Race to vaccinate

On Saturday, Pakistan reported the highest daily death toll of the fourth wave of the novel coronavirus. Driven by the highly contagious Delta variant, Covid-19 infections have risen sharply across the country. An alarming 4,720 fresh coronavirus cases were reported in the last 24 hours with 95 deaths in the same period of time. With the Covid-19 positivity rate currently estimated to be at 8.24 per cent, the National Command and Operation Centre’s (NCOC) data shows we are in the thick of it, despite a steady vaccine rollout.

Still, one cannot fault the government’s coronavirus response. Anticipating this surge, the NCOC recently set an August 31 deadline for vaccinations for the country’s services sector. The education sector was already asked to ensure teachers and students were vaccinated by the beginning of this month. In short, the government needs every Pakistani involved in any activity that deals with large numbers of people to get the jab.

Until now, the structure put in place to protect Pakistanis from Covid-19 had been running fairly smoothly. In the first stage, the government commissioned and developed the National Immunisation Management System (NIMS) under the National Database and Registration Authority (NADRA) to facilitate the coronavirus vaccine rollout. The procedure it implemented is pretty straightforward as well – all one has to do is send a text message to the phone number 1166 with their CNIC number and they will be informed via another text about when and where they can get their first and then second jab. The system not only caters to Pakistan but also has several other options to allow registration of foreign nationals who are living in the country for various purposes.

But the government’s recently announced deadlines may be testing this system to its limits. Already, there had been anecdotes of people unable to access or obtain their immunisation certificates or their status not being updated in NIMS upon getting their first or second shots. In the meantime, opportunistic forgers saw a demand for workaround in fake vaccination certificates. And then there is the case of Pakistanis without CNICs who, despite the government’s efforts, still face immense difficulty in obtaining the jab. Now, with long queues at designated vaccination centres, how well the system copes with pressure remains to be seen.

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What does one do when the system has no record of you? As the vaccine rollout progressed, many Pakistanis who got their second jab discovered their vaccination record remained incomplete for days. Unable to obtain certificate, the only remedy advised by NADRA was for these citizens to revisit the centre they received the vaccine at and convince staff to upload their data again. In the process of manual registration, it emerged that many entries simply were not being made. And for some, once the data was finally updated, the entered dates sometimes did not match their actually dates of vaccination.

“I went to NADRA to get my parent's immunisation cards. My father was issued the card but my mother wasn’t as they said her second dose isn’t registered. Both of them got vaccinated from the same centre,” shared Fiza Khan. She ended up being asked to take her mother to Jinnah Postgraduate Medical Centre again to ask the data operators to register her second dose. “The staff at the NADRA office was clueless and just kept telling me to ‘go to hospital, it is not our job’. Why would I keep going from the hospital to NADRA while it is their responsibility to get the registration done right in the first place,” she asked.

For most citizens, the issue started when the vaccination of all age groups was allowed. In Karachi, the Expo Centre being the only 24-hour centre faced an immense huge rush. With frustration building up day-by-day among those who find no recourse even after approaching hospitals, in Sindh at least, a dedicated team has been deployed by the NCOC to clear a backlog of 30,000 entries daily.

Speaking to The Express Tribune, Parliamentary Health Secretary Qasim Soomro explained that the decision to enter the data for the second dose manually was taken after the vaccination drive was expanded to all ages. “We set up sections of 10 data operators who would update data records of citizens who received the second jab,” he said. “To speed up the system, most entries would be recorded in MS Excel sheets at first. As the immunisation programme is linked to both NIMS and NADRA databases, it would take too much time otherwise.”

Soomro added that the sudden onrush of people receiving vaccines meant this system couldn’t keep up. “The daily numbers meant that the data that needed to be entered kept piling up. Other than these operators, the section where the operators were directly registering through NIMS is 25-28.”

Soomro added that to curb this issue and to let people finally receive their certificates, a dedicated team has been set up. “They are registering around 90,000 entries daily, which is helping to decrease the backlog.”

The secretary also accepted that the issue came due to human error and lack of efficiency to cater to such a huge crowd. “The system and issues with the vaccination system cannot be resolved by one person because there are many stakeholders in this. The simple example is that the salary of the staff working at the centre was released after two and a half months while they have been working day and night tirelessly to serve people. Many young doctors have also lost their lives saving the country from the deadly virus but no sympathy and timely decisions were made for any of them,” he said.

Enter counterfeits

With all the confusion and chaos around the vaccination and non-issuance of salaries there have been reports where people were found creating fake immunisation certificates. “My husband was against the idea of vaccination while everyone in our family is vaccinated but now when he has to present his certificate in his office, he got a fake immunisation card made for free. He got it from one of our relatives, who also got his and his family member’s fake certificates made for 8,000 rupees,” said Anila*, who herself is waiting for the crowds to subside to get vaccinated. She also added that there is a shop which creates certificates and prints them for people in her neighbourhood. However, such tactics are not going work in long run as the NADRA certificates have a bar code and certificates issued cannot be registered through fake cards.

Needs jabs, no CNIC

Up till now, the government’s immunisation system isn’t as easily accessible for those without CNICs. Shehla*, for instance, told The Express Tribune that she cannot get herself or her three sons registered and has spent many months feeling helpless and vulnerable to the virus. There are hundreds and thousands of people who have been born and lived in Pakistan their whole lives but have yet to be granted an CNIC.

Shehla who is a widow and has three sons between the ages of eight and 12 never got her CNIC made while her husband was alive. After his death, when she tried to apply for it, she was unable to get it as she didn’t have all her documentation. “My father came from Bangladesh but I was born here. I am as much a Pakistani as anyone else but no one accepts that here,” she said.

Shehla lives in a two-roomed rented house and earn her bread and butter by stitching clothes. Being less educated and less informed can lead to several problems in this country which can leads to a violation of any rights which the law assures. “I was not educated neither was my father. He used to work as a labourer and whatever he earned was not enough to even have good food then how could we could have studied,” she shared, adding that six years ago when her husband died then her world came crashing down as she realised that even if she wants to work in any factory she needs a CNIC.

Shehla is not just one but there are many more migrants who are legally or illegally living in the country and now do not have access to Covid-19 vaccines. There are also some citizens who can get a CNIC issued by the authority but are not allowed by the heads of their family to get one. Such stories are very common in the settlement of Mauripur where women are not allowed to get their basic right of getting identified in the NADRA because men in the family think they do not need a CNIC. “Some girls have started raising their voice but we know it’s useless as we can’t do anything about this. Many women before us have raised this issue again and again but in the end, we have to live with our fathers, brothers, and husbands,” said Tehmina, standing at the gate of her house in Jhaskani Muhalla near Grex stop on Hawke’s Bay road.

Twenty-year-old Tehmina is a mother of a daughter and stitches dresses for girls of her neighborhood however, what she really wants to do is work in a factory. “My husband works in a small factory but thinks that why would I need a CNIC as I am not smart enough to vote or work. I couldn’t even get vaccinated as he has because if he didn’t get vaccinated, the factory where he works, would not have released his salary,” she shared.

The situation is not just bad for women but some men are unable to get vaccinated and the reasons are similar. Out of many, one such individual is Shamshad, who lives under a settlement and migrated to Karachi from interior Sindh. Due to lack of documentation or proof of being a Pakistani, he could not get his CNIC. “I live here in the settlement and so do hundred other families and none of here have even thought of getting vaccinated as what we think every morning is to earn few hundreds so that we can have dinner,” he said, added that even if the government will offers free vaccination he would not get it because he doesn’t believe the vaccination can save his life when inflation is on the rise.

Among the thousands of transgender people living in the city, there is a large number who do not have a CNIC. The reasons can vary as many do not have complete documentation, some are not interested themselves while some have faced harassment during the application process, which has discouraged them from getting it. “Out of the 18,000 transgender community members registered in Gender Interactive Alliance (GIA), 3,000 do not have ID cards and even though a large number from them wanted to get vaccinated, the government never clearly announced anything for such issues,” shared GIA founder Bindiya Rana.

However, the facilities that are offering the vaccination to non CNIC holders, have also been in complete violation of SOPs. At the centres, there’s no social distancing, no check-ups or proper guidance offered to the people coming in to get vaccinated. “The centre I went to get vaccinated never checked by BP or asked if I had diabetes and that was their lever of negligence towards everyone there however, such negligence can cost someone their life,” said Rana, adding that the vaccination centre needs a counselor to guide which vaccine should be administered to who keeping in view their age and pre-existing health conditions.

The government steps in

The government however, for their part have been trying to develop a system to cater to their non-registered citizens. “The challenge was to cater to such people and encourage them to step up and get vaccinated, just because there was no record or any system present the Sindh government suggested in the NCOC meetings to develop some form or procedure through which they can at least have a data of people which they have vaccinated who do not have ID cards,” said Parliamentary Secretary Health Qasim Soomro.

People who do not have a CNIC or any other identity cannot be left without being vaccinated. One the government feels it’s their responsibility to cater to everyone and secondly, without vaccinations, non-registed citizens would have been in danger of carrying the virus – a considerable risk that could not be ignored. “With initial discussion and to start this vaccination drive for non-CNIC citizens, a simple form was created which mainly required only the address and contact number to follow up for the second dose. Also, as now everyone has a mobile number, it’s easy to contact them to inform them about their second dose,” said Soomro who is also an MPA of the Sindh Assembly.

The suggestion and dire need to establish any such facility was felt as soon as the vaccination drive started at the beginning of the third wave. It was suggested to the meeting held by NCOC which is chaired by the Prime Minister of Pakistan that we need to make some arrangements to cater such residents of the country. “After discussing in several meetings and taking suggestions from task forces, it was a challenge for the health department to take this as an opportunity to develop a system through which such citizens can be catered. Also this was a chance to register them and get some data out of it which can be useful in future as well and also for any other immunisation programmes,” he pointed out.

There are many settlements in the country which were established after people who migrated from Bangladesh or Afghanistan and other such places. Many underprivileged people, who have migrated from other parts of the country to Karachi to live with their relatives in makeshift houses as well all such can be easily carriers of the virus too. “Luckily we have not administered such cases but we can’t let it keep happening around us and wait for the outbreak. A software upgrade is currently being worked on to register the non-CNIC vaccinated people so it can also help in future immunisations as well,” said the MPA.

The facility is not available in all vaccination centres but only one, which is the Expo Centre in Karachi. The reason for only one dedicated centre is because it would be difficult to manage the data from all centres and also the number of people showing up is less as compared to the registered citizens. Even with 96 cubicles in one hall and 54 in another, the Expo Vaccination Centre is the biggest and only center that is working 24 hours a day, seven days a week. For this reason, it was easy to manage and cater to all types of citizens.

Now with the new restrictions since the fourth wave as hit the country, government has taken severe actions to make sure majority of the population gets vaccinated. Several warnings have been announced to persuade people to get themselves vaccinated such as blocking of sim cards, banning entry at eateries or shopping centres etc but the decision which finally influenced people to start getting vaccinated was the announcement to withhold salaries of non-vaccinated citizens. The deadline, which was initially July 31, 2021 and later extended to August 31, 2021 keeping in view issues such as slow registration of vaccinated citizens. “Keeping in view the number people which has increased in last week at the only 24/7 vaccination centre the Government of Sindh declared 12 vaccination centres as 24/7 centres and provided them with at least three day bulk of vaccines to keep the process smooth,” told Soomro, the parliamentary secretary also shared that from the 22 mobile clinics that operate all over Sindh, hve been called into the major cities to help in vaccination. “From the total, 12 will be deployed in major areas in each district while 4 will be deployed in Hyderabad and one in each Larkana and Sukkur”. The mobile clinics are well equipped with the facility of X-rays, checkups for Tuberculosis, Hepatitis etc and provide initial treatment to the patients. They also conduct OPD so such mobile clinics will be and additional help in inoculations across the province.

The Government of Sindh has set their targets too in terms of vaccinating the people across the province, “We have set our target that we will vaccinate 60% of the population by the end of this month. On August 2, 2021, Karachi has crossed 100,000 people who got vaccinated in a single day. The total was 52,000 a day, the previous week,” shared Soomro adding that in the population of over 10 million even when we vaccinate 8 million then the city can get back to normal life with fewer restrictions. “Our aim is to vaccinate at least 150,000 a day to get the situation under control,” he added.

The smaller crowds at the vaccination centres previously were not because people have accepted the pandemic or are fearful of the spread of the virus but because the majority of the people still from the school of thought who believe that Covid-19 is just a conspiracy and vaccination is no good for them. However, now with the condition of non-issuance of salaries, people now no longer have a choice. “Right now the rush is increasing at every centre but eventually within a week or two it will settle down and then we have derived a policy that we will go door to door to reach people and vaccinate them,” said Soomro.

(*Some names have been changed to hide identities)