The Covid-19 pandemic has placed enormous stress on governments, health authorities and individuals across the world, with the total global death count estimated at 4.16 million people, and an infection burden of 194 million. The virus, which originated from an animal market in Wuhan, China, quickly spread across the globe.
Being an easily transmittable airborne disease, with multiple variant offshoots, the virus is hard to contain. As it spread through porous borders, governments around the world were left reeling as the world came to a standstill. Governments dealt with the pandemic in different ways; some countries like Singapore initiated full lockdowns shutting off all land and sea borders and imposing heavy quarantine rules, whilst others took a more lenient approach, like Sweden, the only country in Europe to not have implemented a lockdown at any time during the pandemic.
Pakistan, located in South Asia, bordering India, Afghanistan, China, and Iran having a population of over 200 million people, got its first COVID-19 cases from pilgrims returning from Iran. Every year around early spring, approximately 0.7 million Muslims from Pakistan travel to Iran on pilgrimage. The first two cases were detected in Karachi from two returning pilgrims on 26 February 2020, and by March 24 Pakistan had reported 990 cases and seven deaths.
From then on the virus’s spread was untrammelled. Its spread was hugely concerning in a country lacking health infrastructure, medical supplies, and having a sizable population (five percent of whom live on less than $2 a day) living in abject poverty. The Pakistan Government reacted promptly. at first closing schools, banning big events, and closing its borders with Afghanistan and Iran. Systematic covid-19 detection screening was instituted across airports, with only three airports kept open for international flights, to restrain the virus’s spread from foreign passengers.
Pakistan’s National Security Council established the National Coordination Committee(NCC), which opened up an operational arm known as the National Command and Operation Centre (NCOC) in March 2020. The NCOC was an essential factor in curbing the impact of covid-19 in Pakistan. It functioned as a command and control center, with both government and military personnel working together, making data-driven decisions that ensured real-time implementation.
The global indivisibility of public health has shown us that coordinated multilateral action for people and the planet has never been needed more and we need to act in the here and now for a covid-19-free future. The example of Pakistan may point to a model for other governments to emulate in the future
The effect of COVID-19 on the economy has been considerable. While Pakistan’s economy has been steadily growing over the past two decades, due to the COVID-19 containment measures enforced, GDP growth in Pakistan is estimated to have contracted by 1.5% in FY 2020. Over half the working population suffered either job losses or income cuts, and poverty incidence increased from 4.4 percent to 5.4 percent, leaving over two million people in poverty.
Low-skilled workers however faced the greatest loss in livelihood. As cases continued to rise, despite mounting pressure from citizens, particularly the wealthier economic classes, Imran Khan’s government refused to implement a nationwide lockdown, stating it would be detrimental to let the economy stall completely and leave daily-income earners, of which there are an estimated 67 million, without a job and no livelihood to sustain themselve. As part of a $940 million economic stimulus package to mitigate the adverse socioeconomic effects of the pandemic, the government gave out 12,000PKR, equivalent to approximately $75, to low-income earners.
As covid-19 cases began to decline by June 2020, the government decided to abandon citywide lockdowns, and instead imposed what they termed ‘smart lockdowns’ as a measure to stop the economy from completely stalling. In a ‘smart lockdown’, an area or street identified by an infected person, their family or hospital data as their residential address, would be shut down immediately, with all residents unable to leave.
The Inter Services Intelligence (ISI), the country’s intelligence agency, headed the national contact tracing system to identify individuals who may have been in contact with those who tested positive. This contact tracing system was originally designed to trace terrorist targets, but with the pandemic, the ISI modified the system to help with virus detection. The government also tracked and checked recent journeys of infected persons, in order to minimize the infection spreading from contact with other people across land and air transport. At the risk of being a ‘police state’, all this allowed the government to force the list of people in contact to quarantine, thereby reducing the ability of the virus to transmit further. Contacts of the infected person were also advised to isolate. If the infected person had recently travelled, flight information was also tracked and co-passengers were made to quarantine. In many cities, entire sub-sectors were shut down to curb transmission.
The National Command and Control Centre was crucial to this, coordinating the entire apparatus, but there were several other factors that greatly helped the government in halting the spread of the virus. Pakistan and Afghanistan are the only two remaining countries in the world that have yet to eradicate polio. The government was able to leverage its existing polio eradication programme infrastructure and work with field epidemiologists (trained locally through the US Centers for Disease Control and Prevention) to carry out covid-19 testing and tracking. Additionally, the country quickly built up its polymerase chain reaction (PCR) testing facilities, increased local production of Personal Protective Equipment (PPE), began production of ventilators, and increased the number of intensive care unit beds.
It must however be mentioned that Pakistan’s population on average is a lot younger than other countries where covid-19 struck. Some of the countries where covid-19’s impact has been the deadliest, have populations that are considerably over the global average, such as the USA and Italy. Research shows that people over 60 are more vulnerable to the virus, while younger people are less susceptible to it. The average age in Pakistan is 22 years, compared to 38.1 years in the USA, and a global average of 29.6. According to a leading Pakistani epidemiologist, Dr Rana Jawad Asghar, Pakistan’s younger population is the reason there were less deaths from covid-19 in the country. In an interview with the BBC, he said four percent of Pakistan’s population is aged 65 and above, compared to rates of 20-25 percent in more developed countries.
From a social perspective, what is success? It’s letting people have as much freedom as possible, whilst ensuring their safety and ability to earn money. And from that perspective, Pakistan has performed well. The poorest income workers were able to continue to sustain themselves and although large gatherings were banned, people were still able to meet each other which was important in cementing the social capital of individuals and communities in unusual circumstances like a global pandemic.
In sum, the formula of staying open and imposing ‘smart lockdowns’ played a crucial role in curbing the transmission of COVID-19 and prevented Pakistan’s economy from completely stalling and keeping economic losses relatively minimal.
Like many developing nations, Pakistan spends painfully very little on public health. The WHO sponsored a Joint External Evaluation in 2016 for Pakistan which looked at areas including pandemic preparation and made comprehensive suggestions to improve national health emergency infrastructure but not a lot of progress has been made in that regard.
The current pandemic has indicated that public health is a global good whose costs and benefits spill out into the global arena. While intrinsic actions must be taken at the national level, the spillover effects of these externalities need to be dealt with by all countries and all at once. More specifically, global action across sectors, particularly in the domain of public health and hygiene, will need to be ramped up. Standards around investment and accountability, to guarantee the right to health and universal health coverage must be promulgated.
The global indivisibility of public health has shown us that coordinated multilateral action for people and the planet has never been needed more and we need to act in the here and now for a covid-19-free future. The example of Pakistan may point to a model for other governments to emulate in the future.
