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April 4, 2020

Covid-19 policy focus


April 4, 2020

It’s not just the economy, stupid. The coronavirus has finally killed the platitude-defining politics of the 90s. It’s about lives. It always was.

Sadly, some politicians and interest groups are still insisting otherwise. They’re speaking of social darwinism, possibly prematurely ending lockdowns, and sacrificing those old and sick at the altar of stock markets. Others are suggesting that poor countries can’t afford social distancing through phased shutdowns or suppression measures. They’re wrong. What countries can’t afford is late action or inaction.

A report from the Covid-19 response team at Imperial College London led to recent shutdowns in the US and UK. On March 26, 2020, their new global report pointed out that if countries do nothing, an estimated 40 million people will die globally.

If we mitigate (through shielding the elderly and reducing our population's social contact by 40 percent), then we can save about 20 million lives, but the healthcare systems of all countries would be overwhelmed. If we suppress (through testing, isolation and wider social distancing through lockdown-like measures that reduce social contact by 75 percent etc), then we can save about 30-38.7 million lives globally. For South Asia, an early suppression strategy could save an estimated five million lives.

Would suppression measures have to be sustained for some time? Yes. Whenever these measures stop, cases could resurge. Would the social and economic costs be high for developing countries like Pakistan? Yes. Could those costs be disproportionately high? Depends on who you ask. Those trained in law and ethics don’t put a dollar value to human life. Even economists who do measure the value of statistical life, argue that the cost to the US economy of doing nothing and letting primarily elderly people die will be $8.30 trillion, about half of the size of the US GDP. Similar analysis could apply to Pakistan.

Compared with high income countries, could Pakistan experience lower demand for critical care because our population is primarily younger? Possibly, but researchers predict that the effect of lower demand for critical care could be offset by lower supply of critical care beds in low to middle income countries. Our mortality rate could also be higher than that of high income countries because of risks related to our healthcare system’s collapse. The bottom line from the latest Imperial College London report is this: "Rapid, collective action now could save millions of lives.”

So far, Pakistan’s prime minister has resisted calls for a country-wide lockdown, arguing that if he shuts down Pakistan’s cities, those extremely poor in Pakistan will die of hunger. But it’s imperative that our government recognize: we don’t have to choose between people starving or dying of disease. This isn’t binary. Access to healthcare and subsistence are not mutually exclusive. We can have a public health strategy consistent with an economic one. Our primary policy focus? Saving lives.

Given the state of the global economy and supply chains, economic costs may exist independent of whether Pakistan's government decides to suppress corona-spread through a lockdown of sorts. Through careful procurement, national coordination, proactive planning on food and medical supply chains, as well as emergency measures, when needed, our government can provide access to healthcare and subsistence.

But in legal language broadly applied to the policy world: time is of the essence. The costs, long run and short run, economic and non-economic, of letting our population die, whether by disease or starvation, is unavoidably high. Between now and when a potential vaccine could emerge 18-months on, we may have to switch periodically between suppressing (ie closing down schools, universities and possibly partly operating non-essential businesses) and isolating cases and contacts but otherwise opening the country.

Social distancing through a lockdown doesn’t have to mean a complete curfew always. Essential businesses may be exempt. So agricultural workers, healthcare industry workers, food industry workers, ports & shipping workers, delivery service workers, postal service workers, fuel industry workers, essential utility workers and others may still work. Employers can reduce non-essential staff and increase the proportion of workers working from home.

Simultaneously, in time bought through social distancing measures, we should divert resources to build emergency field hospitals to increase available hospital beds. In the US, New York’s governor has called for nationalization of medical equipment supply chains. If needed, Pakistan should be prepared to do the same temporarily, on a wartime basis, so that regions most affected can get the most medical supplies.

Unlike developed countries, our ability to maintain food security may be more challenging. To ensure subsistence and equal access to food and healthcare for all citizens, we may have to resort to war-time consumption and rationing temporarily in the absolute worst case scenario. I hope we don’t have to. But we should prepare for that scenario. Chiefly, the lesson from China is that coordination works. We need our central government to act in concert with provincial governments, leading a coordinated national effort.

On a global level, we have to pursue the IMF and World Bank for concessions. Encouragingly, the IMF has indicated that it is ready to mobilize $1 trillion for coronavirus lending. We need to lobby for more money with fewer public spending restrictions. Global solidarity combined with state action should define the path forward.

No Pakistani can be left to starve or die of disease. That is the promise of our constitutional right to life. Pakistan is because Pakistanis are – the poor, the old and the sick too.

The writer teaches law at IBA Karachi.

Twitter: @MoruShah