A successful vaccination drive is critical to save lives, preserve livelihoods and contain the adverse impact of containment measures on the economy that’s teetering on the edge as the third wave of Covid-19 hit Pakistan.

With questions hanging over the sustainability of supply lines, efficacy of Sinopharm’s vaccine and the goal of inoculating 20 per cent of the population to achieve herd immunity, Pakistan entered the second phase of the vaccination drive. In the first phase, roughly 35pc of registered health workers were administered a partial or complete course of the vaccine. The programme is now expanded for the adult population, staggering it on the basis of age and keeping vulnerability and administrative limitations in sight.

Commenting on the situation, Dr Saad Shafqat, professor of neurology at the Aga Khan University (AKU), was cautious. “The Covid-19 vaccination drive is a global issue mired in inequality, scientific uncertainty and supply-chain concerns. In the current situation, we have no option but to make do with whatever is available.

“I do believe perhaps questions around delays and efficacy will get resolved in the period ahead as multiple new potentially better products are in the development phase. The bottom line for now remains: precautions, precautions and more precautions.”

‘It’s a global issue mired in inequality, scientific uncertainty and supply-chain concerns’

The economy of vaccination so far seems simple as vaccine donations primarily feed supply. The batches from bilateral and multilateral donors are received by the federal government and the National Command Operation Centre (NCOC) secures, provides guidelines and manages its distribution to the provinces.

The staff of the NCOC has been advised not to interact with the media. They declined to share information/comments on the vaccine budget, province-wise data of administered shots, distribution criteria or the date of the expected arrival of Covid-19 shots. Col Shafiq of the Inter-Services Public Relations (ISPR) confirmed that they have been vested with the responsibility for dealing with the media, but politely ignored the request to share the official position on issues raised.

Special Assistant to the Prime Minister on Health Dr Faisal Sultan evaded queries on the criteria of distribution, vaccine budget and pricing. He opted to repeat what is already known in his response without elaborating on what he means by the target population.

“We started the process with frontline workers over a month ago, then health workers in general. Now vaccination has started for the general population, with the oldest citizens first. There is a gradual increase in the uptake and acceptance, but it will take many months to cover the target population.”

To close the demand-supply gap, the government has in principle allowed private imports of vaccines, but it did not determine the pricing criteria that is critical for its materialisation. An officer said Pakistan has been offered the vaccine on a 50pc discount by a producer at $7 a unit.

“Not sure if the deal was closed,” he said. “Based on whatever I heard, two doses in the open market in Pakistan will cost no less than Rs10,000. The rich class in the country can well afford it and will prefer fancy expensive shots. It makes better sense to save free vaccines for the poor.”

Usman Ghani, a leading medicine importer, told Dawn over the phone that he does not foresee the possibility of over-the-counter sale of Covid-19 vaccines in Pakistan anytime soon.

Federal Health Secretary Amir Ashraf Khawaja and Drug Regulatory Authority of Pakistan (Drap) CEO Asim Rauf were approached, but they were not accessible.

About the criteria for the vaccine distribution, an insider told Dawn the key determinant is the Covid-19 case load and the demand raised by the provinces based on the registered pool of vaccine aspirants. “All provinces enjoy a good rapport with the NCOC and seem fairly satisfied with the system,” he said.

According to information gathered from Sindh, 198,489 of 320,000 health workers got registered. The first batch of 83,000 vaccines landed in the first week of February. The second 83,000 doses were received two weeks later. An additional 38,000 arrived in the last week of last month and the second dose was secured in the first week of the current month, adding up to a total of 228,000 Covid-19 shots. A total of 156,000 vaccines were disbursed in Punjab and 56,000 in Khyber Pakhtunkhwa in two instalments. Balochistan received 49,000 shots in total.

“The rising third wave in Pakistan reminds us that the threat is far from over. Covid-19 has not run its course. It can unleash horror, killing people and jobs and destroying wealth. Quick universal vaccination must take precedence over everything else, including political antics,” a health economist shared his views privately.

Talking to Dawn, the hierarchy of provincial health departments was positive. Khyber Pakhtunkhwa Health Secretary Imtiaz Shah said the vaccination drive is progressing smoothly. Dr Sohail Ahmed, who is steering the programme in Sindh, was also hopeful about defeating the threat. Balochistan Health Director General Dr Ali Nasir Bugti was elated as the drive has proven to be more successful than he expected.

“We have received 34,000 vaccines so far and 15,000 frontline healthcare workers got their first Covid-19 jabs. We have extended the programme and started vaccinating senior citizens. With another tranche of vaccines expected to arrive this week, the requisite supply for the second shot is secured.”

“Never in my 33-year career have I seen this level of awareness in the masses. Thanks to connectivity via mobile phones, people know the problem and its solution. There might be some pockets of resistance, but generally people are not hostile to vaccination. In my opinion, this is truly transformative.”

Dr Bashir Sadique, director of immunisation in Punjab, was satisfied with the coordination and delivery schedule of vaccines. “We received what we asked for and now are moving on with expanding the drive to cover the general public.”

Published in Dawn, The Business and Finance Weekly, , March 15th, 2021