could lead to herd immunity and save precious little for rebuilding the economy. (Covax is an alliance co-led by Gavi, the Coalition of Epidemic Preparedness Innovations and the World Health Organisation that aims to accelerate development, production and distribution of Covid-19 vaccines for equitable access to all nations.)

Public trust, however, is crucial to achieve the target. A system to ensure the free flow of information is almost always helpful. Currently, perhaps the hierarchy at the National Command Operation Centre (NCOC) and the national health ministry is too busy managing the massive inoculation programme to make time to provide further clarity on the subjects of financing, procurement policy, monitoring fitness and quality of vaccines, private sector’s role, pricing and regulatory oversight.

“It’s not easy but we succeeded in containing the devastation of the pandemic in Pakistan and despite crippling limitations, God willing, will deliver on universal immunisation programme. With the best intent of utilising every bit of resources (tangible and intangible) in our command, forging strong global collaboration, we are committed to providing protection against Covid-19 to all citizens,” commented a highly placed source in Islamabad not authorised to go on record without formal permission.

“Yes, we admit there might be some loose ends in the plan but that shouldn’t stop us from action. Look at even the most advanced countries with incomparably higher rate of infections and fatalities. No one can afford to wait for perfection. We will learn as we move and make adjustments for better outcomes. The level of coordination between all tiers of the government on Covid-19 is admirable,” he said.

The federal minister heading the NCOC, the nerve centre that synergises national efforts and implement decisions of the National Coordination Committee on Covid-19, was approached with queries, but his responses did not reach Dawn within the deadline. Parliamentary Secretary on Health Dr Nausheen Hamid, Drug Regulatory Authority of Pakistan CEO Asim Rauf and Ministry of National Health DG Dr Rana Muhammad Safdar were not accessible.

The health hierarchy in the provinces was also reluctant to go public with their concerns for fear of stirring a controversy, the writer learned.

Pakistan has been fortunate to escape the full brunt of the pandemic horror that visited many parts of the globe and fortunate still to be amongst the first few to be in a position to start immunisation to defeat Covid-19 and its variants.

According to a website, Our World in Data, there are so far 25 nations where the Covid-19 immunisation programme is in progress. These include the United States, United Kingdom, Germany, Canada, France, China, India, United Arab Emirates, Russia, Brazil and Indonesia. Israel is said to be ahead of the rest in terms of coverage as 52pc of its citizens have already been vaccinated. The share stands at 29pc for the United Arab Emirates, 12pc for the United Kingdom and 8pc for the United States.

The government in Pakistan has already announced locations of emergency centres where it intends to administer 500,000 Sino Pharm vaccines to frontline public-sector healthcare workers in 20 districts across Pakistan in the first phase. Based on the spread of Covid-19 infections, eight districts of Sindh and seven in Punjab and four in Khyber Pakhtunkhwa have been identified to be covered initially — six districts of Karachi, Hyderabad and Nawabshah in Sindh, Lahore, Faisalabad, Rawalpindi, Gujrat, Sargodha, Multan and Bhawalpur in Punjab, and Peshawar, Nowshera, Mardan and Charsada in Khyber Pakhtunkhwa. The NCOC has picked the complete data of all government employees in the health sector in these districts from the provincial Resource Management System where they are registered. According to insiders, for the two-dose course Sindh will receive 170,000 doses for 82,359 healthcare employees in 20 districts. Details of other provinces were not shared. No one seems to know at this point when and how the private healthcare practitioners will be covered.

The government has announced an eight-step guiding strategy for the administration of vaccines and made clear its order of priority for coverage in line with WHO standards. It approved three vaccines: UK’s Oxford-AstraZeneca, China National Pharmaceutical Group’s SinoPharm and Russian-made Sputnik V.

Dr Palitha Gunarathna Mahipala, WHO representative in Pakistan, was travelling and could not offer comments. The sources in the WHO office told Dawn that the organisation’s involvement is limited to consultation, policy advice and sharing training modules in the context of the pandemic.

Muhammad Younus Billoo, whose Sind Medical Stores is one of the recipients of the licence to import Covid-19 vaccines, told Dawn over the phone that orders would only be placed once the government offered clarity on pricing.

Dr Muhammad Tariq, contractor for USAID Global Supply Chain programme advising the government on Covid-19, was excited over the collective pool of scientific prowess that developed, produced and disbursed multiple vaccines at an unprecedented pace. He believes for the long-term solution Pakistan needs to build capacity around bio and supply chain sciences.

Khurram Lodhi, director of the Punjab Health Initiative Management Company, said when states are primarily conducting immunisation programmes, arriving at the baseline pricing of multiple Covid-19 vaccines is difficult.

Qaisar Waheed, leader of local drug firms, saw no scope in the near future for the production of bio vaccines in the country. “It is a highly risky, technically advanced capital intensive business that does not make sense for the local private drug companies to venture into when there is scope available to expand business in the sector without as much risk and pain.” He mentioned the National Institute of Health Islamabad and Dow University’s state-of-the-art labs.

“If utilised to the potential, local vaccines can be developed in a few years and marketed. It makes perfect sense to build bridges between bio scientists and industry for affordable healthcare in the country for all.”

“We are keeping our fingers crossed as Pakistan enters the next stage in its fight against Covid-19 and its new variants,” commented a doctor involved in the exercise.

Published in Dawn, The Business and Finance Weekly, February 1st, 2021