‘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

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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.

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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

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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

388473

277

132

581

1286

2819

911

574

274

285233

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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