Of reliance and reliability

A small story in probably the most widely read Urdu newspaper caught my attention late last week. It was about antibiotic resistance, and its impact on Pakistan. I have been working on the issue of antibiotic resistance for over a decade, so I was naturally curious. The story was short — it simply said that a new report from the World Health Organisation has estimated that approximately 60,000 people die from antibiotic resistance in the country. I was immediately intrigued. I had not seen any recent WHO report on the subject, but given everything that is happening in the world, it was quite likely that I had simply missed it. I searched online in the recent database of reports and could not find anything. As has become the norm in our newspapers (particularly in Urdu newspapers) there was no link, no reference and no mention on when or where the particular report was published. The reader is simply expected to believe. There was also no mention of who the reporter for the story was, so I could not contact anyone asking for more details. The story was written so poorly that it was unclear whether it was news, analysis or a public service announcement.

Two days later, similar stories started to emerge in English papers. This time, the numbers were in a completely different ballpark. One newspaper said that 300,000 people die in Pakistan due to antimicrobial resistance, another one reported the number to be 700,000 and the third one said that it was more than a million. So we had a full range from 60,000 to more than a million — same issue, same country, just vastly different number of dead people, and no source! The English papers, to their credit, were arguably quoting the numbers from a recent conference in Karachi on the issue of antimicrobial resistance. They were quoting public health professionals but provided no basis for the numbers. The Urdu paper, on the other hand, were supposedly quoting WHO.

As I dug deeper, I finally found the source of the 60,000 number. It is not a WHO report, but a study conducted by Institute of Health Metrics and Evaluation (at the University of Washington), and the GRAM project at Oxford. The report is available online at: https://www.healthdata.org/sites/default/files/files/Projects/GRAM/Pakistan_0.pdf.

IHME and GRAM are run by leading experts in the world, and I have personally worked with them and have learned a ton from them. But the way their results and data have been presented (or attributed to) in Pakistan is both misleading and problematic. First, they are not WHO, and second, the results in the report are nuanced and require serious engagement. The newspaper reports fail to capture any of that.

The issue of antimicrobial resistance is both serious and urgent. It is also one that is largely underappreciated in Pakistan and both public understanding and public policy has been shockingly weak. But as I reflect on the state of antimicrobial resistance in the country in particular, or public health in general, I cannot help but be concerned about the near and long-term future. For starters, we rely on external reports to understand how big our own problem is. This is not because of lack of capacity, for I know plenty of capable, qualified and dedicated researchers in the country. It is largely due to lack of seriousness from the part of public sector funding agencies. Second, even when we do get an analysis done by international researchers, we are unable to communicate the results in a clear, precise and succinct manner. Instead, we come up with half-facts, half-truths and a full confusion.

There is much to be said about the lack of seriousness in the public health policy sector — and much has been written. However, we fail to recognise and acknowledge that the poor performance of the policy sector is multiplied by the incompetence and ignorance of those who report important public health issues. Lack of knowledge, understanding and seriousness on part of the journalists and reporters creates confusion and ignorance. The end result — as we see it — should surprise no one.

Published in The Express Tribune, May 21^st, 2024.

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