The problems beyond science

The idea of science-based policy in a society is a relatively simple one. Let rigorous science generate evidence for what works and what does not, and then incorporate those findings in a policy to benefit society. Of course, it is much easier said than done. Scientific findings can be murky and different studies can contradict each other. Research funded by for-profit entities can be biased and steer researchers in a direction that are good for the companies, but not necessarily the public. Thinking only about the good of the majority may mean minority groups that are vulnerable or historically marginalised may continue to suffer. Lately, pushback through misinformation on issues ranging from vaccines to climate change has further undermined the foundational ideas of science-based policy.

And then there is something else. A complete disregard for scientific findings and predictions, which are not disputed on merit or ethics, but simply because there is no interest in pursuing them. In 2019, when an HIV outbreak in rural Sindh made international headlines, many in the public health sector of the country had warned that this was unlikely to be an anomaly. In fact, infectious disease researchers had been warning about micro epidemics in other parts of the country, including southern Punjab. In 2024, when a cluster of patients were infected with HIV at the dialysis unit at Nishtar Hospital in Multan due to criminal negligence, public health practitioners had warned once again about other likely outbreaks. We now know that they were right. Another outbreak, this time in Taunsa, has affected several hundred children who were given the disease by those who were entrusted to treat them.

The BBC report that uncovered the awful tragedy in Taunsa is difficult to watch. Those children, whose lives have been permanently altered, are not some distant people; they are our own children. We see a pattern here we have seen in other outbreaks before. A pattern of denial by the doctors in charge. A pattern of deflection from those who were supposed to fix the system. Other conversations have focused on the tenure of a former chief minister who is from the region or whether the HIV outbreak here is more or less severe than the one in Sindh. These are not particularly serious questions. However, some other important questions remain unanswered. For example, how come these things only happen in the poorest parts of our society? Why is it that our own news organisations, often interested in delivering real or imaginary breaking news at breakneck speed, rarely go for an in-depth investigations of this kind? Which news organisations have dedicated health reporters on their staff to report on myriad health challenges in the country? Why isn't there more serious and sustained conversation on health crises in the country?

It is not hard to imagine that what happened in Taunsa is likely to repeat again – in another area, in another province. And HIV is just one of the many on the list of likely diseases.

If we know the mechanism of disease transmission, which in the case of most communicable diseases in our midst is well-established, recognise the underfunding of control mechanisms, and combine it with deeply rooted issues of medical negligence, stigma, corruption and lack of accountability, predicting an outbreak is not very difficult. The science part is actually quite straightforward. There is no alternate theory here and no competing hypothesis. In the world of science guiding policy, this does not have the naysayers or the vaccine skeptics. What we see is something else – a lack of concern for the poor, and our inability to care for them. The problem here is one that cannot be solved by science.