response analysis, challenges & strategic vision for
TRANSCRIPT
‘Response Analysis, Challenges & Strategic Vision
for Pakistan Amidst the COVID-19 Crisis’
By
Senator Sehar Kamran T.I.
Central Coordinator
PPP-Research, Communication and Social Media
Cell
(Based on data up to 18th May 2020)
“If things do not change, there will be nothing left to change.”
Shaheed Zulfikar Ali Bhutto
3
Contents
Executive Summary ................................................................................................................. 4
1. The Pandemic .................................................................................................................. 6
What is COVID-19?
Information and Conspiracy
Impact
Entry into Pakistan
2. Federal Government – Response & Analysis .............................................................. 12
Policy Timeline, Pre and Post COVID-19
Analysis
o Parameters
o Faulty Narrative Building
o Decision-making
o Politicization of a Health Crisis
3. Interim Provincial Policy Initiatives & Interventions ................................................ 22
Sindh
Gilgit-Baltistan
Khyber Pakhtunkhwa
Punjab
Baluchistan
4. Continuing Challenges .................................................................................................. 30
Strong Leadership
Economic Crisis
Food Security
Health Sector
Human Rights Issues
5. Way Forward ................................................................................................................ 35
Aim
Objective
Economic Strategies
Social Strategies
Health Sector Strategies
Political Strategies
6. Key Findings and Conclusion ....................................................................................... 43
Bibliography .......................................................................................................................... 45
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Executive Summary
The Pakistan Peoples Party has composed an analysis and strategy document following
the recent crisis in the wake of the COVID-19 pandemic, with the aim of attaining clarity
apropos Pakistan’s national response, its shortcomings, and the challenges ahead, to
enable greater coherence and inclusivity in our policy vision moving forward. The
objective is to understand where and why the response strategies to COVID-19 have
fallen short, and to identify strategies that best utilize national resources and efforts,
both for short term containment and long term recovery.
The outbreak of the coronavirus pandemic has resulted in disruptions within political, social,
economic, religious and financial structures across the planet, indiscriminately. Some of the
most developed nations and economies in the world, including but not limited to the United
States, United Kingdom, Germany, France, and Italy have been the hardest hit, and are
struggling to cope with pressure placed on their healthcare systems and economies by the
unexpected speed and scale of the pandemic. Pakistan is no exception. The country has
seen a consistent and exponential increase in cases, (even while thus far mortality rates
have been fairly contained). It is generally accepted among epidemiologists, however, that
the contagion has yet to reach its peak. Consequently, it is fair to assume that the stress
on Pakistan’s healthcare systems, provisions and economic resources is bound to
increase in the coming weeks.
In the case of Pakistan, additional stress can be expected due to factors such as the critical
dearth of income equality and social inclusion, narrow social safety nets, large scale poverty
and unemployment, distributive justice, and the general paucity of strong policies for
common good/safety.
Additionally, the extent of the economic impact for Pakistan is exacerbated by the fact that
growth was already at an all time low when the pandemic hit. Over the past 19 months, the
policies of the current administration had pushed the national economy towards a severe
revenue shortfall, shrinking it to an estimated PKR 42 trillion, with the current ratio of debt
to Gross Domestic Product (GDP) rising above 84.4%, according to a recent Debt Policy
Statement 2019-20 1 by the Ministry of Finance. The current government had attained power
by espousing egalitarian causes, including the building of five million low-cost houses and
the creation of 10 million jobs, but has thus far been unable to deliver on the broad and
unrealistic promises made on the election campaign trail. With a shrinking economy
reducing employment opportunities and the inability of the government to create new jobs
as promised, the pandemic has hit this area particularly hard. The phenomenon is
particularly visible within Pakistan’s informal sector; the country has a labor force of
1 ‘Debt Policy Statement 2019-20’, http://www.finance.gov.pk/publications/DPS_2019_2020.pdf
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approximately 63 million people, of which the 46 million within the informal sector, and
amongst them wage workers in particular, remain the most vulnerable.2
Against the background of such deep-rooted challenges, inconsistent and confused
leadership, delayed and contradictory decision-making, based on incomplete or
misunderstood information, disagreements on strategy between the Center and the
Provinces, as well as problems with access and distribution of aid and medical equipment
have been further exacerbating the problem. Incoherent statements and unclear messages
conflating lockdown and social distancing measures with economic death and untenably
catastrophic consequences resulted in a political point-scoring and prejudiced criticisms of
Provincial governments’ decisions by the Center, thereby damaging early containment
efforts, particularly by Sindh, and confusion amongst the masses.
In view of the developing situation around COVID-19, this paper advocates several
measures within the social, economic and institutional frameworks, in order to better
manage the current and looming crises over both short and long terms. Provincial
autonomy, the resource sharing formulas of the 18th Amendment, and equitable division
of responsibilities as well as opportunities, remain at the forefront of these strategies
and are the only way forward. The document also highlights opportunities at the
national and international levels for inclusiveness, soft diplomacy, regional connectivity
and exploring choices for economic relief in order to facilitate an improvement in the
current state of affairs.
2 ‘Population, Labour Force and Employment’, http://www.finance.gov.pk/survey/chapters_16/12_Population.pdf
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1. The Pandemic
The relationship between plagues, pandemics and the human race predate written historical
accounts, and evidence of the existence and impact of these phenomena can be traced back
as early as circa 3000 BC3. From the Black Death of the 1300s to the 16th century American
plague and the Spanish influenza of 1918 (which killed over 50 million people, 14-17 million
in the subcontinent alone) to more recent epidemics (which are region-based) like Ebola in
2013-2016, mass infections have long shaped and altered human discourse,
demography and history itself, in rarely controllable and generally permanent ways.
What is COVID-19?
The most recent pandemic and the subject of our scrutiny is COVID-19, (commonly referred
to as the ‘coronavirus’). It is a viral infection that belongs to the family of viruses known as
the coronaviruses, which can cause illnesses such as the common cold, severe acute
respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The current
mutation of the virus is known as the severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), and the disease it causes is called the coronavirus disease 2019 (COVID-19)4.
It first emerged in Wuhan, China in December 2019.
The incubation period for COVID-19 is between two to fourteen days since first exposure.
Symptoms and severity of impact vary, depending on numerous factors including age,
gender, underlying health conditions, etc; amongst recovered patients, there are similar
discrepancies between those who regain health completely and others who retain
significant/lifelong damage to vital organs. The disease an extremely high transmission rate,
and spreads through respiratory droplets released when someone with the virus coughs,
sneezes or talks, allowing the droplets to be inhaled or land in the mouth or nose of a person
nearby. It can also spread if a person touches a surface with the virus on it and then touches
their mouth, nose or eyes5.
The number of secondary infections generated from one infected individual is understood
to be between 2 and 2.5, which is higher than for influenza.6 Current understanding places
older age and people with underlying conditions at increased risk for severe infection. Initial
3 Jarus, Owen, ‘20 of the worst epidemics and pandemics in history’, https://www.livescience.com/worst-epidemics-and-pandemics-in-history.html 4 Coronavirus disease 2019 (COVID-19)https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963 5 Ibid 6 ‘WHO Q&A: Similarities and differences – COVID-19 and influenza’ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza?gclid=EAIaIQobChMIn5S5s62o6QIVk-F3Ch2BQgliEAAYASAAEgIk0vD_BwE#
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data indicates that children are less affected than adults, getting infected from adults rather
than vice versa (as in the case of influenza), and clinical attack rates in the 0-19 age group
are low. Data to date also suggests that 80% of infections are mild or asymptomatic, 15%
are severe infection, requiring oxygen and 5% are critical infections, requiring
ventilation. While the true mortality of COVID-19 will take some time to fully understand,
data thus far indicates that the crude mortality ratio (the number of reported deaths
divided by reported cases) is between 3-5%, but varies by region. However, mortality is
also, to a large extent, determined by access to and quality of health care7.
Information and Conspiracy
From the moment the epidemic was officially recognized by the World Health Organization
as a pandemic, COVID-19 has become the Center of a maelstrom of misinformation and
conspiracy theories. The latter issue relates to the origin of the virus – whether it was
natural or man-made – and the potential role of China in the creation and/or spread.
Scientific evidence regarding the genomic data8 of COVID-19 confirms, beyond a doubt, that
the virus is not man-made; claims to the contrary by governments (particularly the US)
attempting to incriminate China in this regard have since been retracted9.
On the other hand, the former aspect - misinformation or incomplete information - is
significantly more problematic, and not as easily dealt with. It is this element in particular
that can radically impact a State’s crisis response strategies, and ability to make timely
and informed decisions. The COVID-19 pandemic is the outbreak of a ‘new’ disease – from
the same family as SARS or MERS, but unique in its own characteristics. Consequently,
there is not nearly enough data or scientifically verified information regarding
transmission, symptoms, risks and long term impact, and not enough time has passed
for all data to have been thoroughly processed. And as a result, a series of myths have sprung
up around the disease. The WHO has a developed a webpage10 dedicated to countering some
of the most common and the most dangerous rumors around COVID-19.
7 ‘WHO Q&A: Similarities and differences – COVID-19 and influenza’, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza?gclid=EAIaIQobChMIn5S5s62o6QIVk-F3Ch2BQgliEAAYASAAEgIk0vD_BwE# 8 Dr. Francis Collins, ‘Genomic Study Points to Natural Origin of COVID-19’, https://directorsblog.nih.gov/2020/03/26/genomic-research-points-to-natural-origin-of-covid-19/ 9 ‘Pompeo Backtracks About Wuhan Lab: The Latest In The Controversial Coronavirus Origin Theory’, https://www.forbes.com/sites/jackbrewster/2020/05/06/pompeo-backtracks-about-wuhan-lab-the-latest-in-the-controversial-coronavirus-origin-theory/#3334ff9f2f72 10 ‘WHO - Coronavirus disease (COVID-19) advice for the public: Myth busters’ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
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Some of the most common amongst these misconceptions are as follows11:
Temperature or weather have an impact on infection rates: Being exposed to the
sun or to temperatures higher than 25°C degrees DOES NOT prevent infection; the
virus can be transmitted in areas with hot and humid climate, as well as in cold
weather and snow.
COVID-19 only affects the elderly: People of all ages are equally susceptible to
contracting the virus; the elderly and those with (known or unknown) underlying
conditions are more vulnerable towards the most severe symptoms of the virus.
Thermal scanners and handgun thermometers: These aids can only detect fever
once symptoms have already developed. Milder or different symptoms, or
undeveloped carriers cannot be identified with these.
Vaccines against pneumonia, etc, and/or antibiotics can protect against the new
coronavirus: Untrue. Data suggests vaccines for other respiratory diseases have no
impact on COVID-19, and antibiotics do not work against viral infections. Similarly,
there are currently no drugs licensed for the treatment or prevention of COVID-19.
Ingesting or spraying regular cleaning products, such as bleach or other
disinfectants, drinking methanol, ethanol or alcohol does not prevent or cure COVID-
19 and can be extremely dangerous.
Food supplements and immunity boosters: Adding pepper or garlic etc. to meals
does not prevent or cure COVID-19; neither does taking a hot bath.
Being able to hold your breath for 10 seconds or more without coughing or feeling
discomfort does not mean no infection.
5G mobile networks do not spread COVID-19.
Further problematic rumors circulating around the virus include the idea that the pandemic
virus has evolved into significantly different forms in different regions, which is why
there have been differences in symptoms, severity and mortality rates. There is no evidence
to suggest this is the case, and there cannot be enough evidence in this regard for many more
months. The same is also true for potential vaccines against the virus. As of now, neither
does such a vaccine exist, nor can it for at least another year.12 Furthermore, the WHO
has warned of the possibility that COVID-19 may become endemic (not ‘go away’)13.
11 ‘WHO - Coronavirus disease (COVID-19) advice for the public: Myth busters’ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters 12 YONG, Ed, ‘The Problem With Stories About Dangerous Coronavirus Mutations’, https://www.theatlantic.com/health/archive/2020/05/coronavirus-strains-transmissible/611239/ 13 Global report: WHO says Covid-19 'may never go away' and warns of mental health crisis, https://www.theguardian.com/world/2020/may/14/global-report-who-says-covid-19-may-never-go-and-warns-of-mental-health-crisis
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Impact
The COVID-19 pandemic has caused severe socio-economic disruptions across the planet,
and one of the largest predicted recessions in modern history. In an attempt to clamp
down on transmissions, governments have had to cancel or postpone most global events,
including meetings, conferences, sporting events like the Olympics, football, basketball etc,
as well as political, cultural, and religious activities all over the world. Pakistan is no
exception. Stock markets across the planet have plunged, supply chains have been disrupted,
airlines grounded as travel is restricted, the healthcare sector is in duress, and mass
unemployment is on the rise. The informal or cash-based sectors in developing countries
have come to a grinding halt as nations have gone into lockdowns, after prevention of rising
transmissions through the alternative strategy of ‘isolation, quarantine and contact tracing’
alone was no longer possible. Widespread supply shortages have been exacerbated by panic
buying, and reduced supply chains are creating economic difficulties for both small and large
big businesses alike.
Entry into Pakistan
By the 12th of February 2020, approximately two months from the first reported cases in
China, the global tally of total confirmed cases had risen to 45,171, and reported deaths
numbered 1,11514. Up to this point, however, no cases had been reported in Pakistan. To
prepare for a possible outbreak, a few SOPs had been laid out, and airports had started to
make arrangements for the screening of incoming passengers, with particular focus on
passengers from China, given the close economic ties and geographical proximity of the two
states. The methods at the time have been reported as ‘casual testing’ rather than serious
preventative measures.
The first two cases in Pakistan were reported on the 26th of February, among pilgrims
returning from Iran15, while the first death was reported on 18th March16. As of 18th May,
the tally of confirmed cases had risen to 42,125, with over 903 deaths17; Thursday, 7th May
being the deadliest yet with 48 fatalities recoded in one day.18 As the Federal Government
seeks to take measures to ease the lockdown, these figures are expected to rise exponentially
during the coming 20 days, particularly in light of loosening controls by the Center. Even as
14 WHO Situation Report 23, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports 15 ‘WHO warns Pakistan's COVID-19 cases can surge to 200,000 by mid July’, https://www.pakistantoday.com.pk/2020/02/26/sindh-health-two-coronavirus-cases-confirmed-in-pakistan-confirms-first-coronavirus-case-in-karachi/ 16 ‘WHO warns Pakistan's COVID-19 cases can surge to 200,000 by mid July’, https://www.geo.tv/latest/277989-one-patient-passes-away-in-mardan-kp-health-minister-jhagra 17 Live information, http://covid.gov.pk/ 18 ‘Pakistan's Covid-19 death toll doubles in last 10 days’, https://www.dawn.com/news/1555305/pakistans-covid-19-death-toll-doubles-in-last-10-days
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the figures currently stand, there is an immense possibility that the numbers may be a
fraction of the actual persons infected. This is due to factors such as In Pakistan for
example, “low willingness to come forward due to stigma or fear of being quarantined, not
enough testing, deliberate under-reporting by governments, efficacy and accuracy of tests
being conducted leading to false negatives and/or false-positives (Rare but certainly a
possibility”.19
The current toll stands as follows:
18th May 2020 Cases Deaths Recoveries
World 4,801,350 316,652 1,858,072
South Asia 167,172 4410 53,924
Pakistan 40,151 873 11,341
* Source: “World meter for Coronavirus”20
One study indicates that projected infectious cases could potentially reach 90% of the total
population of Pakistan by 24th June, 202021. The WHO has issued a similar warning to
Pakistan of a potential surge in cases to 200,000 by mid-July, should appropriate measures
not be taken immediately.22
The Federal and Provincial Governments responded to the situation by enacting various
controls and measures, under their respective constitutional capacities. Unfortunately, from
the get-go there was a vast fracture between the perspective of the Center and the
Provinces on the approach to be taken. This led to a difference in response strategies that
also became directly linked with the provinces’ ability to perform, while maintaining a
balance between the social and economic impact of any protective measures. These divisions
have only continued to strengthen, and have also rekindled debate on the 18th
Amendment, and its implications, on decision making processes in the country. In this
context, the quick response and effective measures taken by the Sindh government
19 ‘'It's the math, stupid': Why we may be reading the Covid-19 numbers all wrong’, https://www.dawn.com/news/1548809 20https://www.worldometers.info/coronavirus/?utm_campaign=homeAdUOA?Si 21 Syed & Sibghat Ullah “Estimation of the final size of the COVID-19 Epidemic in Pakistan”, March 2020 22‘ WHO warns Pakistan's COVID-19 cases can surge to 200,000 by mid July’, https://www.thenews.com.pk/latest/648722-who-warns-pakistans-covid-19-cases-can-surge-to-200000-by-mid-july
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were particularly lauded by monitoring bodies such as the WHO,23 even as discord with
the Center continued at home.
The principal cause for this additional strain and rupture between the Center and the
provinces was the refusal by the Federal government to acknowledge the urgency of
the situation and take emergency action immediately upon the documentation of the first
cases, rather than waiting for a crisis to develop before responding in a reactive manner. The
policy of ‘wait and see’ is perceived as highly risky in the context of a pandemic, and the
Sindh leadership had no desire to be playing catch up endlessly as Pakistan’s situation
jumped from the frying pan into the fire. As a report from London’s Imperial College put
it, the PPP understood that “rapid, decisive and collective action that can prevent the spread”
was the need of the hour.24 Consequently, in a paradoxical stance from the Center, Sindh
immediately began organizing resources, and raising public awareness in order to tackle the
crisis head on. The Federal government was eventually obliged to succumb to internal
and external pressures, and follow suit. Unfortunately the delays in closing borders and
effectuating quarantine measures for returning pilgrims had already led to a rise in cases
within the country by this point.
23 ‘WHO Praises CM Sindh and His Efforts On Containing Coronavirus’, https://abbtakk.tv/en/who-praises-cm-sindh-and-his-efforts-on-containing-coronavirus/ 24 Lodhi. M “Leading in a pandemic crisis” https://www.dawn.com/news/1548796
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2. Federal Government – Response & Analysis
The general contours of the Federal Government’s response to the COVID-19 pandemic
have been enacted with the intent of adhering to a few key features:
The prevention of mass hysteria;
A ‘watchful’ approach, based on appraising local developments before crucial
decision-making;
Over-contextualization of and hyper-sensitivity to the condition of Pakistan’s
economic reality; and,
Attempts to maintain balance during an extreme event. In short, ‘business as
usually, as far as we are able’.
Theoretically, all of the above have the semblance of a well-adjusted emergency
response – practically, they fall critically short, and may be described as naïve at best, or
callous at worst. A closer inspection of the narrative and course of action undertaken by
Center can best serve to demonstrate this seeming paradox.
Policy Timeline, Pre and Post COVID-19
Following the global emergence of the COVID-19 pandemic, amongst the foremost policy
initiatives undertaken by Pakistan was unconditional support for China during the crisis.
Key amongst the decisions taken was to not allow the 800 Pakistani students in Wuhan
to return home. The goals were two-fold; prevent the risk of importing the infection
with the return of the students, and perhaps more significantly, publicly signal
support for China during a moment of distress25. This was an appropriate policy
decision towards Pakistan’s longest standing ally and closest friend, recognized and
appreciated by the Chinese government and people.
Pakistan’s Special Assistant to the Prime Minister for Health, Dr Zafar Mirza,
erroneously declared on February 19, that the nation’s health care facilities were
adequately resourced to tackle any outbreak26.
Pakistan temporarily closed its borders with Iran on 23rd of February27 after the
COVID-19 death toll in the neighboring country rose suddenly, but within 14 days of this
25 Afzal, Madiha, ‘Pakistan teeters on the edge of potential disaster with the coronavirus’, brookings.edu/blog/order-from-chaos/2020/03/27/pakistan-teeters-on-the-edge-of-potential-disaster-with-the-coronavirus/ 26 Maqsood, N, ‘On the Coronavirus, Pakistan’s Government Is Missing in Action’, https://foreignpolicy.com/2020/05/11/on-coronavirus-pakistans-government-is-missing-in-action/ 27 Wintour, Patrick, ‘Turkey and Pakistan close borders with Iran over coronavirus deaths’, https://amp.theguardian.com/world/2020/feb/23/turkey-and-pakistan-close-borders-with-iran-over-coronavirus-deaths
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closure, the border was re-opened in the Taftan area, 28 for resumption of trade
activities, which remained a priority with the Federal government.
On 26 February, a returning pilgrim from Iran became the first confirmed coronavirus
patient in Karachi. He was quickly isolated and his contacts traced.
On March 1st, thermal scanners were installed at airports. Guidelines and SOPs were
put into place to manage potential imported cases, but implementation remained
sloppy. Proof on testing was requested from international arrivals only from 21st March,
when international flights were also suspended. Domestic flights were halted from
March 26th. 29
In March 2020, the Ministry of Health Services, Regulation and Coordination presented
a National Action Plan to fight COVID-19 (based on data up to 12th February – before
the first confirmed cases in Pakistan or any local data)30. During this time, most key
preparatory decisions - like closing borders with neighboring countries, especially
Iran - remained pending. A helpline and an online platform for support on COVID-19
related issues were launched.31
On March 13th, the government announced a number of aggressive steps, including
closing the country’s western border (with Iran and Afghanistan), shutting down all
public and private educational institutions, and canceling the Pakistan Day parade set
for March 23rd. A National Coordination Committee (NCC) was set up to deal with the
coronavirus on a federal level, and the National Disaster Management Authority was
tapped to implement the response32.
On March 22nd, PM Khan ruled out the possibility of a complete lockdown – on March
23rd, Pakistan’s Armed Forces were engaged to implement a nation-wide lockdown.
33
28 ‘Coronavirus: After 14 days, Pakistan opens Taftan border with Iran for trade’, https://www.thenews.com.pk/latest/625285-coronavirus-after-14-days-pakistan-opens-taftan-border-with-iran-for-trade 29 https://www.garda.com/crisis24/news-alerts/325761/pakistan-army-deploys-to-enforce-countrywide-lockdown-measures-over-covid-19-as-of-march-23-update-9 30 ‘National Action Plan for Corona virus disease(COVID-19) Pakistan’, https://app.adpc.net/sites/default/files/public/publications/attachments/National%20Actional%20Plan_compressed.pdf 31 ‘A timeline of the spread of coronavirus in Pakistan’, https://www.geo.tv/latest/276711-a-timeline-of-the-emergence-of-the-coronavirus-in-pakistan 32 Afzal, Madiha, ‘Pakistan teeters on the edge of potential disaster with the coronavirus’, brookings.edu/blog/order-from-chaos/2020/03/27/pakistan-teeters-on-the-edge-of-potential-disaster-with-the-coronavirus/ 33 ‘Pakistan’s Imran Khan sidelined by military during coronavirus outbreak’, https://www.ft.com/content/686714d7-ae05-431d-a13d-1966153be151
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Around the same time, on 27th March the formation of a Corona Relief Tiger Force
was announced; this was intended to be a voluntary force comprised of young people
believed by the Government to be at low/no risk from the virus to carry out five core
responsibilities including ration distribution, implementation of the 20-point guidelines
introduced by the government for prayers during Ramazan, generating awareness
against coronavirus, and observing the implementation of social distancing and market
timings34.
The Federal Government also launched the Ehsaas Emergency Cash Program (the
reapportioned Benazir Income Support Program) under the umbrella of Ehsaas Amdan
(Income) Program on 1st April 2020. The purpose was to provide relief to the hardest
hit lowest income strata by providing temporary financial relief35. A registration portal
was set-up until 19th April, but the greater part of distribution lists were the existing
beneficiaries from BISP.
In the first week of April, the Federal government announced projected economic
losses worth PKR 2.5 trillion in three months due to the pandemic, and estimated
that 12.3 million to 18.5 million people would become unemployed36. The Ministry of
Planning assessed losses at PKR 1.2 trillion in limited lockdown scenario, PKR 1.96
trillion in moderate and PKR 2.5 trillion in case of complete restrictions on movement,
in a curfew-like situation. The initial official estimates are higher than the first
independent assessment by two former high level government functionaries, Dr Hafiz
Pasha and Shahid Kardar, who put the losses in the range of PKR 891 billion to PKR 1.6
trillion.
On April 3rd, the Federal Government elevated the status of the construction sector to
that of an industry, while announcing incentives for investors and businessmen, in an
effort to mitigate the economic impact of the coronavirus outbreak. These included
immense tax breaks, no background checks/income verification, PKR 30 billion subsidy
for the Naya Pakistan Housing Scheme, and elevation of sector to industry, amongst
others 37.
34 ‘Where are the Tigers?’, https://www.thenews.com.pk/tns/detail/659126-where-are-the-tigers 35 ‘Ehsaas Emergency Cash’, https://www.pass.gov.pk/Detailf90ce1f7-083a-4d85-b3e8-60f75ba0d788 36 Rana, S, ‘Coronavirus forecast to render 18.5m jobless in Pakistan’, https://tribune.com.pk/story/2189904/2-coronavirus-forecast-render-18-5m-jobless/ 37 ‘PM Imran announces incentives for construction sector, elevates it to industry’, https://www.dawn.com/news/1546154
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Other initiatives at this time included allowing local production of chloroquine, clinical
trials of plasma therapy and the locally manufactured ventilators for the treatment of
pandemic38.
Ministry of National Health Services, Regulation and Coordination and the NIH
deliberated on strategies to scale up COVID-19 laboratory testing. NDMA provided
the provinces of Sindh, Punjab and Baluchistan with 20,000, 5,000 and 4,800 testing kits
respectively while up to 37,000 kits were put in to reserve. A relief package proposed
by Economic Coordination Committee (ECC) was also approved by the Federal cabinet.
On 15thApril, Federal government announced the extension of the prevailing
lockdown for two weeks with a few essential industries being allowed to reopen. PM
stressed on the need to seek assistance from religious scholars and clerics during
Ramadan to control the spread of COVID-19. The Federal Government went on to
approve a 20-point plan regarding the re-opening of mosques for prayers, with
precautionary measures in Ramadan. The decision, despite the Saudi grand Mufti’s
fatwa to keep mosques closed during the pandemic, was greeted with criticism by
opposition parties.
On 25th April, the nation-wide lockdown was extended for another two weeks.
International flight ban was extended through April 30th, while domestic flights were to
remain grounded until May 1339.
30 chartered flights announced to repatriate over a 100,000 citizens from 88 countries
between May 2 and May 10.40 Many more remain stranded, and schedules remain
uncertain, marked by delays and cancellations. Additional flights have since been
planned but scheduling remains haphazard.
On May 1st, PM Imran Khan announced a further easing of the lockdown, as ‘intensity
of the coronavirus in Pakistan was much lower than that in Europe and the United
States.’41 On the same day, the Health Ministry predicted a surge in cases by May 30th. 42
38 ‘DRAP allows local production of anti-malarial drug’, https://nation.com.pk/10-Apr-2020/drap-allows-local-production-of-anti-malarial-drug 39 https://www.garda.com/crisis24/news-alerts/341036/pakistan-authorities-extend-suspension-of-domestic-flights-until-may-13-update-22 40 ‘Pakistan to bring back over 100,000 stranded citizens’, https://www.aa.com.tr/en/asia-pacific/pakistan-to-bring-back-over-100-000-stranded-citizens/1826742 41 ‘Lockdown to be further eased, says PM Imran’, https://www.dawn.com/news/1553653/lockdown-to-be-further-eased-says-pm-imran 42 ‘Govt predicts surge in cases by May 30’, https://www.dawn.com/news/1553649/govt-predicts-surge-in-cases-by-may-30
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Corona Relief Fund, under the Ehsaas (BISP) Program, was launched on May 3rd for
those who lost jobs during the pandemic.43 Applications only to be accepted through the
web portal set up for registration, which is not the easiest or most accessible form of
registration for the target demographic of this scheme.
On May 8th, a phased lifting of the lockdown was announced, as health experts called
for extensive community level testing.44
Lockdown officially lifted on May 11th as the number of cases surged. PM called
lockdown a temporary solution; distrust and conflict between the Center and Provinces
continues as people ignore SOPs on first day of lifting of lockdown; 1,312 new virus
cases, 30 deaths reported in 24 hours. 45
Analysis
Perhaps the most significant characteristic that emerges from this data above is the
coherence (or lack thereof) in the series of policy decisions taken by the Federal Government
in preparation and response to the COVID-19 crisis in Pakistan. The four features of the
Center’s response may effectively be held responsible for the Federal Government’s
continuing clashes with the provinces and divided decision making that continues to be
reactive, particularly in the face of easing lockdown restrictions without clarity over a way
forward, even as the number of cases in the country continue to surge. The following brief
analysis of some of these key decisions considers the implications of the atmosphere of
uncertainty, and the inexperience in crisis management of the current government, that is
becoming increasingly visible with every new decision.
Parameters
In order to judge the effectiveness of the response strategies of any state, a set of parameters
must be established for the analysis. Foremost amongst these is the question:
Is data driving policy or policy driving data?
In the case of countries that have been successful in largely suppressing the spread of COVID-
19 within their countries, and keeping fatality rates low, like New Zealand and Australia46,
Norway, Denmark, Greece, South Korea and Vietnam etc, the common denominators despite
43 ‘PM launches relief scheme for those who lost jobs’, http://www.dawn.com/news/1554139/pm-launches-relief-scheme-for-those-who-lost-jobs 44 ‘Health experts urge massive testing for virus in Pakistan’, https://www.dawn.com/news/1555438/health-experts-urge-massive-testing-for-virus-in-pakistan 45 ‘Lockdown a temporary solution to Covid-19 crisis: PM’, https://www.dawn.com/news/1556479/lockdown-a-temporary-solution-to-covid-19-crisis-pm 46https://www.theguardian.com/world/2020/apr/09/have-australia-new-zealand-stopped-covid-19-in-its-tracks-coronavirus, cited April 29, 2020
17
the differences in sizes of population, economies, location, healthcare facilities, etc, appear
to be a data-based, proactive, pre-emptive and decisive approach, in combination with
a coherent long-term strategy for both flattening the curve and post-lockdown
economic recovery. As Mr Husain puts it,
‘One, their leaders were swift in recognizing the threat. Two, they understood
very quickly that the only way to slow the spread of the virus was to lock
down without delay and start aggressive testing. Three, they understood
lockdown would not make the virus go away but would allow them time to
beef up their medical defences and provide space for other measures. Four,
they figured out that lockdown could not be sustained for long so they had to
achieve the most out of the limited time for lockdowns they had. So they
ensured a complete and strict lockdown, extracted the most out of this time,
suppressed the spread of the infection, and opened the lockdown. Their
strategy was clear, efficient, strict, tangible and comprehensive. They got the
job done.47’
In the case of Pakistan, it is becoming increasingly clear that data-driven policy is not the
chosen path of the Federal government in the fight against this pandemic. Even the loosest
application of these parameters to the responses of the Federal Government in the face of
the COVID-19 crisis indicates massive shortcomings.
A brief exploration of this conclusion follows below.
Faulty Narrative Building
The prevention of mass hysteria is a laudable goal, but one that cannot be achieved by
downplaying the severity of a problem, or promoting messages of calm based on
unsubstantiated rumors and incomplete facts. Premier Khan’s statements from the early
days of the crisis unfortunately seem to promote both; on more than one occasion has he
gone on record to state half-truths and assumptions ranging from the inability of the virus
to survive high temperatures to the immunity of youth from the pandemic.
Consequently, one of the most predictable problems with the Federal Government’s
response to the COVID-19 crisis lies in the narrative that it has developed, upon which its
policies are based.
Premier Khan’s slogan of ‘Ghabarana nahi hai’ (‘We Mustn’t Worry’) may have been well
intentioned, but in a country like Pakistan, where the greater part of the population is
desensitized to crises as a result of over-exposure to them during two decades of the War on
Terror, and consequently unlikely to fully grasp the gravity of the situation beyond the most
47 Fahd Husain, ‘Vaccine for Success’, https://www.dawn.com/news/1557470/vaccine-for-success
18
immediate, short term economic impact on their own lives, it has become nothing short of a
ticket to blatantly disregard the warnings and awareness campaign efforts by provincial
governments. The results speak for themselves; in less than a day of easing lockdown
restrictions, blatant disregard for SOPs and overcrowding in marketplaces is forcing various
authorities to threaten a re-imposition of the lockdown. In AJK, this has already taken place.
Furthermore, this flawed narrative is now being picked up within other institutions as well;
the justification for the Supreme Court’s decision of reopening malls and restaurants appears
to parrot the Center’s misinformed stance that Pakistan “is not … seriously affected” by
Covid-19.48 It is also visible in some of recommendations by the National Command and
Operation Center (NCOC) on the subject.49 Benign manipulation is transforming into
actively injurious policy.
Another problematic part of the narrative built by Center is the false equivalency between
a lockdown and debilitating curfews. Premier Khan appears to have been pandering to his
populist support base when pushing the message that provincial lockdowns are mistakes
that are tantamount to a death sentence for the most vulnerable. In attempting to put
forward the idea of an ‘incomplete’ lockdown, where daily wage laborers obtain work in
the selection of industries opened by Federal Government, he is putting the most vulnerable
at the greatest risk, without catering to concurrent facts; for example, the poorest in the
country also have the greatest number of undetected underlying conditions (as a result of little
to no access to affordable healthcare), and consequently are at the greatest risk of contracting
the severest forms of the infection; they live in close knit communities and risk spreading the
disease exponentially; and, the sickness/death of primary wage earners is likely to put greater
strain on these families long-term, than a well-planned lockdown directed towards flattening
the curve. There IS no tradeoff between livelihoods and the pandemic, because the
latter would shatter livelihoods much more than a shutdown. Framing a pandemic as a
‘choice between death by starvation or death by infection’ is self-serving and irresponsible
in the short run, and irreversible health disaster in the long term. 50
Similarly, not acknowledging the extent to which younger, non-vulnerable populations may
require hospitalization and thus impose a burden on the health system, or even become
vectors for further infections through programs like the Corona Relief Tigers in another
example of the misunderstanding of basic information.
Perpetual incomplete comparisons with other countries’ transmission scales and response
strategies, as well as using false equivalencies as demonstrative evidence for building
48 Supreme Court Judgment - SUO MOTO ACTION REGARDING COMBATING THE PANDEMIC OF CORONA VIRUS (COVID -19), https://www.supremecourt.gov.pk/downloads_judgements/s.m.c._01_2020_18052020.pdf 49 ‘NCOC proposes recommendations to ease countrywide lockdown’, https://www.globalvillagespace.com/ncoc-proposes-recommendations-to-ease-countrywide-lockdown/ 50 Brad Adams, ‘Pakistan Reopens Malls Claiming No Covid-19 Crisis’, https://www.hrw.org/news/2020/05/19/pakistan-reopens-malls-claiming-no-covid-19-crisis
19
policy narratives is another feature of the faulty response by the Center. Sweden for
example, may not be following lockdown and social distancing measures, but they are also
not testing widely, and have a significantly higher proportion of COVID-19 cases and
fatalities per capita than any of their neighboring states. Similarly, Greece was faced
with many economic and social problems similar to Pakistan’s, and has produced immense
results with preemptive, decisive decision-making, that has both restored faith in the
State institutions, and allowed Greece to reopen its economy in control of the problem.
This series of mismanagements and misunderstandings by the Federal Government poses
governance-related risks as well. The gap left by the Center is once more being filled by the
Armed Forces – as indicated by the lockdown fiasco.
Decision-making
With incorrect premises, it is no surprise that many of the decisions made by Center were
also problematic at best. However, the greatest challenge has not been misinformation, but
hesitation, uncertainty, delays and inconsistency. Delays in closing borders, reopening
without preparation, delays in strategic planning and implementing the lockdown, followed
by uncertainty of the purpose of the lockdown has led to immense conflict between the
Federal Government and the Provinces. In not understanding the purpose of flattening the
curve, the decisions of the Center may inadvertently be fueling an unseen spread of the
disease.
Viewing a halt in goods transport system, the Center decided to keep highways and roads
open, and increase the number of freight movement to avert shortage of food and other
essential supplies. This in itself is not problematic. However, failure to introduce strict
protocols to be followed in the transfer of goods and the travel of people to contain the
spread of COVID-19 from one district to another was problematic. Wanting to bring religious
scholars and community on board to devise counter strategies is a good idea; giving in to
pressure from extreme religious outfits to keep mosques open during Ramadan (despite
flagrant disregard of SOPs in many locations), was not. Attempting to conduct business as
usual, with minimum disruption, (as has been the case in some of the countries impacted the
most by the pandemic – the US, the UK, Italy, etc), when a war-footing response has proven
to be more effective world-wide (Greece, New Zealand) and led to the fastest reopening of
economies with minimum continued threat is another example. Not taking into account
non-traditional vectors of transmission, the government is now faced with the spread
of COVID-19 in densely populated areas; the first cases have also been confirmed in
jails.
The Federal government, in a pledge to generate employment, has offered a special package
to construction industry. The decision had two major flaws: according to the studies of
vulnerability conducted at Pakistan Institute for Development Economics (PIDE), among the
20
various sectors like agriculture, manufacturing and transport etc, construction has the
lowest sectoral vulnerability, which stands at 5.5% across the provinces, compared to the
agriculture and manufacturing sectors, which are close to 95% and 40% respectively51.
Furthermore, the benefits from the initiative are likely to extend only to builders,
property dealers, speculators and property holders, those evading taxes and reaping
high profits, or seeking to transform illegal incomes into real estate assets. For low
income, and even middle class households, it will likely only push the rents and prices of
houses further out of reach.
Another and perhaps the gravest problem with the Federal Government’s decisions in
response to the COVID-29 crisis is an almost malignant refusal to allow an accurate picture
of the scale and depth of impact to emerge. In recent criticism in Human Rights Watch, it is
highlighted that “by understating the threat of the pandemic, the Pakistani government is
denying those returning to work the information they need to protect themselves from Covid-
19. It has also failed to ensure protection for healthcare workers, and has arrested and
intimidated medical workers who have raised concerns about the lack of protective equipment
and the looming health crisis.”52
Politicization of a Health Crisis
The process of unnecessarily politicizing a global health crisis began as early as the policy
interventions related to China. The discussions around the repatriation of Pakistani students
from Wuhan were unduly utilized as a smokescreen by the Federal government to delay key
decisions and preparations at home. Consequently, serious debate on the COVID-19 issue
was not initiated in the country’s Senate, National Assembly and Provincial Assemblies until
as late as mid-February, delaying the possibility of all further advanced preparation for the
outbreak.
Political mileage was also sought by interfering in the established Benazir Income
Support Program (BISP) and bringing it under the umbrella of the Ehsaas Program, not
only diverting resources from one into the other, but simultaneously making it dangerous
and cumbersome for the beneficiaries of BISP to receive support by making it mandatory to
receive them in person. The program clearly violated social distancing and health and
safety requirements during the distribution of funds process, for people who would
otherwise get the amount through an ATM or from NADRA offices. Similarly, the formulation
of a Tiger Force, when similar, legitimate elected Union Councils and administrative body
51https://pide.org.pk/index.php?option=com_content&view=article&id=695 cited 30th April, 2020. 52 Brad Adams, ‘Pakistan Reopens Malls Claiming No Covid-19 Crisis’, https://www.hrw.org/news/2020/05/19/pakistan-reopens-malls-claiming-no-covid-19-crisis
21
structures53 already exist serves no purpose other than wasting time (the Tiger Force is yet
to be made effective – two months after its formation) and scoring political points.
In the same context, blaming the 18th Amendment formula for the Center’s low performance
during a health crisis is unnecessary and in bad taste. The Federal government, despite its
own irregular narrative and continued criticism of the decisions of Provincial governments,
did “allow” the provinces to take measures as they saw fit, exercising their constitutional
freedom. As a consequence however, the Federal government has claimed to have contacted
several political parties for key changes in the NFC award and 18th Amendment itself.54 This
interference is taking undue advantage of a crisis to gain political advantages which is both
highly unethical and detrimental to national harmony. Any move to further this debate
would jeopardize an already fragile working partnership with the Center, and emphasis must
instead be placed on the timely and effective devolution of resources, so that provinces may
be able to tackle the pandemic in a more effective manner. Criticisms of the clarity and
decisiveness of provincial governments is counter-productive and anti-democratic.
Similarly, it is interesting to note the timing of the Diamer-Bhasha Dam execution contract
award, at a time when the popularity of the Federal Government and faith in its decisions
appears to be waning, and the COVID-19 crisis is at its peak, and provinces distracted with
containment and mitigation efforts.
53 Arif Hasan, ‘Union Councils’, https://www.dawn.com/news/1550444/union-councils 54https://www.thenews.com.pk/print/650201-change-in-nfc-award-18th-amend-on-the-cards
https://www.bloomberg.com/news/articles/2020-04-22/central-banker-says-ready-to-do-more-to-shield-pakistan-economy
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3. Interim Provincial Policy Initiatives & Interventions
With the emergence of the first cases not long after the first discussions on the subject in
Parliament and Senate, the Federal and Provincial governments ought to have been in a
race against time to prepare for a looming healthcare crisis and organize national and
medical resources in the most effective manner possible, by enhancing cooperation across
institutions and provinces. This was particularly important in light of the manner in
which the crisis was crippling some of the most developed countries on the planet, and
the fact that Pakistan has often been chastised internationally for having a reactive
approach to healthcare crises, and generally low emergency preparedness. Decisions
were taken at all levels, however coordination and agreement on policy direction became a
pipedream when the Federal Government opted to play the situation by ear, and take
decisions as the situation developed.
Measures were then adopted by both the Federal and Provincial governments to contain the
spread of disease and enhance medical facilitation for positive cases, but with varying
degrees of seriousness, as demonstrated in the table below.
Date Location Policy/Initiative
1st March Sindh Decision to close all schools and universities till 30
May
21st March Gilgit-Baltistan Chief Minister announces indefinite lockdown from
22 March
23rd March Sindh/Baluchistan Chief Minister announces a 14 day complete
lockdown, from 24 March to 7 April
24th March Azad Jammu & Kashmir Chief Minister announces a 20 day lockdown until 13
April
24th March Punjab Chief Minister announces a 13 day lockdown until 6
April
As indicated by the timeline, the swiftest response to the entry of COVID-19 into Pakistan
was by the Sindh government. Prompt and clear decision making prevented the
escalation of the crisis, particularly in Karachi, which, if the situation had been left
unchecked, had the potential to turn into a national health landmine. Gradually, lockdowns
were enforced in different parts of the country, with varying degrees of decision and resolve.
With the speedy spread of the virus during the month of March, the Federal and remaining
Provincial governments were necessitated to take rigorous measures for early detection of
potential cases and control measures to prevent further transmission. The lockdown itself
23
however, remains a means to end; it cannot be implemented unendingly – the goal around
the world has been to flatten the transmission curve in order to give the State time to breathe,
and free up resources to prepare strategies for moving forward. In this context, it is useful to
look at what has been achieved thus far, and how various stakeholders foresee the future of
anti-COVID strategies.
Following is a brief overview and analysis of the various response strategies adopted by the
Provincial Governments respectively. The subsequent segment will take a closer look at the
measures undertaken by the Federal government, and their strength/performance.
a) Government of Sindh
The Government of Sindh was the first to heed the gravity of the COVID-19 pandemic and
spring into action. The preparatory and response measures undertaken demonstrated the
single minded determination of the Province’s leadership, as well as the clarity of the vision
it had picked as its fighting stance towards the crisis. Such clarity engendered rapid and
coherent decisions and messages that have resulted in the effective management of one of
the most severe health crises in modern history. The simple circumstance of having
contained transmission in Karachi, the most populous city in the country and the beating
heart of Pakistan’s economy, speaks volumes for the efficacy of the Province’s response.
Stepping up has also allowed the Sindh government to take the lead in demonstrating
possible mechanisms for resistance to the other provinces.
International guidelines and recommendations were followed: preventive measures like
social distancing, monitoring and self-isolation for people possibly exposed to the virus
were put in place. Travel restrictions were implemented quickly, followed
by quarantines, stay-at-home orders, workplace hazard controls, and facility closures, as
the situation demanded. The Provincial administration also worked rapidly to
increase testing capacity and tracing for infected individuals.
Furthermore, upon the report of patient one, (26th February, 2020), the government or-
dered closure of schools and educational institutions for three days to evaluate the
situation. This was followed by the extension of school holidays for an extra two weeks,
and the advancement of summer vacations. At the time, the decisions were met with
criticism for haste, but eventually the rest of the country followed suit. When transmission
cases increased, the second order of business was the closure of public gathering spaces
such as restaurants and parks. As the debate on the necessity of a complete lockdown was
held across the country, Sindh’s provincial leadership once more became the first to
enforce it and ban all non-essential activities by 21st March 2020. It also restricted
movement and allowed necessary activity only between 8AM to 5PM, directing all the
grocery stores to be closed by 5PM.
24
Even as health and safety was prioritized, the province remained cognizant the economic
and social difficulties that would impact the population in light of these measures, and took
immediate steps to provide relief to the people, exercising all its power to support the
public at large. In March55, the Sindh government announced the provision of two million
ration bags for the needy during lockdown. A mobile application was also launched,
through which welfare organizations could register to support the government in the
distribution of ration among daily wage workers at their doorsteps. Furthermore, a
circular was issued by Sindh government, directing private schools, factories and other
private entities operating in the province to disburse salaries to their employees by 31st
March.
Simultaneously, the government introduced and ramped up its public awareness drive, to
inform and prepare the masses against contracting the disease. A mass quarantine facility
was prepared on 19thMarch for 10,000 people. Screening and isolation facilities and other
medical measures to contain COVID-19 were initiated much earlier.
Fearing an increase in COVID-19 cases, Sindh government also ordered the setting up of
field hospitals in every district of the province, and issued statements regarding
transparency in the use of the Corona Relief Fund, over the concerns highlighted by the
Supreme Court. A number of FIRs were registered pertaining to hoarding and profiteering
from safety masks, gloves and hand sanitizers, public gatherings, opening shops and
restaurants and travelling in passenger buses. Pilgrims from Iran, quarantined in Sukkur,
were also kept under observation for prescribed period of time before and after their
return home. By mid-April, Sindh government decided to keep the 11 union councils with
COVID-19 sealed until the incubation period came to an end.
Following "no response” from the Federal government regarding the province’s request to
import necessary medical equipment from China and the UK, Sindh government obtained
a consignment of 50,000 testing kits, imported to increase the testing capacity of COVID-
19. In the first week of April, the province also set up a bio-safety level-3 (BSL-3) clinical
laboratory in Karachi; rapid testing machines were procured from Canada and a drive
through testing facility was setup in Clifton
The province also remarkably increased its testing capacity, as illustrated in the Fig. 1
below:
55https://tribune.com.pk/story/2181138/1-sindh-govt-mulls-total-lockdown-Provincial-covid-19-tally-crosses-350/ Reference copied on 21st April, 2020
25
Figure 1: Testing capacity during the last week of April, 2020.
A contradictory narrative from the Center caused multiple violations of the lockdown in
the province, due to which the Provincial government was forced to take action. The local
police detained a total of 472 persons, with 222 of them in Karachi alone. Doctors stepped
forward to support the Provincial government in its resolve to protect people’s lives and
held press briefings to inform the public on importance of self-isolation, social distancing
and lockdowns.
Early intervention against the COVID-19 by the Sindh Government was lauded by the
World Health Organization56. Due to this lockdown a visible dip was seen in the number of
new COVID-19 infections57.
b) Gilgit-Baltistan
The first case in Gilgit-Baltistan was confirmed on 2nd March, when a 45-year-old woman
from the northern mountainous region of Gilgit-Baltistan, who arrived from Iran a few days
previously was tested positive58. On 13th March, the region declared a medical emergency,
56 https://nation.com.pk/23-Mar-2020/sindh-lockdown-a-chaotic-policy 57 https://nayadaur.tv/2020/03/number-of-coronavirus-cases-in-sindh-lowered-after-lockdown/ 58 ‘Coronavirus: Pakistan confirms fifth case after Gilgit-Baltistan woman tests positive’, https://www.geo.tv/latest/275241-pakistan-confirms-fifth-case-of-coronavirus
23
6 47
0
37
0
40
9
51
3
31
6
51 66 10
4
21 11
3
13
2
16
4
11
1
12
5
11
7
13
2
14
4
54
0
39
6
29
8 49
4
45
8 73
0
11
46
82
1 95
9
84
8
81
2
90
3
20
89
17
55
15
00 17
95
23
90
22
9525
54
25
99 3
03
5
27
33
41
12
37
29
0
500
1000
1500
2000
2500
3000
3500
4000
4500
24-Apr 25-Apr 26-Apr 27-Apr 28-Apr 29-Apr
Balochistan AJK Gilgit Baltistan Islamabad KP Punjab Sindh
26
and educational institutions were shut down until 31st March.59 On 22nd March, the first
fatality was recorded – a doctor at the DHQ Hospital60. Consequently, the government
decided to go into lockdown indefinitely.61
During the last week of March, the local government initiated testing for all those coming
from the Taftan border. Medical support was extended to the local government by China
(rather than the Federal Government), which included five ventilators, 2,000 N95 masks,
200,000 face masks, 2,000 testing kits and medical protective kits.62 A steady rise in
positive cases has been recorded in Gilgit-Baltistan ever since. Not being an official
province or a self-administered unit, Gilgit-Baltistan is mainly dependent on the decisions
and support of the Federal Government, particularly in the context of COVID–19 crisis,
which remains deficient. As of May 11th, the total number of cases in the region stands at
442.
For non-compliance with decisions regarding lockdown, Gilgit-Baltistan Minister for
Works, Dr. Mohammad Iqbal, announced his resignation, citing the deprivation of Gilgit-
Baltistan from constitutional recognition as the reason behind this sort of humiliation of
the GB people.
c) Khyber Pakhtunkhwa
The first confirmed case of COVID-19 surfaced in Khyber Pakhtunkhwa on 13th March63.
All educational institutions were also closed at this time until 31st March, and all public
events and festivals postponed indefinitely. By end of March the province had deputed
screening teams at all district entry and exit points.
Around this time, the Provincial government also approved a stimulus package of PKR 32
Billion, of which PKR 11.4 billion were aimed at providing relief to 1.9 million families
affected by the lockdown. Exemptions to the business community from taxes, worth PKR 5
billion, were also offered as part of the package. In mid-April, the KPK government
allocated a further PKR 13 billion for the assistance of daily wage workers.
59‘ Medical emergency declared in Gilgit Baltistan to contain coronavirus spread’, https://arynews.tv/en/medical-emergency-gilgit-baltistan-coronavirus-outbreak/ 60 ‘Pakistan's fifth Coronavirus death confirmed in Gilgit Baltistan’,https://nation.com.pk/22-Mar-2020/pakistan-s-fifth-coronavirus-death-confirmed-in-gilgit-baltistan 61 ‘GB Govt decides to observe lockdown for indefinite period’, http://www.radio.gov.pk/22-03-2020/gb-govt-decides-to-observe-lockdown-for-indefinite-period 62 ‘G-B receives medical aid from China to fight spread of coronavirus’, https://tribune.com.pk/story/2185641/1-g-b-receives-medical-aid-china-fight-spread-coronavirus/ 63 ‘24 out of 27 suspected coronavirus cases cleared in KPK’, https://nation.com.pk/13-Mar-2020/24-out-of-27-suspcted-coronavirus-cases-cleared-in-kpk
27
The Provincial government recruited 1,300 new doctors across Khyber Pakhtunkhwa to
help stem the spread of COVID-19, while recruitment of another 635 doctors to join
province's health force was approved. The province also claimed to have remarkably
increased its testing capacity by mid-April, while also reporting a surge in confirmed cases.
The number of diagnostic kits was also enhanced by 500, thereby increasing the province’s
testing capacity significantly. PDMA also provided 50,000 N95 masks, 8,000 surgical kits
and caps, 5,000 protective kits and 750 liters of sanitizers to the health departments of KP.
The immense increase in the number of cases, and the sharp surge in fatalities, was
associated with the international passengers quarantined in the province.
By and large, the response of the provincial government has been prompt; limitations if the
efficacy of some of the measures are tied to other factors. Towards the end of April the
Provincial government made it mandatory to wear masks in the public places. This,
however, was a much delayed decision. With the doctors and paramedics falling victim to
the virus, concerns in the province are being raised at the insufficiency of the measures in
place to contain the virus. The tally in the province has now reached over 4669 cases, with
highest number of deaths (245) across the country.
d) Punjab
Punjab confirmed its first case of COVID-19 on 9 March. Transmission rates in the province,
however, increased rapidly in the following weeks, bringing the tally to more than 11,000
in a very short space of time- the highest amongst the provinces. Initially quarantines were
enforced in the southern parts of Punjab, thus putting the lower Punjab districts and their
health facilities at forefront of the fight. This caused an immense surge in transmissions in
the districts of Multan and DG Khan, over-stressing the fragile health systems of these
districts, and adding to the burden on their weak economic resources. Consequently,
Punjab recruited 10,000 doctors/paramedics to fight the pandemic and enhanced the
capacity of provincial laboratories to test 3200 people each day. Punjab also decided to
give one month salary in honorarium to the Medical staff all over the province.
Prioritizing economic assistance, the Provincial government announced a relief package of
PKR 10 billion, for the financial support of 2.5 million families of daily wage workers.
Punjab parliamentary body proposed zero deduction in wheat buying to save the small
cultivators from any worry during COVID-19 crisis. The Punjab Provincial Development
Working Party approved ‘Punjab Rozgar Scheme’ with an estimated cost of PKR 9500
million allocating it to Punjab Small Industry Cooperation to chalk out employment
opportunities for youth.
Due to rapid increase in cases, an 80-bed field hospital was built in Taxila by District
administration Attock, in record time of two weeks to isolate and treat confirmed patients
28
in a safe & secure environment. A 120 bed quarantine facility was also established by
district administration at Shahbaz Sharif Sports Complex, Rawalpindi. The Chief Minister
of Punjab called upon CM Sindh to appreciate the provision of masks by Sindh Government
to Punjab on the 13thof April.
Punjab has recorded the highest number of COVID-19 patients in a day, numbering 518 on
21st April, 2020. With the increase in patients, the province fell short of ventilators, as a
number of them were found to be out of order in various hospitals of province.
Furthermore, on 16thApril, Pakistan Medical Association objected the handling of COVID-
19 by district administration in a quarantine center in Faisalabad Punjab. The association
warned that due to shortage of PPEs, handling of corona is becoming difficult for the
medical staffs in province Punjab, day by day. Since then, there have been patient protests
over quarantine facility conditions and hungry strikes by doctors over PPE shortages.
e) Baluchistan
The Baluchistan Government constituted a 14-member technical committee at the end of
January to tackle the outbreak. Provincial government of Baluchistan released PKR 500
million for the up-gradation, rehabilitation and establishment of quarantine centers in
Quetta and important districts bordering Iran.
A state of emergency was imposed in five districts which bordered Iran on 24th March
2020. On the same day, the Baluchistan government imposed a complete lockdown in the
entire province until 7th April. This was followed by an extension of the lockdown for
another two weeks in April. It included a complete ban on public getting out of their homes,
all kinds of social and religious gatherings or any public or private event. All public and
private offices were ordered closed. Exemptions included essential services
All schools were closed at the end of February till 31stMarch 2020. Baluchistan Minister,
Sardar Yar Mohammad Rind stated that "action will be taken against schools that do not
comply with the decision". Matriculation exams were also postponed.
Fumigation was carried out across the entire central jail of Quetta on 30thMarch, while
spray pumps and disinfectants were distributed to 10 districts of the province. On 31st
March, the Provincial government released further PKR 500 million for upgrading,
rehabilitation & establishment of quarantine centers in the areas
of Quetta, Chaman, Taftan and other areas of Baluchistan
In the first week of April, it was decided to arrange for training to the staff of Private
Hospitals on guidelines of COVID-19 and Infection Prevention and Control. During the
same time, outpatient departments of all hospitals were closed in the wake of COVID-19
29
outbreak and lockdown. Provincial Finance Minister, Zahoor Buledi announced on 8th
April, that a tax relief of PKR 1.5 billion would be given during the lockdown.
The province of Baluchistan initially supported the border forces, established quarantines
and maintained essential medical supplies, trying everything in its power to contain the
spread of the virus, without the support of the Federal government. However, the lack of
necessary arrangements and absence of clear instructions along with a great number of
pilgrims coming from Iran exposed the insufficiency of the arrangements. People broke
free from quarantines and headed to their home towns, causing the spread of COVID-19
into other parts of the country.
30
4. Continuing Challenges
Moving forward as the lockdown eases, the number of challenges facing both Federal and
Provincial leadership remains multi-fold. There is no one set of strategies applicable or
effective in all circumstances; consequently, it is a given that planning and decision-making
will have to cater to a particular level of uncertainty. What does remain certain, however,
is that no matter which path is chosen, it must be based on facts and data, demonstrate a
clear vision, and be followed decisively in order to produce any sort of sustainable results,
whether within the economic realm or the health sector. The challenges facing Pakistan
may differ from those in developed countries generally, but attention must also be paid to
the similarities in order to not repeat mistakes, and even learn from the success stories.
Lessons learnt can transform way forward far more effectively than incoherent and
reactive strategy.
In the case of Pakistan, the following sectors may require the greatest attention:
Strong Leadership
The foremost challenge for Pakistan in a crisis such as this remains the question mark
above the quality of its central leadership. Inexperience, indecisiveness, delays, and a
lack of coordination with the Provinces has thus far been the hallmark of the Federal
government’s response to COVID-19. This cannot continue. All these factors expose the
country to a greater threat of exponential growth in transmissions and continuing
economic decline. Furthermore, efforts to enhance cooperation and coordination between
the Center and the Provinces are at the heart of a thorough response strategy – using the
18th Amendment for political dissociation jeopardizes the entire nation, and undermines
faith in narratives at both the Federal and Provincial levels.
As new information regarding the disease continues to come in, and the fact that it is
unlikely to be eradicated anytime soon, planning must incorporate preparation for the
short, medium and long term, within every sector. Mitigating the threat will require
creativity and unity like never before. Tough decisions will have to be made. Modes of
business operation may have to be altered entirely, in an era of continuing social-
distancing. Unprecedented crises call for unprecedented responses, but also present
unprecedented opportunities for growth. It is the strength of leadership that will
determine whether Pakistan can turn the crisis into an opportunity to evolve at an
exponential rate.
It is high time that the government acknowledges its responsibility and steps into its role,
rather than continuing to act in the manner of an opposition party, and provide crucial
31
leadership to the federation, so that provinces do not have to shoulder the burden for key
policy decisions alone.
Economic Crisis
There are no two opinions on the reality of the economic vulnerability and looming crisis
in Pakistan. While the pandemic is likely to be blamed now for the greater part of upcoming
economic challenges, the fact remains that the country was already in an economic
meltdown when it hit. The effects will certainly be exacerbated for an economy that was
already bleeding. For example, the PTI government has often highlighted the shrunken tax
base as part of the economic losses experienced by Pakistan during the pandemic;
however, from July through February of the current fiscal year 2019-20, the FBR collected
PKR 2.72 trillion in taxes, according to provisional figures. This collection fell short by a
record PKR 490 billion when compared with the original target of PKR 5.555 trillion.64 The
initial targets were not just ambitious, but outright incompetent. Furthermore, the fiscal
deficit was revised upwards to PKR 4300 billion (almost doubling within 19 months of the
PTI government).
The crisis however, has also brought with it an unprecedented opportunity. To Pakistan’s
advantage, with the world completely focused on containing the spread of COVID-19 and
‘Islamabad successfully navigating its ties with states such as China and the United States,
Pakistan may not be forced to confront the circumstances that existed in the pre-COVID-
19 era’65. For example, amid the COVID-19 crisis, the FATF has extended Pakistan’s review
deadline until September 2020. This not only takes away some pressure from Pakistan’s
economy, but it also gives the country more time to consolidate gains made against terror
financing. Under its Rapid Financing Instrument (RFI) scheme, the IMF has approved a loan
of $1.4 billion for Pakistan. Moreover, Pakistan is also to receive around $1.5 billion relief
in the form of delay in repayment of loans to bilateral creditors.
The crisis also presents an opportunity for Pakistan to improve the terms of the China-
Pakistan Economic Corridor (CPEC), and has already requested ease of payments for major
power projects. This may a unique opportunity to apply this leverage to other bilateral loan
agreement renegotiations, and obtain deals that may not have been possible before,
boosting economic recovery for months to come. The drop in oil prices – a quarter of
Pakistan’s imports, offers the possibility for considerable savings in foreign exchange
reserves.
However, exponential increase in unemployment, continued risk to the informal sector
from healthcare concerns, despite easing of the lockdown presents significant challenges
64 https://tribune.com.pk/story/2166326/2-fbr-collects-rs2-72tr-taxes-misses-target/. 65 https://thediplomat.com/2020/04/pakistan-gets-unexpected-economic-relief-in-a-time-of-global-crisis/
32
that require a comprehensive and unified internal and external strategy, developed and
implemented on rigid timelines, as if the country were in a war-like situation. Business as
usual will not work, and ‘every ounce of creative energy and close coordination will be
required to extract Pakistan from the upcoming crisis’66.
Food Security
Food security in the coming months is another major challenge Pakistan must contend
with. This crisis is unfolding in two key forms – locust attacks, and water damage due to
unseasonal rainfall to wheat crops. In the case of the former, the Government of Sindh has
repeatedly informed the Federal government about expected locust attacks during the past
six months, with requests for assistance. But despite assurances, little to no co-operation
had been received.67 The Food and Agriculture Organization has also warned that the
intensity of the locusts' attack will be more severe than it was in the same month last year,
adding that the Federal government should show seriousness over the matter.68 In Punjab,
large scale damage to standing crops due to hailstorms and gale force winds is another
looming crisis. At least 14 districts across southern Punjab have reported damage, the scale
of which is still being determined. Reports from farmers and officials suggest that crops
including wheat, maize, mango and vegetables have either been severely affected, or in
some cases even completely destroyed.69 Flash floods in Kohat have also destroyed crops70,
and Pakistan may miss wheat targets in the ongoing season. Strategies must be devised to
counter the impact of these damages in the coming weeks, before shortages hit the
population.
Health Sector
Challenges in the health sector have always been and continue to remain manifold. With
generally slow progress in the development and expansion of the healthcare system, and
less than 0.49% of the GDP71 spent on health in Pakistan, provinces have been struggling
to improve conditions in accordance with their respective priorities. Sindh has taken the
lead in this regard by establishing 143 new Hospitals over the past ten years (2008: 330 –
2018 473 hospitals) as well as hundreds of dispensaries, mother and child welfare centers,
followed by Punjab, with the addition of 82 Hospitals72. The Federal government, however,
66 https://www.dawn.com/news/1544172 67https://www.brecorder.com/2020/05/03/593958/cm-warns-pm-of-locust-attack/ 68 https://www.dawn.com/news/1554148 69 https://www.dawn.com/news/1476848 70 https://agroinsurance.com/en/pakistan-flash-flood-destroys-wheat-crop-in-kohat/ 71 Pakistan Economic Survey 2017-18, http://www.finance.gov.pk/survey/chapters_18/11-Health.pdf 72http://www.pbs.gov.pk/sites/default/files//tables/Hospitals%20Dispensaries%20and%20Beds%20by%20Province%20%28Progressive%29%201.pdf
33
has shown a decrease in the number of hospitals and other health facilities being developed
during the same period. Current health provisions are reflected in the figure below.
Fig. 2 Provincial distribution of health facilities across Pakistan
Furthermore, the expected rise in coronavirus cases is likely to place further strain on the
country’s limited infrastructure, leading to an overwhelming of the entire system. Pakistan
cannot afford the disruption of healthcare services, particularly to the poorest segment of
its society, most of which is engaged within the informal labor sector and stands at greatest
risk. The economic strain from a weakened healthcare system is the most likely to have a
domino effect on the country’s economy, and mitigating strategies must be formulated with
this scale of threat in mind.
Human Rights Issues
The COVID-19 pandemic is placing stress on every segment of civil life, and human rights
and mental health issues are no different. Pakistan already has a fairly dismal human rights
record, which is at further risk due to the social distancing and lockdown measures that
are necessary during the pandemic. At greatest risk remains the most vulnerable segment
of the society – women, children and the transgender population. An increase in domestic
9
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132
581
1286
2819
911
574
274
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132 9315
0
250
500
750
1000
1250
1500
1750
2000
2250
2500
2750
3000
Federal Punjab Sindh KP/ FATA Balochistan Gilgit Baltistan
Health Units in Pakistan
Hospitals Dispensaries Maternity & Child welfare centres
34
abuse has already been reported during the weeks in lockdown. The second facet is the use
of the crisis to increase controls on media and restrictions on political dissent, under the
guise of unified national policy development.
35
5. Way Forward
Vision
The only way forward for Pakistan is the development of a cohesive, unified national strategy
response that caters to the immediate needs of a country in crisis, without compromising
clarity of vision for mid and long term policies.
Objective
The purpose of this section is to propose and promote strategies for multi stakeholder policy
dialogue, and to build consensus for holistic, comprehensive national policies and strategies
in the fight against the COVID-19 pandemic. To this end, ideas for institutional strengthening
in all sectors through necessary resources and reforms have been put forward, as well as
concepts for mitigating short, medium and long term impact.
a) Economic Strategies
The IMF estimates the pandemic will severely impact Pakistan’s exports, foreign remittances
and domestic production and consumption. Thus Pakistan will not only face a foreign
exchange crisis, it will also face a balance of payment crisis. IMF estimates project -1.5% GDP
growth and a double digit inflation of over 11% in 2020. IMF estimates that it will take at
least 4 years till the growth rate again touch the pre-virus projections of 5% in 2024. To help
Pakistan face its balance of payment problems, on 16th April 2020, IMF Executive Board
approved a purchase of Pakistan under the Rapid Financing Instrument (RFI) equivalent to
SDR 1,015.5 million (US$ 1.386 billion, 50 percent of quota). Additionally, other donors have
pledged $250million to help Pakistan deal with the crisis and some donors have allowed debt
payment roll overs. Together these steps should ensure that forex levels remain around $12
billion by the end of 2020 to mitigate the negative pressure on the exchange rate and to allow
Pakistan to have forex reserves worth about 2.7 months of imports.
Major Impacts on Pakistan:
a. Reduced demand for Pakistani exports in major markets such as China, EU and USA.
This would lead to lower export earnings.
b. Reduced foreign remittances as Pakistani workers abroad lose employment and need
more money for themselves. Remittances are expected to be $5 billion lower than
pre-virus estimates.
36
c. Reduced domestic consumption as unemployment increases and uncertainty reduces
non-essential expenditures
d. Reduced investment due to virus related uncertainty and increased checking of
financial transactions.
e. Severe revenue losses and resultant high unemployment in manufacturing
(especially textile), transportation, and service industries such as restaurants and
tourism. Additionally, other employment is expected to be lost in the short term due
to structural problems such as unavailability to transport.
f. Primary deficit is now expected to deteriorate to 2.9 percent of GDP in FY 2020 (from
0.8 percent expected earlier). This is because of a 1.8% decline in tax revenue
(relative to the pre-virus baseline) and higher spending budgets to support the health
response, social safety nets for the very poor, and employment.
g. Nonresidents have already taken about $2 billion out of Pakistan. This may increase
in the coming months if the investment climate does not improve.
Government and SBP Response
On March 24, the Prime Minister announced a massive package to mitigate some of the
negative impacts of the pandemic. The State Bank has also announced several step aimed at
monetary loosening, increasing liquidity and providing cheap loans to stimulate the
economy and assist businesses affected by the pandemic. The fiscal stimulus package, worth
1.2% of GDP, includes:
a. Cash payments to poor people including higher payments to those on schemes such
as the Benazir Income Support Program (BISP);
b. A PKR 200 billion fund for the most affected workers, especially daily wage earners;
c. Increased funding and networking of the Utility Stores Corporation to provide food
security and price stability;
d. Temporary reduction in food prices of essential food items;
e. Elimination of taxes and import duties for medicines, machinery and supplies
intended for the medical and health sectors;
f. Largest reduction in oil prices in Pakistani history;
g. Optional deferment or payment in installments of electricity and gas bills;
h. Increase funding for the National Disaster Management Authority of Pakistan, for the
purchase of additional equipment and operations;
i. Building a contingency fund.
The government has also introduced incentives for the construction sector with the stated
purpose of creating employment for daily wage laborers. This includes a special tax regime
37
and no wealth declaration for projects launched during 2020. An ex-post audit by the
Auditor General of Pakistan on medical sector imports and supplies, to be published on the
website of the Ministry of Finance has been announced in a bid to curtail corruption.
It would be advisable that the government should also create similar packages for the
agricultural, manufacturing and service sectors to create employment and help businesses.
SBP measures to support liquidity and credit challenges created by the pandemic include:
a. Slashing the policy rate by a cumulative 225 basis points to 11 percent;
b. Interventions in the FX market to support the exchange rate;
c. Allowing the exchange rate to act as shock absorber, accommodating an 8%
depreciation of the Rupee against the dollar, while intervening in the FX market to
ensure the rupee does not suffer from disorderly market conditions and excessive
rupee volatility.
d. Expanded refinancing schemes;
e. Relaxing conditions associated with export refinancing and long-term financing
schemes;
f. Easier access to loans especially for firms in the medical and manufacturing sectors;
g. Measures to maintain soundness of the banking system such as:
1) Reducing capital conservation buffer from 2.5% to 1.5%
2) Allowing 44% more credit to SMEs, up to Rs.180 million
3) Relaxing debt burden ration for consumer loans from 50% to 60%
4) Providing regulatory permission for banks to defer repayments of principal
amounts.
Going Forward: A Multi-pronged strategic approach towards various sectors
The government has to cater to a variety of challenges created by the pandemic, in addition
to challenges it was already facing. The government has to mitigate the effects of the virus in
three broad categories:
Past – Mitigate the impact from the lockdown in Pakistan and abroad. This includes
people already made jobless, production already lost, lower revenues from taxation
and utility bills etc.
Present Short Term - Guide the economy through uncertain times in the coming
months while balancing the economic and health issues. Providing relief to industries,
agriculture and manufacturing sectors without specifically favoring industrialists,
feudal lords and favorite businessmen.
38
Future Long Term - Create a new framework for the economy to deal with the lag
effect of the economic stall, which will take a year or two to fully manifest, as well as
creating a contingency plan for future outbreaks and other similar distortions.
Given that WHO and eminent doctors are talking about the pandemic prevailing for a year or
two and possibly forever, as well as the delay in creating a vaccine, the government should
look at what structural changes might be required for optimal adaption to the new realities
of the post-COVID world, which will undoubtedly contain changes to preferences in lifestyle,
consumption, communication etc. The government should look into tackling the following
issues:
How much of the population would prefer to work from home and can this be made
more widespread by encouraging firms to let their staff work from home?
Can more youth be given vocational training in jobs that will be safe in future
pandemic outbreaks?
Which essential sectors of the economy need further strengthening? This pandemic
has exposed weakness of health sector world over. Can this be overcome through
investment in equipment and personnel?
Pandemic has exposed weakness of the federal/provincial divide for managing
provincial subjects such as epidemic response. This aspect needs to be overcome
through lawmaking or mutual agreement
What is the best way to seal borders effectively while still allowing essential foreign
travel and return of Pakistanis abroad?
What is the provincial share of the pandemic contingency fund?
There should be an agreed upon mechanism for sharing foreign funding and loans
given to the federal government between the provinces
What monetary and honorary awards can be set up to honor essential health workers
to motivate them to keep working? How would these awards be funded?
In an era of social distancing, is boosting indigenous production for local markets a
necessity?
b) Social Strategies
Inclusion of Stakeholders
With a global pandemic in the offing, had the federal government taken the opposition,
academia, religious scholars, civil society, media and various state institutions on board to
prepare a comprehensive advance strategy, similar to the manner in which Vietnam
proceeded, Pakistan could potentially have contained the infection much better than it has.
From the get-go, the Sindh Government has made proactive efforts towards inclusivity with
39
great results; a board with senior health practitioners and members from civil society was
formed to advise the province on data-based counter-strategies. Their guidance and support
continues to be taken seriously, allowing the space for innovative solutions. This mechanism
may be usefully emulated at the national level as well.
Education and Awareness
Social distancing and limited public interactions are the anti-thesis of the very fabric of
Pakistan’s social culture; consequently the implementation of social distancing measure has
been met with skepticism, ridicule and anger. In a country where social and religious values
take precedence over health concerns, building an effective narrative to explain the reasons
for and importance of these measures, in way that is relatable for the masses is of the utmost
importance. This is of even more importance in light of the fact that Eid is coming up, and
domestic movement and unnecessary social interactions on this occasion may become
extremely difficult to restrict, despite the high rise in COVID-19 cases.
Pakistan’s formal and informal education severely lacks the inclusion of basic civic values
and wisdom in early childhood development. When principles such as honesty, tolerance,
cleanliness and respect for law are not internalized during early year education, it becomes
practically impossible to retrain adults to incorporate these values into their daily lives. The
crisis caused by COVID-19 has further exposed this flaw in our social and normative
education by highlight the discord between rational thinking, civic duty and excessive self-
centeredness. Incorporating health and hygiene, as basic civic values within early education
is one way forward.
c) Health sector
According to WHO promulgated doctor-population ratio is 1:1000. In Pakistan however, this
ratio stands at 1:1200. Keeping in view the fragile health system, there is a need to
immediately plan for strengthening the health system, through increasing per capita
availability of the hospitals, doctors, beds and medical equipment. The already distressed
medical practitioners may be supported through:
a) Strict penalties on violation of minimum safety measures and increased inductions of
young doctors and paramedics to assist the seniors;
b) Increase in the health budget for maintenance and upgradation of the system;
availability of pharmaceutical and non-pharmaceutical supplies and acquisition of
necessary upgraded healthcare machinery;
40
c) In the absence of a COVID-19 vaccine, the potential role of a number of public health
measures – so-called non-pharmaceutical interventions (NPIs) – aimed at reducing
contact rates in the population and thereby reducing transmission of the virus,
including:
(i) Possible mitigation73, which focuses on slowing but not necessarily stopping
epidemic spread – reducing peak healthcare demand while protecting those
most at risk of severe disease from infection; and,
(ii) Suppression, which aims to reverse epidemic growth, reducing case numbers to
low levels and maintaining that situation indefinitely.
Each policy presents its own set of challenges. Optimal mitigation policies
(combining home-based isolation, home quarantine and social distancing of the
elderly and others most at-risk) might reduce peak healthcare demand by two-thirds,
and the mortality rate by half.
Mental Health
The consequences and after effects of the pandemic may soon become visible and continue
to affect society in multiple ways for a long time afterwards, including a general increase in
stress, anxiety, violence and crime. The timely formulation of strategies and implementation
mechanisms to cater to this looming vulnerability is of the utmost importance.
Gender based health provisions
The data shows infection spread among men at a much higher rate compared to women
(fig.3) which can be attributed to several factors.
73https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf “Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand” by Imperial College COVID-19 Response Team
41
Fig-3 gender based data of COVID – 19 cases
Low social mobility among women may be one major reason behind this difference; the
disparity of health provisions, access to testing facilities and hospitals maybe the other
major cause. There remains a need to significantly enhance testing and treatment
facilities, and access of women to such them in particular.
A helpline for this purpose may be an important facilitating factor, connecting women
suspecting exposure or seeing possible symptoms in themselves. Such helpline may serve
the purpose of a support system not only to report COVID related health cases, but also
for support in violence and/or mental health related issues in light of the pandemic.
Medical Research and Development
Medical education in Pakistan is at par with international standards in the field.
Investment in Medical Research and Development, however, remains abysmal.
Pakistan must enhance R&D facilities and mechanisms in the field, thereby strengthening
the health industry at home, instead of looking for solutions outside the country. This will
not only improve the healthcare system, but also create multi-stage employment
opportunities, and a complete health industry which can contribute at the international
level. Monetary support and liaison with international organizations for health
cooperation in medical research as well as engaging investors in this sector is the way
forward.
6.49%
0.71%3.09%
9.02%
12.54%
12.30%
14.84%
15.17%
4.71%
2.02%
0.22%
0.83%
1.79%
2.77%
2.89%
4.17%
4.19%
2.25%
0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% 20.00%
Misc.
80+
70-79
60-69
50-59
40-49
30-39
20-29
10-19
Age
COVID-19 | DEMOGRAPHICS
Male Female
42
d) Political Strategies
The Parliament has a central constitutional role in the discussion, analysis and strategizing
over important issues of national interest and security. Crises such as the COVID-19
pandemic are the moment for the bi-cameral legislature of Pakistan to rise to the occasion
and build strong national narratives, discuss and negotiate on important issues like the rising
debts, fiscal deficit, social transfers to the vulnerable sections of society, and striking a
balance between securing lives versus livelihoods.
The parliament has to come forward to make crucial decisions and create national harmony,
as it is the duty of a complete legislature system to make decisions, not the Prime Minister
or his cabinet alone. It is important for the Prime Minister to attend parliament sessions and
respect parliamentary processes in order for this to occur. The Parliament of Pakistan may
also initiate some key steps to improve its effectiveness, including:
Enhancement of technological options for holding regular meetings and sessions through
web-hosting, particularly in view of the upcoming budget exercise;
In case of online sessions, new rules must be developed and passed urgently, in order to
have transparency on voting and discussion on key issues/ legislation;
International connectivity, support and learning, with a special regional focus needs to be
initiated by the parliamentarians in their collective and individual capacities;
Connectivity with public to show their presence and support is an important task for
parliamentarians to perform in these difficult times.
Political reconciliation is required to dispel the lack of unity at such a crucial moment in
time, and work in coordination for common national interests.
Pakistan also needs to step up its diplomatic game. International Diplomacy, particularly
soft diplomacy, is a key tool in the country’s arsenal, particularly in terms of renegotiation
on key loan agreements, as well as in terms of regaining traction for the Kashmir issue.
Groups and entities that are otherwise unable to exert any meaningful influence find the
general uncertainty around COVID-19 as a means to legitimize their existence and garner
widespread ground-level support74. The past three years have witnessed the rapid rise to
prominence of diverse and polarized interest groups which have the potential to challenge
the writ of the state and create implications for the existing law and order systems. In no way
74Zaki Khalid“COVID-19-and-Emerging-Challenges-to-the-State-of-Pakistan” “https://cscr.pk/pdf/perspectives/COVID-19-and-Emerging-Challenges-to-the-State-of-Pakistan%E2%80%99s-Writ.pdf
43
should any such groups be allowed to challenge the writ of the state, and negatively impact
law and order within the country.
44
6. Key Findings and Conclusion
This response analysis and strategy document acknowledges that as the COVID-19 crisis is
nowhere near its end, any affirmations of success and failure must be relative in terms of
scale (transmission, fatalities) and time. Within this limited realm, it is however, possible to
gauge relative success by using the framework of leadership success in navigating the
challenge – how it ‘processed the challenge, crafted a comprehensive strategy and executed
it with clarity and conviction’.
Pakistan’s timeline of response strategies displays immense similarities with countries that
have failed to contain the threat of the pandemic. Delays, a non-serious approach to the
gravity and scale of the problem, uncertainty over which path to take, late lockdown
and early exit – rendering its effectiveness abortive, and the politicization of a public
health issue.
As time passes and the world attains more information on the virus, and we develop vaccines
or immunity, the fight against COVID-19 will become easier. But until then, the gains in terms
of upgrading health facilities, instituting Tracing, Testing and Quarantine (TTQ) and
distributing cash aid through the Ehsaas (BISP) programme —amounts to little more than
bandaging the wounds we inflicted on ourselves in the initial days, by emulating countries
that have failed to produce an effective/timely response and are now paying the price.75
It is this point that PPP Chairman, Mr Bilawal Bhutto-Zardari raised at the recent NA session,
where he pointed out that the primary responsibility for the uncontained spread of
coronavirus in Pakistan lies with no one but the Federal Government.76 Border controls and
screening have been abysmal, from the initial mismanagement of the returning Zaireen to
the recent repatriation flight from the UAE.
Furthermore, while the Center’s concerns regarding the survival of millions of low-income
families are valid, but they ignore the fact that people in the lower socioeconomic strata fall
sick and die in far greater numbers due to greater exposure. A strict lockdown at least until
infection rates start declining is the kinder course of action, not the other way around.77 In
criticizing the lockdowns, the Federal Government was “undermining and sabotaging”
Sindh’s efforts to fight the pandemic, instead of acknowledging the province’s efforts.
Furthermore, by refusing to sign the legislation meant for providing relief to the
people of Sindh, the governor was actively punishing the province for its difference in
75 Fahd Husain, ‘Vaccine for Success’, https://www.dawn.com/news/1557470/vaccine-for-success 76 ‘Barbs fly in NA over fight against Covid-19’, https://www.dawn.com/news/1556480/barbs-fly-in-na-over-fight-against-covid-19 77 ‘Lifting lockdown’, https://www.dawn.com/news/1557724/lifting-lockdown
45
opinion and strategy. Mr Bhutto Zardari, at the NA session, also said that his party had
always been ready to offer cooperation to the federal government. “The federal government
should have stood with us shoulder to shoulder. We are in the midst of a war, and the prime
minister expects us to fight the war on our own.”78 In tussle between the Centre and
Provinces, and the governance failures from PTI, the leadership of Chairman PPP, Mr
Bhutto Zardari and CM Sindh, Syed Murad Shah has emerged as rational and mature,
head and shoulders above the former’s in both vision and efficacy.
What the Federal Government continues to fail to realize, when it cites the US and UK as
examples of how even rich countries could not cope with the challenge, is that they took the
threat lightly, prioritized economic safety and did not take a proactive approach towards
containing the virus. Conspicuously missing in the Center’s narrative is the concept of
‘flattening the curve’, or lowering transmission rates, so that there is less stress on medical
services on any given day, and there are more ICU beds and equipment available for those
who need them. 79 . Pakistan’s leaders should be learning lessons from the countries that
were successful in their response to the pandemic, instead of comparing themselves with
countries ‘that have lost badly due to a failure of their leadership to provide leadership when
such leadership was required the most.’80
Furthermore, tampering with numbers and playing the blame game is not going to achieve
any positive results for Pakistan, not even any political gains for political entities. If Sindh is
reporting higher number of cases, it is because the province has increased its testing capacity
and is making efforts to find, isolate and help the infectious cases. It is not a product of policy
failure, and must be acknowledged as such, encouraging other provinces to increase testing
and report accurately as well, rather than fudging numbers for temporary political relief.
Finally, transmission and fatality rates for Pakistan may not be as grim as they are in other
countries yet, but they are certainly not good either, and are continue to increase
exponentially. Health Ministry data predicts that over 150,000 people will be infected with
the virus by end of May 2020. Devising a strategy to deal with this sort of scenario must be
our collective and utmost priority. Mixed messages are unnecessarily baffling a nation that
has already started to become uncertain about the gravity of the threat. And its gravity
cannot be under emphasized - Pakistan’s future may well depend on the success or failure of
the management of the COVID-19 crisis.
78 ‘Barbs fly in NA over fight against Covid-19’, https://www.dawn.com/news/1556480/barbs-fly-in-na-over-fight-against-covid-19 79 ‘Lifting lockdown’, https://www.dawn.com/news/1557724/lifting-lockdown 80 Fahd Husain, ‘Vaccine for Success’, https://www.dawn.com/news/1557470/vaccine-for-success
46
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