Pakistan’s Covid-19 report card

Four weeks ago, in this very space, I identified the four policy outcomes that would need to be pursued by Pakistan:

“First, to limit the spread of the disease and minimize mortality. Second, to protect the overarching capacity of the public health system and enable it to cater to the already under-serviced demand for primary, secondary and tertiary health. Third, to prepare for the economic impact of the Covid-19 crisis on individuals, families and communities, and on the wider macroeconomic situation at large. And fourth, to find ways to reach a scientific solution to the Covid-19 crisis, including the search for R&D that delivers a vaccine and/or drugs to deal with Covid-19.”

One month later, how has public policy in Pakistan performed?

On the question of flattening the curve, and slowing down the spread of infections and fatalities, there is arguably enough to indicate early success. There is, for example, evidence that the rate of spread and fatalities has indeed been slower than it would have been absent a number of important decisions by respective provincial governments, and the federal government.

Among these, are the decision to limit the return of Pakistani students in China in January and February, the decision to establish quarantine centres on the Pakistan-Iran border for Pakistanis that were physically forced out of Iran as that country struggled with the virus, and the decision, first by the Sindh government, and later all provincial governments and the federal government, to adopt reduced movement or mobility, or what has incorrectly come to be called a “lockdown”. Given the mortality rates in other countries have spiked faster and more dramatically, it seems Pakistan has successfully flattened at least the early slope of the curve.

On the question of protecting the capacity of the public health system to deal with this crisis, lower numbers of infections and fatalities softens our ability to make a judgement. Until the public health system confronts a spike in numbers that puts unprecedented pressure on it, it is hard to be able to say with certainty exactly how effectively protective measures for the health system have performed. There are two bits of early evidence that offer clues to us. Sadly, they point in different directions.

First, the testing rates. The low rates of testing, nationwide, indicate that procurement and deployment of testing has not been up to the mark. But part of this may be due to an abundance of caution. There has been great pressure on governments to adopt ‘rapid’ testing, for example, with governments choosing to stick to what is called “PCR” testing. The latter takes longer, and is more expensive, but is also more certain. Low testing rates do however mean that our data for infections may well be telling us a nicer story than what is actually out there.

Second, the volume of critical caseload. The number of incoming critical patients being admitted to hospitals is, anecdotally, not at the level of what constitutes a crisis. Yet. Now, because of the absence of coherent and detailed national data, as well as a lack of disaggregation and clarity on public versus provision, or Covid-19 versus other disease-related criticality, this point needs to be taken with a large dose of salt. But the bottom line is that the absence of a critical patient caseload that would overwhelm the public health system so far suggests at a minimum that Pakistan still has time to prepare for the worst – that future moment where caseloads spike, mortality spikes, and the system is truly overwhelmed. This is, tentatively, good news.

On the question of preparing for the economic impact of Covid-19 on individuals, families, communities and the wider macroeconomic situation, I would argue that Pakistan has done remarkably well, both in terms of the range of its responses, as well as the tactics used. First, let’s enumerate the responses. There is the Rs1.2 trillion Covid-19 relief package, the bulk of which was meant to put the business community at ease. Within this package is the Ehsaas Emergency Cash programme, meant to provide Rs12,000 to 12 million households. There is a construction industry stimulus, which is meant to offer big construction businesses a number of tax concessions and subsidies, and meant to offer low skill labour a large quantum of employment opportunities.

In addition to these measures, there is a series of negotiations being conducted with the multilaterals, which has thus far yielded a $1.4 billion IMF facility, and will likely generate both World Bank and Asian Development Bank loans. Finally, there is PM Khan’s personal appeal for debt relief, an issue on which he is assuming global leadership. Now if the question is whether all of this will work, it is clearly too early to tell. But if the question is how this stands in terms of a range of responses, then the judgement has to be, quite emphatically, that this represents a remarkably timely, well-conceived, people-centric economic response to Covid-19.

Finally, on the question of ways to reach a scientific solution to the Covid-19 crisis, there are numerous indications that, to the extent possible, from the Higher Education Commission to the National Incubation Centers, to the Ministry of Science and Technology, the state has sought to engage innovators, inventors and entrepreneurs in helping devise timely and low cost solutions to problems: this has produced, among others, ventilator repair processes that are already increasing nationwide vent capacity, and ventilator multiplier technology that allows one vent to be used for four or more critical patients. Again, for a country that has never been a juggernaut in science and technology, save for Dr Abdus Salaam’s brilliance, this represents a surprising swiftness and openness to solutions.

For all this, Pakistan’s leaders should be lauded, from Prime Minister Imran Khan (for prioritizing the economic well-being of the poorest and most vulnerable, whilst also listening to Dr Zafar Mirza on China and Taftan, and Dr Sania Nishtar, on BISP and Ehsaas), to Shahbaz Sharif (for bravely returning to Pakistan to demonstrate commitment and seriousness of the Covid crisis), to Sirajul Haq (for leading the Jamaat in demonstrating pluralistic Jinnahist values), to Khyber Pakhtunkhwa Health Minister Taimur Khan Jhagra (for communicating transparently, responsibly and calmly), to Sindh Chief Minister Murad Ali Shah (for exemplifying executive leadership in a time of personal and national crisis).

Now of course, comes the hard part. There is an unmistakable complacency on the streets in Pakistan. There is nothing that justifies this complacency. The initial success of the government’s response may be as much fact as it is illusion – we simply don’t have enough credible data to be able to be complacent about it.

The national leadership faces more pressure today than it did a month ago. India’s behavior on the Line of Control, the state of affairs in Afghanistan, the UAE and Saudi Arabia’s economic vulnerability, and the metastasizing impact of the Covid-19 crisis on North America and Europe all point toward lower exports, lower remittances, less aid, and more insecurity for the people and republic of Pakistan.

Reducing the movements and mobility of the general public, securing food and medicine supply chains, and ensuring that Pakistan’s national security is not compromised by opportunistic religious extremists – especially those that occupy 7, Lok Kalyan Marg, and the Lok Sabha at large – will test Pakistan in the weeks and months to come, like never before.

Pakistan’s leaders must do even better than they have in the last month.

The writer is an analyst and commentator.