ISLAMABAD: With the vaccination process officially launched by Prime Minister Imran Khan on Tuesday, the government is confident that Pakistani citizens will be fully inoculated by the end of the year.

The National Command and Operations Centre (NCOC) has drawn up detailed plans for procuring the vaccine, distributing it and administering it to the citizens on a clearly defined priority list. These plans — seen by Dawn — provide the broad framework for managing the task with projected timelines and targeted numbers.

“My worry is there will be more vaccines and not enough people willing to have themselves injected,” says Asad Umar, federal Planning and Development Minister and the head of the NCOC. He has piloted the country’s massive operation to combat Covid-19 and managed to weave a success story — in comparative terms — despite massive odds.

These odds are reflected in the numbers. Here’s how Special Assistant to the Prime Minister on Health Dr Faisal Sultan explains these numbers: Pakistan’s approximate population is taken at 220 million people. It is an accepted fact globally that people under the age of 18 will not require a vaccine. If we take out all Pakistanis under the age of 18 from the total population, that leaves roughly 100 million people. Experts believe a population reaches herd immunity if 70 per cent of the people have either been infected with the virus or administered the vaccine. In approximate numbers this means of the 100 million Pakistanis above the age of 18, 70 million will need to be vaccinated (this does not take into account all those who have already had the infection and recovered from it).

How does Pakistan procure vaccine for 70 million citizens? And how long will it take? The plans drawn up by NCOC, and approved by the federal cabinet, explain the strategy. “Funds are not an issue,” says Asad Umar. He states that Prime Minister Imran Khan has approved enough money to cover all expenses for the vaccination plan. Dr Faisal Sultan says the prime minister has told him if he wants more funds, they too shall be approved without any hesitation.

According to the plan, there are three avenues for procuring the vaccine: first, bilaterally from a manufacturing country, second, via The Global Alliance for Vaccines and Immunisations (GAVI), and third through the private sector. With a target of 70 million Pakistanis to be vaccinated, the procurement numbers as planned are as follows:

China has gifted Pakistan 0.5 million doses of Sinopharm vaccine which will inoculate 0.25 million people. GAVI has committed to providing AstraZeneca, and possibly Pfizer, vaccine for 45 million Pakistanis. Chinese vaccine Cansino is in its final stages of testing and Pakistan has booked doses to vaccinate 20 million citizens. These three sources together will cover 65.25 million of the targeted 70 million Pakistanis that require to be vaccinated.

There are at least two additional sources of the vaccine included in the official plan. The Russian vaccine Sputnik has shown 93 per cent efficacy in Phase 3 trials. Pakistan is in talks with Russia to acquire Sputnik. In addition, the government is strongly encouraging the private sector to import vaccines. However, the importers will be required to register the vaccines with the NCOC and can only acquire the ones that are approved and registered by the government. These two sources of vaccine — Sputnik of Russia and private sector — should be sufficient to make up the small difference left.

However, this may not be an issue. Dr Faisal Sultan, SAPM on Health, believes the figure of 70 million Pakistanis requiring vaccination may theoretically be the target, but the actual number will be lower. He argues that if we factor in the number of citizens among these 70 million who will refuse the vaccine and for some reason not opt for it, the realistic numbers of those actually opting for vaccination will be closer to 40-50 million.

“I do not believe we will face a supply side problem with the vaccine,” he says. “We are more concerned about the demand side.”

The timelines are equally important. According to the official plan and its projections, Sinopharm has already been made available while AstraZeneca is likely to be procured by March. Cansino, if it is approved, will also be in the pipeline possibly in March. Pfizer may come later in the year while Sputnik could also ready for acquisition in the next month or two.

What does this mean in terms of various stages of vaccination? Officials say they can comfortably claim that by the end of 2021 all Pakistani citizens who require vaccination will have been inoculated. Production of vaccines is expected to be speeded up as more manufacturers bring their products to the market in the course of the year.

Yet, there are some uncertainties. Pakistan is banking on Cansino and we have already pre-booked 20 million doses (it is a single dose vaccine), but there could be a problem if for some reason its tests do not come up to the required efficacy. Similarly, Sputnik is also not yet fully approved. The next few weeks will determine the situation much more clearly, though it appears the government is in fairly good control of the vaccine operation.

Published in Dawn, February 3rd, 2021