The writer is an Adjunct Professor of Epidemiology at the University of Nebraska and has worked for the US Centers for Disease Control and Prevention. He can be reached at [email protected]

Is Pakistan a rockstar of Covid control strategy?

Problem of a broken system is that we don’t have facts to win an argument


Dr Rana Jawad Asghar September 04, 2021

In recent weeks we have seen a lot of self-congratulatory announcements declaring Pakistan a winner of coronavirus control strategy. Many international magazines have also put Pakistan on the top of their lists. What is the real situation? If Pakistan’s Covid control strategy is so successful, then why are other countries not approaching us to learn from our experience? Why have top scientific journals not published our success story? If Pakistan is a rockstar then where are the queues of people willing for an autograph or a selfie with our experts?

It’s not that Pakistan has not done anything good in the context. A lot of good work went into our control efforts, including the fact that we started early in mid-January 2020. By the time Pakistan had its first patient, we were getting ready for six weeks. Response still floundered but not that much, even when instead of China we started getting cases from Iran. NCOC was set up to give the logistic and muscle support to otherwise benign Ministry of Health advisories. Polio teams, including NSTOP, were reassigned to get the daily number of Covid cases. District health and administrative teams got a new mandate to control Covid-19. Now our EPI has stepped up to play a role for which it was never trained.

Why does then the UK still refuse to remove Pakistan from its red list? Even with all the diplomatic negotiations we got a letter telling us that Pakistan is not testing enough so we may not know what is happening in our own country. Many felt that the UK may be using politics rather than real data to make this decision. That may be true. But the larger question is: why after more than one and half years, we have not increased testing, implemented trace capacities, and added genomic sequencing in our surveillance system in a structured way? Unfortunately, we still believe that daily numbers from labs are a replacement of a disease surveillance system.

But what about The Economist praising Pakistan? The much-touted normalcy index talks about countries doing business without Covid curbs. Yes, Pakistan is number three on that list after Hong Kong and New Zealand, but do you want to know which countries are next to Pakistan with very close scores? The next three countries are Nigeria, Romania and Ukraine. The index has two types of countries. One set of countries are those that vaccinated their population or used public health measures to control the pandemic before coming back to the business. Others, like Pakistan, could not afford both measures and opened anyway. Nearly all developing countries including most of Africa have fared well in this pandemic. Apart from younger populations (not many people survive to live long lives), they may have different viral exposures early in life. But the pandemic is not yet over and tomorrow some new variant may show affinity for younger populations; then what? That has happened before. In the Swine flu pandemic in 2009, children 5 to 14 were 14 times more vulnerable than those above 60.

If we had a working disease surveillance system following structured parameters, sticking to case definitions, set up in a representative manner and providing timely actionable information, we would have been at a much better place. Problem of a broken system is that we don’t have facts to win an argument. No disease reporting system (surveillance) needs to test and report 100% of cases. If done properly, even the 10% or less cases could give good estimates for the remaining 90% of population. A haphazard information collecting system on the other hand will still not be reliable even if we increase our testing from 60,000 to 200,000 daily. Here you need a technical — and not administrative or political — leadership. Not for any red list but for safety of our own population, we need to know what really is happening with us.

Published in The Express Tribune, September 4th, 2021.

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