Can Pakistan Effectively Respond to Coronavirus Pandemic?

[Riaz Haq]

Pakistani public health system's ability to deal with Covid19 pandemic is increasingly being questioned with the number of confirmed coronavirus cases spiking in the country. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan. Hydroxycholroquine (HCQ), made by Getz Pakistan, is also reportedly effective in treating Covid19.

Coronavirus Global Pandemic

Is Pakistan Ready?

Pakistan is among only 6 countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The 6 countries named in the report are: Eritrea, Finland, Pakistan, Saudi Arabia, Tanzania and the United States.

Covid19 Coronavirus. Source: US CDC

Pakistan's ability to deal with a pandemic is now being tested by the coronavirus. The current hotspot for it is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings such as weddings and conferences. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic. Pakistani health experts are advising people with flu-like symptoms to self-isolate in their homes.

Pakistan is ramping up coronavirus testing and setting up isolation wards at many hospitals in Sindh and across the country. More testing accounts for the spike in confirmed cases. The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.

In response to a recent request by Pakistan's Express Tribune newspaper staff, World Health Organization Executive Director Dr. Michael J. Ryan said Pakistan has great capacity in public health but he also talked of challenges posed by the Coronavirus pandemic. “Pakistan has a highly mobile population with mega cities and undeserved people,” he said.  “So there is a great challenge facing Pakistan. But Pakistan has also demonstrated time and again with dengue, polio and other diseases how all of the government and society’s approaches can be made to work.”

Dr. Palitha Gunarathna Mahipala, World Health Organization (WHO) representative in Pakistan, also lauded Pakistan's response to Covid19 pandemic, according to The News. He said,  “Pakistan has timely come up with one of the world’s best National Response Program against COVID-19 and it is being implemented very effectively. Authorities are doing their job and now it is the responsibility of the people to follow the instructions and take preventive and precautionary measures to avoid contracting the viral disease.”

The World Bank report titled "From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level" was written by experts from the World Bank,  the World Health Organization, the International Monetary Fund, the African and Asian development banks, and finance officials from various governments. The report included estimates of the economic damage various epidemics had done. For example, the viral pneumonia SARS — which ultimately killed only 774 people — shrank China’s gross domestic product by 0.5 percent in 2003. The report also broke down costs on a per capita basis. A major flu pandemic, for example, would cost Afghanistan only $12 per citizen, India $31, Pakistan $28 and the United States $248.

Social Distancing:

The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.

Italian experience with coronavirus has shown that even a well-developed public health system in a rich European country can be overwhelmed by rapidly growing pandemic such as Covid19.  The best way to handle the situation is to cut the infection rate by keeping people about 6 feet apart. This is being called "social distancing".

Social Distancing to Limit Infection Rates

Based on what the United States has learned from what is happening in Italy, major cities and states in America are taking steps to reduce large gatherings of people. Offices, schools, restaurants and shopping centers are closed with shelter-in-place orders in Silicon Valley and the larger 6-county San Francisco Bay Area.

Herd Immunity:

Herd immunity develops when a large percentage of population is infected or vaccinated. Dr. Arindam Basu, Associate Professor of Epidemiology and Environmental Health at University of Canterbury, has recently written an article in The Conversation arguing that it is "unethical and potentially dangerous" to wait for herd immunity to develop in the absence of a vaccine.  It could result in hundreds of thousands or even millions of deaths among the most vulnerable segments of the population such as the elderly and the immune-compromised.

Pakistan's Assistance to China:

Chinese President Xi Jinping has thanked Pakistan for its support during coronabirus outbreak in his country. "China is deeply grateful for Pakistan's support. Facts have proved once again that China and Pakistan are true friends who share weal and woe and good brothers who share each other's joys and sorrows. The special friendship is a historical choice, and is deeply rooted in the hearts of the two peoples," said Xi.

Resochin (Chloroquine) Produced by Bayer Pakistan

At the peak of the outbreak in February, Bayer Pakistan exported to China 300,000 tablets of Resochin (Chloroquine) that proved effective in treating coronavirus infections and saving lives in Wuhan. Resochin is an antiviral drug used for treating malaria. Chloroquine is manufactured by not just Bayer but several other drug companies as well.  China and many other countries discontinued its production years ago.   Several Pakistani pharmaceutical companies also manufacture HydroxyChloroquine which has lower toxicity and fewer side effects. The United Kingdom has banned hoarding and export of both of these drugs. In addition, Pakistan donated 7,000 surgical masks to China at the peak of the coronavirus outbreak.  A recent paper titled "An Effective Treatment for Coronavirus (COVID-19)"  by James M. Todaro, MD and and Gregory J. Rigano, Esq. has published data showing the efficacy of familiar anti-malaria drugs Chloroquine and Hydroxychloroquine for treatment of and as prophylactic against COVID-19.

In Vitro Efficacy of Chloroquine(CQ) vs Hydroxychloroquine (HCQ) Ag...

Recently, Chinese research (reported in Clinical Trials Arena) reported that “data from the drug’s [chloroquine] studies showed ‘certain curative effect’ with ‘fairly good efficacy’ … patients treated with chloroquine demonstrated a better drop in fever, improvement of lung CT images, and required a shorter time to recover compared to parallel groups. The percentage of patients with negative viral nucleic acid tests was also higher with the anti-malarial drug… Chloroquine has so far shown no obvious serious adverse reactions in more than 100 participants in the trials… Chloroquine was selected after several screening rounds of thousands of existing drugs. Chloroquine is undergoing further trials in more than ten hospitals in Beijing, Guangdong province and Hunnan province.”

A small French study found only 25% of COVID19 patients who took it for 6 days still had the virus while 90% of those who had not taken it still had Covid-19.

HCQ (Hydroxychloroquine) Manufactured by Getz Pakistan

Economic Impact of Coronavirus Pandemic:

Service sector accounts for  50% of the world GDP and 54% of Pakistan's GDP.  Social distancing will significantly impact the services, particularly retail, restaurants, travel, transport and education sectors. Imran Khan has expressed fear that the pandemic will devastate the economies of developing countries.

“My worry is poverty and hunger," Khan said. "The world community has to think of some sort of a debt write-off for countries like us, which are very vulnerable, at least that will help us in coping with (the coronavirus).”

Summary:

Pakistan is among only six countries in the world that have taken the steps they need to evaluate their ability to withstand a global pandemic, according to a 2017 report sponsored by the World Bank. The current hotspot is in southern Sindh province where the provincial government is taking the lead in fighting its spread by shutting schools, closing restaurants and shopping malls and banning large gatherings. The federal government has closed Pakistan's western border with Iran where the coronavirus pandemic is raging. Pakistan Civil Aviation Authority has started screening all incoming passengers and stopped flights to and from several countries hit by the pandemic.  The best known treatment for the severely ill is Resochin, the anti-malarial antiviral made by Bayer Pakistan.  Dr. Michael Ryan and Dr. Palitha Gunarathna Mahipala of the World Health Organization (WHO) have talked of challenges Pakistan faces but also praised the steps it has taken to fight coronavirus pandemic.

Here's the latest Coronavirus Pandemic Update:

https://youtu.be/vE4_LsftNKM

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[Riaz Haq]

#COVID #Vaccination Status in #Pakistan: 42.2 million doses administered. 12 million (5.5%) fully vaccinated https://ourworldindata.org/covid-vaccinations?country=OWID_WRL

https://twitter.com/haqsmusings/status/1426760799914102789?s=20

[Riaz Haq]

#Pakistan ranks 16th in the world with 50.5 million #CovidVaccine doses administered to date. #COVID #vaccination https://www.statista.com/statistics/1194934/number-of-covid-vaccine...

https://twitter.com/haqsmusings/status/1431444787366752259?s=20

[Riaz Haq]

#Pakistan among top 15 countries in terms of #COVID19 #vaccine dose administered to-date https://www.atlas-mag.net/en/article/covid-19-vaccine-ranking-of-co...

https://twitter.com/haqsmusings/status/1443664398694813714?s=20

Rank Country Doses * Rank Country Doses * Rank Country Doses *
1
China
2.18 billion 11
France
92.26 million 21
Philippines
41.41 million
2
India
804.78 million 12
Russia
87.74 million 22
Saudi Arabia
40.89 million
3
United States
385.59 million 13
Italy
82.41 million 23
Malaysia
40.38 million
4
Brazil
222.32 million

14
Pakistan
73.83 million
24
Colombia
38.33 million
5
Japan
149.88 million 15
Spain
69.09 million 25
Morocco
37.24 million
6
Indonesia
124.65 million 16
South Korea
55.51 million 26
Poland
36.96 million
7
Germany
105.67 million 17
Canada
55.06 million 27
Bangladesh
36.83 million
8
Turkey
105.11 million 18
Argentina
48.83 million 28
Vietnam
34.10 million
9
Mexico
95.27 million 19
Thailand
44.49 million 29
Chile
30.79 million
10
United Kingdom
93.00 million 20
Iran
42.00 million 30
Sri Lanka
24.80 million

[Riaz Haq]

#Pakistan has administered 80 million doses of #COVID19 #vaccines so far. Over 27 million #Pakistanis are now fully vaccinated as of September 29, 2021. #pandemic #VaccinationDrive https://tribune.com.pk/story/2322527/pakistan-crosses-80-million-co...

https://twitter.com/haqsmusings/status/1443644359866388500?s=20

National Command and Operations Centre (NCOC) chief Asad Umar announced earlier in the day that cities with a slow pace of vaccination as well as unvaccinated individuals will be imposed with higher restrictions.

He said in a tweet, “The only way out of the Covid pandemic is to get a high percentage of citizens vaccinated."

The NCOC chief added, “Therefore as part of the strategy to reward citizens and cities which vaccinate, there will be higher restrictions on cities with a low level of vaccination and on citizens who are not vaccinated.”

“We have set the target of vaccinating at least 70 million people in the country by December 01, 2021 and we are moving fast to achieving the target,” said Umar later in a press conference along with PM’s aide on Health Dr Faisal Sultan in Islamabad.

Dr Faisal said before vaccine availability main focus was on restrictions, while “now we are gradually shifting our strategic focus towards vaccination”.

He said children are super-spreaders of the virus that’s why it had been decided to open vaccination for children above 12 years of age.

Meanwhile, 52 more deaths were reported due to Covid-19 and at least 1,560 people contracted the virus in the country over the last 24 hours.

According to the NCOC statistics, 48,836 tests were conducted yesterday and the positivity ratio remained 3.9 per cent.

[Riaz Haq]

#UNICEF: #Pakistan has administered nearly 90 million doses of #COVID19 #vaccines, with 32 million people now fully vaccinated. 97% of #Pakistani teachers are fully vaccinated as #schools reopen. #education #pandemic https://www.unicef.org/press-releases/unicef-deputy-executive-direc...

At the end of a four-day visit to Afghanistan and Pakistan, UNICEF Deputy Executive Director Omar Abdi stressed the need for greater action to meet the increasing needs of children in both countries.

Arriving in Afghanistan amid an escalating health and nutrition crisis for children, Abdi visited the Indira Gandhi Children’s hospital in Kabul alongside UNICEF Regional Director George Laryea-Adjei and UNICEF Afghanistan Representative Hervé Ludovic de Lys. In the nutrition ward, he met dozens of children suffering from severe acute malnutrition, a life-threatening condition. Without immediate action, an estimated 1 million children in Afghanistan are projected to suffer from severe acute malnutrition in 2021 and could die. Severe outbreaks of measles and acute watery diarrhoea have further exacerbated the situation, putting more children at risk.

During his meetings with the de facto authorities in Kabul, Abdi highlighted children’s need to access basic health care, immunization, nutrition, water and sanitation, and child protection services. He called for polio, measles and COVID immunization campaigns to resume immediately to help protect children and communities from vaccine-preventable diseases.

Abdi also stressed the critical importance of ensuring all boys and girls are allowed to continue their education at all levels and participate meaningfully in building the future of their country.

“UNICEF will continue to press for the rights of every girl, boy and woman in Afghanistan. Our objective is to see an Afghanistan where every girl and every boy are in school, have quality health care, and are protected from all forms of violence,” Abdi said. “The de facto authorities, UN member states, donors and humanitarian organizations must act together immediately to prevent the humanitarian crisis from deteriorating further, in the interest of children’s survival in Afghanistan.”

After Kabul, Abdi continued on to Pakistan, where he visited a number of projects as part of the cooperation between UNICEF and the government. Abdi, who had served as UNICEF Representative in Pakistan from 2003 to 2006, visited a school, a COVID-19 and polio call centre as well as the National Emergency Operation Center in Islamabad, alongside Laryea-Adjei and UNICEF Pakistan Representative Aida Girma.

At Islamabad Model School for Girls, he met with students and teachers who use an innovative mix of digital and traditional learning to teach children.

Currently, 80 blended learning classrooms are being established in public schools in Islamabad. The lessons and activities are provided offline, using a portable device provided to all schools. This is part of a pilot by the Government of Pakistan to assist students and teachers with additional material for learning and teaching.

The COVID-19 pandemic had a devastating impact on children’s learning, with girls especially at risk. Many students were left grappling with the realities of remote learning without the right tools.

“I commend the Government of Pakistan for reopening schools across the country safely and prioritizing the vaccination of teachers, 97 per cent of whom are now vaccinated,” Abdi said. “The Ministry of Education has adopted efficient measures to promote digital learning with UNICEF support, but in-person learning remains key.”

[Riaz Haq]

#US to ship 2.4 million doses of #COVID19 #vaccine to #Pakistan, bringing total doses to the country to about 18.3 million, more than any other country in the world, according to the White House. Pakistan has administered at least 93.6 million doses so far https://wkzo.com/2021/10/14/u-s-to-ship-2-4-million-doses-of-covid-...

WASHINGTON (Reuters) – The U.S. government will ship 2.4 million doses of COVID-19 vaccine to Pakistan on Thursday, bringing the total number of doses sent to the South Asian country to about 18.3 million, more than any other country, a White House official said.

The latest shipments of the vaccine lots made by Pfizer and Germany’s BioNTech, are due to arrive on Saturday via the COVAX distribution program, said the official, who asked to remain unidentified.

Pakistan has administered at least 93.6 million doses so far, according to data compiled by Reuters https://graphics.reuters.com/world-coronavirus-tracker-and-maps/cou.... Assuming every person needs two doses, that would suffice to have vaccinated about 21.6% of the country’s population.

Previous U.S. shipments of Moderna and Pfizer-BioNTech vaccines have gone to Pakistan every month since June.

The shipment is part of an ongoing U.S. vaccine diplomacy effort that has sent vaccines to dozens of countries.

[Riaz Haq]

#US Donates 9.6 Million Additional #COVID #Vaccine Doses to #Pakistan, Bringing Total #US Donations to Pak to 25 million. Pak has administered 95.4 million doses so far. #coronavirus #pandemic #Pfizer #Moderna https://www.voanews.com/a/us-donates-9-6-million-additional-covid-1...

The United States announced Friday an additional 9.6 million doses of Pfizer coronavirus vaccine are being shipped to Pakistan through the global vaccine-sharing COVAX initiative.

The shipment brings to more than 25 million the total number of COVID-19 vaccine doses donated by Washington to the Pakistani people, said the American Embassy in Islamabad.

“The United States is proud to partner with Pakistan to get effective, life-saving Pfizer vaccinations into the arms of Pakistanis, and Pakistan has done a great job of distributing our donated vaccines,” U.S. Chargé d’affaires Angela Aggeler was quoted as saying. “This donation comes just in time for young Pakistanis over age 12 to get their first jabs.”

COVID-19 infections are decreasing in Pakistan, with fewer than 1,000 new daily cases reported on average. The government last week eased restrictions on almost all public movement, education activities and businesses across the country of roughly 220 million people.

The latest government data show there have been 1,262,771 confirmed cases of infections, 39,953 of them active, and 28,228 COVID-19-related deaths since the pandemic hit Pakistan.

Officials reported Friday that more than 95 million doses have been administered to Pakistanis, including roughly 1 million in last 24 hours alone, since the national vaccination drive was rolled out in February.

The vaccination campaign has largely relied on Chinese vaccine, but the U.S. donations are helping officials overcome critical shortages of Western-developed anti-coronavirus shots.

“These Pfizer vaccines are part of the 500 million Pfizer doses the United States purchased this summer to deliver to 92 countries worldwide, including Pakistan, to fulfill President [Joe] Biden’s commitment to provide safe and effective vaccines around the world and supercharge the global fight against the pandemic,” the U.S. Embassy noted in its statement.

Washington has also delivered $63 million in COVID-19 assistance to Islamabad.

The COVAX program is co-led by Gavi (the Vaccine Alliance), the WHO (World Health Organization) and CEPI (the Coalition for Epidemic Preparedness). The United States is the single largest contributor supporting the initiative toward global COVID-19 vaccine access.

[Riaz Haq]

OPINION
PETER COY

The New Magazine Alexander Hamilton Might Have Written For

https://www.nytimes.com/2021/11/03/opinion/hamilton-national-develo...

I recently interviewed Asad Umar, Pakistan’s federal minister for planning, development, reforms and special initiatives, about Pakistan’s success in fighting Covid-19. Its reported Covid mortality rate is well below that of Afghanistan, Bangladesh, India and Iran. Last year Lawrence Summers, the former Treasury secretary, indirectly complimented Pakistan’s record while denigrating America’s Covid-19 response, saying, “Heck, if we had run it as well as Pakistan ran the response we would have saved in the neighborhood of $10 trillion.” The World Health Organization and the World Economic Forum have also lauded Pakistan.


Pakistan is far from perfect. There have been only 46.7 vaccination shots per 100 people as of Oct. 31, compared to 131.3 shots per 100 people in the United States. Mask-wearing is spotty. There are too few doctors, partly because many women who go to medical school never practice medicine, instead becoming “doctor brides.” And the rate of infections and deaths might be understated (the government says it’s not). Still, even a modicum of success is welcome in a nation that still hasn’t eradicated polio.

“We’ve done reasonably well,” Umar, whose ministry oversees the National Command Operation Center that’s battling Covid-19, told me. One key to success has been centralized planning and policy formulation, he said. That has included testing, tracking, vaccinations, data collection and “micro” lockdowns that are calibrated to local conditions. “Countries with centralized, coordinated responses did well” in fighting Covid-19, Umar said. (Left unsaid: Those without centralized responses — such as the United States — have stumbled.)

[Riaz Haq]

#WHO Rep Dr. Palitha Mahipala: #Pakistan, a developing country of nearly 220 million inhabitants has fared well in its fight against #COVID19. Pakistan’s #Covid fatality rate ie 124 casualties per million population is amongst the lowest in #SouthAsia & #MiddleEast regions. https://www.dawn.com/news/1656263/managing-covid-19

At the national level under the prime minister’s leadership, the National Coordination Committee was established as an apex body which is tasked with supervising the national response towards the Covid-19 pandemic. In April 2020, the government in collaboration with partners launched a $595m Pakistan Preparedness and Response Plan (PPRP) that chalked out a coordinated international effort in consultation with the foreign affairs ministry to support the health ministry at the federal and provincial levels.

Pakistan’s vaccine roll-out has been remarkable.

The establishment of the National Comm­and and Operation Centre was one of the stepping stones which made the Covid response pragmatic and swift. It led the coordination between various government agencies, provinces and regions. Based on epidemiological data, the model of testing, tracing and quarantine was implemented for identifying disease spread and hotspots so as to enable targeted smart lockdowns...
---

Also, Pakistan’s economy performed beyond expectations amid the Covid-19 pandemic, resulting in a 3.94 per cent economic growth rate during the fiscal year, compared to a revised negative 0.47pc in 2019-20. The government, under the umbrella of the Ehsaas Emergency Cash programme, disbursed over Rs200 billion to nearly 1.7m families across Pakistan. This valuable assistance benefited nearly 109m people or half the country’s population.

The success of Pakistan’s Covid response management was also acknowledged by WHO director general Dr Tedros Adhanom, who noted that Pakistan effectively utilised the well-established community health workers’ infrastructure for surveillance, contact tracing and care. Dr Tedros appreciated Pakistan’s approach that the choice is not between controlling the virus or saving the economy; the two go hand in hand.

For a developing country, Pakistan’s vaccination roll-out programme has been remarkable. A recent significant milestone in this regard is the administration of 100m vaccine doses across the country. Moreover, special measures have been taken by deploying mobile vaccination teams which are reaching out to senior citizens, people living with disabilities and marginalised populations.

The silver lining during the pandemic has been the identification of the gaps in the existing health infrastructure, providing us with the opportunity to take corrective measures to strengthen health systems in the country. In 2016, WHO facilitated a joint external evaluation for Pakistan, which looked in detail at 19 technical areas, including pandemic preparation. As a result, comprehensive recommendations were made to improve the national health emergency infrastructure.

Notwithstanding the success of the Covid-19 response, there are a few areas where we can do better. The pandemic does not discriminate with regard to caste, creed and gender. However, data indicates that the vaccination rates amongst women are much lower in comparison to men. A similar predicament has been observed amongst the refugee population in Pakistan.

As the WHO representative in Pakistan, I state this with cautious optimism that Pakistan’s Covid-19 management is headed in the right direction with a particular emphasis on close coordination, strengthening surveillance systems, tracking the evolution of new variants and investing in research and innovation.

[Riaz Haq]

#Pakistan revs up #COVID vaccination drive amid #Omicron fears. 40 call centers set up to promote #vaccination. #Boosterdose to be administered to #healthcare workers, senior over the age of 50 or #immunocompromised. #pandemic https://aje.io/cqfnmz via @AJEnglish

Pakistan’s government will step up COVID-19 vaccination efforts and is expanding the criteria for vaccine booster shots, amid fears of the Omicron variant, authorities say.

On Wednesday, the leadership of the National Command and Operation Centre (NCOC), which is heading the country’s COVID-19 response efforts, held a meeting in the capital Islamabad to review steps to curb the spread of the virus.

Authorities will set up 40 call centres to follow up with citizens who have missed their second dose of a COVID-19 vaccine, a statement issued after the meeting said.

Booster doses will also be administered to healthcare workers or citizens who are either over the age of 50 or are immunocompromised.

Pakistan has not yet detected Omicron, which was first designated a variant of concern by the World Health Organization on Friday.

On Wednesday, the South Asian country recorded 377 new cases of the coronavirus, with eight deaths recorded, taking the country’s total death toll since the pandemic began to 28,745.

Pakistan saw its fourth wave of the virus peak in August, and daily cases have been close to all-time lows in recent weeks.

The government’s vaccination efforts have seen more than 50.7 million Pakistanis, out of a population of 220 million, fully vaccinated, although a significant number of others have only received one dose, according to government data.

Last week, the NCOC banned inbound travel to Pakistan from seven countries or territories where Omicron had been detected, including Botswana, Eswatini, Hong Kong, Lesotho, Mozambique, Namibia, and South Africa.