KARACHI: Despite notable successes in controlling the Covid-19 pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civil society engagement and working with religious scholars to ensure compliance with preventive strategies including wearing face masks and physical distancing.

This is stated in an analysis of Pakistan’s Covid-19 response that has recently been published in an international journal Eastern Mediterranean Health Journal.

Widespread flaunting of Covid-19 curbs not seen on Eidul Azha and Muharram

The analysis — ‘Balancing science and public policy in Pakistan’s Covid-19 response’ — is contributed by a group of experts associated with Institute of Global Health and Development at the Aga Khan University, Centre for Global Child Health at the Hospital for Sick Children in Toronto, Canada, Shaukat Khanum Memorial Hospital and Research Centre, Lahore, National Institute of Health, Islamabad, AKU’s Medical College and Health Services Academy, Islamabad.

It evaluates the chronology and depth of the response to Covid-19 in Pakistan that experienced early introduction of Covid-19 in February 2020 followed by widespread community transmission.

The review is done with the help of available national and sub-national epidemiological and burden information on Covid-19 cases and deaths in Pakistan, including projection models available to the government at an early stage of the pandemic.

What went well?

According to experts, the resource-constrained Pakistan government moved with alacrity once the scale of the disaster in other countries became apparent and the federal health ministry was able to spearhead a multi-stakeholder national Covid-19 response despite its limited role following the devolution of health services to the provinces in 2011.

“The NIH rose to the task of training technicians, procuring testing equipment and boosting capacities across Pakistan, and daily testing capacity was enhanced from less than 2,000 tests daily to a capacity of over 50,000 across the public sector testing sites by August 2020.

“The NCOC [National Command and Operation Centre] resolved the issues of logistics, supplies and procurements as a national emergency through the National Disaster Management Authority [NDMA] ranging from vital Personal Protection Equipment, oxygen supply systems and establishment of Covid-19 care and treatment centres across the country.”

A remarkable achievement, they pointed out, was the establishment of a central reporting system for data at national and provincial levels with the ability to provide district-level estimates. This was real-time reporting and publicly available, in contrast with many other governments in South Asia.

“The future in a Covid-19 era could depend on the objective analysis of the past experience and identification of possible trigger points for imposition/withdrawing of non-pharmacological interventions while the new cases continue to rise and fall in a population.

“Pakistan utilised the polio surveillance programme to monitor and track Covid-19. This must be replaced by a robust surveillance and disease warning system.”

“Premature celebration of the ‘victory’ over Covid-19 and reduced compliance of mask use and physical distancing are major risk factors for resurgence of Covid-19, as was seen in the national Independence Day celebrations on 14 August or in some schools after reopening.”

Pakistan also launched a robust response to the secondary effects of the sudden lockdown and loss of income for daily wage earners. A key intervention was the launch of cash disbursement through an existing social safety net Ehsaas.

“It is imperative, however, that all learn to live with the virus and its unpredictability. That means a gradual reopening of the economy and learning the ‘new normal’; the latter could be that the virus might continue to coexist for several years and have periodic upsurges.”

What didn’t work?

Despite these achievements, experts pointed out, there were several levels of Covid-19 response in Pakistan that could have gone better. For instance, the numbers of tests achieved at population level remained a fraction of the desirable numbers, with considerable diversity across the country.

The numbers tested in Islamabad Capital Territory were higher (124,888 tests per million population) than those achieved in the provinces, especially Balochistan (5,955 tests per million population) and Khyber Pakhtunkhwa (7,271 tests per million population), and the latter numbers appear to have gone down further in recent weeks.

“However, it is unlikely that large-scale excess population mortality has been missed, given that burials are universal and with the limited numbers of burial sites across the country, any excess would have been evident.”

With some disagreements on the nature of response and strictness of the lockdown, mixed messages led to unnecessary acrimony and discord, and polarisation of opinions between political parties. Lack of consensus among religious scholars on the nature of restrictions and measures needed for Friday communal prayers forced some local governments to impose lockdowns covering Friday prayer times.

Over time, this discord has settled and the most recent festival of Eidul Azha and religious congregations during the month of Muharram did not see widespread flaunting of rules and crowding of public places.

However, communication strategies and community buy-in for preventive measures such as use of face masks and physical distancing remain an issue, compounded by stigmatisation of some households once identified by the smart-lockdown process.

Published in Dawn, September 19th, 2021