State of permanent preparation

Thinking about a time in the future when so much is happening right now, or preparing for an event that can be more disrupting than the present pandemic to our lives may be hard — but is exactly what we should be doing. Pakistan, for many reasons, actions and policies, has done relatively well in Covid-19, and though the death of over 6,000 citizens is a tragedy, it could have been much worse. But there is no guarantee that another wave of the current pandemic, or a future outbreak, will not be more damaging to our people and economy. We cannot predict when that may happen, but there is a good chance it may happen sooner than later. It may not be possible for us to have perfect stockpile of supplies for a future disease of unknown origin, but it’s within our capacity to create institutions capable of responding to the sudden need. That situation may require more than a mere coordination of an emergency response. It may require us to rapidly create new technological solutions. And for that, we remain inadequately prepared.

If we go back to the pandemic’s early days, when things were not going well for Iran and Italy, we would remember there was anxiety among many about lack of adequate technology in the country. People were worried about the availability of diagnostic kits and ventilators. Fortunately, through increased supply in the global marketplace, international engagement and import, and some domestic production, we never had to face shortages. We also did not have to put a large number of patients on ventilators. In hindsight, one can criticise the decisions of Italian doctors, but what if we were in Italy’s position? Probably, we would have done much worse. Instead of import of technology, what if we had to rely on domestic production? Some in government may argue now that we can produce ventilators or some version of testing kits, but in reality our production capacity is nowhere near what is needed. Moreover, it took us months before even the first local ventilator was announced and still the country lacked serious production capacity. The testing regimen and safety standards remained shrouded in confusion and chaos. The quality — compared to international standards — remains unclear.

Increasing domestic technological capacity will require more than hollow statements about the greatness of the nation. It will require serious financial investment, institutional restructuring and reform. At a fundamental level, it requires three key things. First, we need an incentive for local industry to invest in medical technologies. This would require government support and subsidies to incentivise existing companies to invest in medical technologies, and for new entrepreneurs to enter the market. Given some technologies may be used only under acute circumstances, market entry rewards may be needed. Also, the incentive to create will remain weak, or non-existent, if there is no protection of technological creativity.

Innovators are unlikely to spend their intellectual capital because of poor enforcement of patent laws.

Second, a stronger culture of quality control and regulation is desperately needed. The past year has shown serious gaps in the ability of the Drug Regulatory Authority of Pakistan (DRAP) in being able to regulate technologies. DRAP has neither competence nor capacity to come up with a well-defined and scientifically grounded regulatory approval process. It is a nightmare for both the innovators and medical professionals.

Finally — and most importantly — we need a culture change within the government. Any government, regardless of its political orientation, will last for only so long. People come and go, but robust institutions stay and continue to serve. Instead of building institutions, do we really need more than half the cabinet to focus exclusively on one individual and his family?

Published in The Express Tribune, October 6^th, 2020.

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