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Pakistan in the time of coronavirus: an interview with Pakistan’s Minister for Health Dr Faisal Sultan

It started at the end of 2019. On May 16, 2021, it still rages–deadly, fearsome, unending. The global fight against the coronavirus continues with the third wave of COVID-19 causing pain, despair, and death in many countries across the globe.

In Pakistan, on May 15, the total number of COVID-19 cases was 874,751. Patients who recovered were 783,480. The number of people who lost their lives was 19,467. To me that is 19,467 families mourning the passing of their loved ones to a disease that follows no rules. Its infliction of pain and loss is according to the rules of its daily-changing playbook that becomes incomprehensible just when humans think they have grasped its intricacies.

In Pakistan, an eight-day national lockdown will end tomorrow. Departments of health continued to work during the lockdown, and on Eid day. Smart lockdowns are in implementation in all high-risk areas of Pakistan where the number of cases is more than 11 percent. According to Prime Minister Imran Khan, a complete lockdown is hardly a viable possibility in a developing country where a large part of the population is dependent on daily wages for their basic survival. So far, Pakistan, mashAllah, seems to be dealing with the third wave without any sign of an overflow of patients in hospitals.

The number of patients losing their lives varies on a day-to-day basis. The pain of their families is unimaginable.

On May 13, on Eid-ul-Fitr, NCOC tweeted:

Total Tests in Last 24 Hours: 39,101

Positive Cases: 3,265

Positivity %: 8.35%

Deaths: 126

On May 14, NCOC tweeted:

Total Tests in Last 24 Hours: 30,700

Positive Cases: 2,517

Positivity %: 8.19%

Deaths: 48

On May 15, NCOC tweeted:

Total Tests in Last 24 Hours: 30,248

Positive Cases: 1,531

Positivity %: 5.06%

Deaths: 83

On March 10, Pakistan began its vaccination programme.

On the frontline of Pakistan’s battle against COVID-19 are Pakistan’s splendid doctors, nurses, paramedics, and other medical and hospital staff. Their services and sacrifices are unquantifiable. The nation’s gratitude to all of them is immeasurable.

Leading Pakistan’s fight against COVID-19 since August 3, 2020, in coordination with the National Command and Operation Centre (NCOC), is Dr Faisal Sultan, Special Assistant to the Prime Minister on National Health Services, Regulations and Coordination [with the status of federal minister]. Dr Sultan is the CEO of the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, and in his own terse description, is “an infectious diseases specialist and currently the special assistant to the PM on national health.”

Working 24/7, Dr Sultan is fully attentive to everything related to coronavirus in Pakistan. To me, his dedication to his new job is visible in his constant concern for all those suffering from COVID-19, and in his deep empathy for their families.

I asked Dr Faisal Sultan a few questions:

Mehr Tarar: Looking at Pakistan’s COVID-19 patients, what is the major difference between 2020’s mostly Wuhan strain and 2021’s mostly UK strain?

Dr Faisal Sultan: There are no major, discernible changes between the then and now, between 2020 and 2021. But some observations include the fact that the spread is greater this time (which fits well with what is known with B117); and a minor change in the case fatality rate (again consistent with what is known).

MT: The common assumption is that the number of people who have registered for the vaccine is miniscule in a country with the population of almost 221 million. What is the official number?

DFS: The number of registered people, so far, [May 11] is 5.7 million. This is a little over the 10 percent mark for the population that was opened for registration–the age group over 40 years.

MT: If the number of people registered for vaccination is low, what, in your opinion, is the reason? Is the governmental campaign of information and awareness as effective as it should be?

DFS: There is no doubt that the number will go up. We will do more media campaigns to increase awareness with the expansion in the supply and availability of vaccines per month.

MT: In medical terms, what percentage of Pakistan’s population would need to be immune for Pakistan to attain herd immunity?

DFS: When approximately 25 percent of the main urban areas are immunised, we will start to see the effects. That effect is incremental to around 70 percent eventually.

MT: What is the long-term planning as the global impact of coronavirus does not seem to abate? What is the latest medico-scientific evaluation on the possibility of the coronavirus becoming an endemic disease but of a lesser potency?

FS: No one knows for sure, but historically, pandemics, die out due to a number of different factors. Sometimes, it is the attenuation of the severity of the virus, and at times, it happens when large swaths become immune due to vaccine or [having suffered from the] disease.

MT: The fear of more pandemics is more real than ever in 2021. What is Pakistan’s long-term plan in terms of enhancement of medical infrastructure–specialised hospitals, properly trained staff, and medical supplies, including oxygen, ventilators, medicines, vaccines? Is the present government planning to make a substantial investment? Would the private sector be involved in the process?

DFS: During the pandemic, in the last year more than 7,000 beds were added, and 66 percent increase in oxygen capacity was made, steps without which we would have faced a shortage right now. That was short-to-intermediate term. Long term, we have remade the National Institute of Health (NIH) equipping it with a Centre of Disease Control and Prevention and other important additions to counter pandemics. A new board of top-class professionals has recently taken shape and is now operational. Major investments have been made to increase manpower via the newly formed Pakistan Medical Commission to ensure the induction of medical specialists with better and higher credentials. Similar changes are planned for nurses and allied healthcare professionals.

MT: Repackaging a Chinese vaccine in Pakistan does not amount to a made-in-Pakistan product, and that elicits the question that Pakistan’s virologists, epidemiologists, and medical scientists would have: does Pakistan have any plan to make its own indigenous vaccine?

FS: For Pakistan to have its own vaccine, major investments are needed for the overall milieu and ecosystem of health research. The new NIH has seven institutes, one of which is the health research centre, a built-in structure for advancement of research. It will fund research proposals. The entire thing will take time, but it is doable. And for that to happen, a partnership of academia and industry is required, which, unfortunately, hasn’t ever been seen in our country for the field of research in a major way.

MT: One criticism from specialists of viral diseases is that transfer of technology should have been the top priority in 2020 instead of wasting time in daydreaming that the worst was over, and that there would not be new and more lethal waves of infection. Is that a valid criticism?

FS: No, it is not. Technology transfer and innovation are being developed. But it must be understood that such things do not see fruition right away. The current production–from concentrate for vaccines to other prep–is what has given us room to keep our heads above the water in the third wave. The other things that we have been working on include the local production of ventilators and other spinoffs that will be generated. The most important investment was made for coordination and data flow through the NCOC.

These steps might have escaped our media and some of our health analysts, but there has been positive acknowledgement by global bodies that monitor each country’s responses. Remember the comments of the renowned US economist on Pakistan’s handling of the pandemic? [Former US treasury secretary and Lawrence ‘Larry’ Summers said in CNN’s Farid Zakaria’s October 18, 2020 show: “America’s failure on Covid-19 is almost unimaginable. Heck, if the US had handled the pandemic as well as Pakistan, we would have saved in neighbourhood of $10 trillion.”]

MT: Another criticism: what is the reason behind’s Pakistan reliance on Gavi and COVAX initiatives to supply vaccines for merely 20 percent of our population?

DFS: We were not solely relying on that supply. That reliance was for a certain portion of the population, and it was to be topped up by the funds of the government of Pakistan. Since COVAX got delayed, the government financing was brought in earlier. The delay was just a matter of unforeseeable timing.

MT: Is AstraZeneca that has finally reached Pakistan as part of the COVAX gift for developing countries produced in the Serum Institute of India?

DFS: The AstraZeneca vaccine that we have received is from South Korea.

MT: How and when is our economy expected to be back on track without what the naysayers dub as a well thought-out, more expansive vaccination plan?

DFS: The plan is clearly thought out and envisages reaching to 70 million people over the next few months. The only current limitation is supply of vaccine, but even that will go up with time. We will need to do a broader awareness-raising campaign for information about vaccination to reach every corner of Pakistan once we have dealt with the current wave of those that have self-identified themselves at risk. This self-identification has been generally accurate and consists of people from urban populations, but we will also need to go deeper within urban and other less-populated areas.

MT: Moving away from COVID-19, do you think there should be a substantial increase in Pakistan’s present federal and provincial healthcare budgets that is more suited to the needs of a country the size of Pakistan?

DFS: Yes. I think a good example is the Sehat Sahulat Card insurance, which started with Khyber Pakhtunkhwa’s government providing full medical cover to its entire population, and the federal and Punjab governments following suit. This will not happen without massive investment in healthcare. More investment on primary care is also needed.

All planned interventions like the Sehat Card, improved functionality of large hospitals, primary care, and developments in prevention will certainly need more resources than the current budgets of federal and provincial health ministries.