As Pakistan faces the third wave of Covid with number of critical care patients rapidly rising, the fear of oxygen shortage looms large over private and public hospitals in the country. With the country grappling with slow vaccine rollout, Pakistanis are more vulnerable than ever before. Emphasising the gravity of the situation, Special Assistant to the PM on National Health Services Dr Faisal Sultan Saturday said that Pakistan was consuming at least 90 per cent of oxygen it is currently producing. He added that the capacity to produce oxygen has been increased by 380 metric tonnes and the country is now producing 800 metric tonnes of oxygen. There is little room for further enhancement.
The number of oxygen-requiring patients in Pakistan currently stands at over 4500, which is 30 per cent higher than the peak of pandemic in June last year.
In a joint statement released on Saturday, oxygen producers warned that bulk of oxygen produced in Pakistan is being used for treatment of Covid patients. They expressed the fear that if Covid cases continue to surge, there may be a shortage at the hospitals because oxygen producer companies are currently working at their maximum capacity.
Islamabad hospitals filled to capacity
The situation in the federal capital appears to be particularly grim. All scheduled surgeries at Islamabad's two major hospitals, PIMS and Poly Clinic, have been postponed for an indefinite period due to the latest surge in Covid cases. The PIMS administration wrote a letter to the Health Ministry on Friday announcing that it has run out of beds for Covid patients. The letter called on the government to 'ramp up' other facilities to cater to Covid patients because PIMS has reached its maximum capacity as several Covid patients await treatment in the 'Emergency Room'.
With a complete lockdown not on the cards anytime soon, the government appears to be relying on the public to take precautionary measures on their own.
Saadia Izhar, a resident of Lahore and one of the many parents who are concerned about their children appearing in the ongoing Cambridge exams, points out that the government is warning about exhaustion of healthcare system and severity of the situation on one hand, and refusing to cancel physical exams on the other. "This mixed messaging is not helping," she says.
O/A level students had petitioned four different high courts in the country, seeking cancellation of physical examinations and use of the method involving school-assessed grades. A social media campaign was also run for the cause with several celebrities and politicians lending support to the students. However, all four petitions were rejected and the exams are being conducted as per routine.
It was expected that the meeting of the NCOC held last week will address the concerns raised by students, but the government decided that the exams are to be held as per schedule. Around 85,000 students sat for the first day of Cambridge exams on Monday, and reports indicate the social distancing arrangements were not up to the mark.
"I will not send my child to the crowded examination hall even if it means he lags behind his peers after missing the exams. Safety of my child comes before his education," says Saadia.
Awami Workers Party (AWP) activist and researcher Ammar Rashid, talking to Naya Daur Media, said that all kinds of exams which require students to gather need to be called off, just like they have been cancelled all over the region. "Moreover, risks of large gatherings for celebrations and shopping in Ramzan and Eid-ul-Fitr present a huge risk as we witnessed last year," he said.
Ammar added that Education Minister Shafqat Mehmood insisting on physical exams and Prime Minister Imran Khan suggesting that Covid-19 in Pakistan did not spread in mosques is deeply unhelpful. "It goes against what the evidence tells us. People must be convinced to spend much of their Ramzan and Eid at home, or we will have a far worse repeat of the disaster that occurred after Eid-ul-Fitr last year," he said.
Is deployment of army the answer?
Pakistan Army's deployment to ensure Covid SOPs compliance has generated a debate on social media, with people questioning as to why the Corona Tiger Force, formed by the prime minister in April last year to help the administration implement Covid SOPs, is not being put to use.
Ammar Rashid says the deployment of the military 'in matters that should be the domain of civil law enforcement' was a hasty move. "The potential for abuses of marginalised and working class communities in the process of enforcing covid SOPs – even while religious groups and powerful industries continue to flout the law at will - is a very real one," he said.
Ammar thinks implementation of Covid SOPs should remain with civil law enforcement with support, under civilian oversight, only in moments when it is absolutely necessary.
In a televised address last week, Prime Minister Imran Khan ruled out the possibility of a complete lockdown on the grounds that it would negatively impact the working class. But the reluctance to go for a complete lockdown begets the question if enough steps are being taken to mitigate the spread of the virus.
"There are plenty of steps that can be taken before lockdown, including enforcing mass masking (which we’re currently far from), an emergency-based mass communication effort, shutting down indoor gatherings and limiting mosque attendance," says Ammar Rashid.
Ammar added that if the government decides to do a full lockdown, it needs to be accompanied by another large scale cash transfer mechanism that builds on the lessons of the Ehsaas Emergency Cash program, as the current inflationary crisis has already pushed millions under immense economic stress.
Where are the vaccines?
With the third wave of pandemic rearing its head, unclarity surrounds Pakistan Covid vaccination program. The vaccine rollout is marred by lack of planning and accessibility leaves a lot to be desired. The country has so far been relying on donations from other countries.
1.6 million Pakistanis have so far been vaccinated since the commencement of vaccine rollout in March, which is not even 1 per cent of the population.
According to a report by The Economist, Pakistan will be able to vaccinate 60-70 per cent of its population by early 2023 if the present pace of vaccine administration continues. India, according to the same report, will achieve this milestone by late 2022.
Pakistan is currently vaccinating the following groups: healthcare workers, citizens over 60 years and those over 50. While the vaccination process for 60+ group seemed fairly efficient, many individuals in the 50 or 50+ age group who registered for the vaccine are yet to receive confirmation for the date and location of the vaccination centre.
Following a meeting of the NCOC on Monday, Asad Umar announced the decision to open vaccine registration for citizens aged 40 and 40 plus from today (Tuesday) onwards. Walk-in vaccination of citizens over 50 who have registered for the vaccine will also begin today.
However, since the vaccine rollout is based on age and not medical conditions, even immunocompromised and high risk individuals belonging to younger age groups still await their turn.
Slow per capita vaccination rate of Pakistan -- lowest in all of South Asia
Experts fear slow procurement of the vaccine may have consequences. Pakistanis may have to face restrictions on international mobility if the country's vaccination drive fails to keep up with the rest of the world.
Commenting on Pakistan's vaccine policies so far, Ammar Rashid said, "There is of course a global supply shortage and shameful evidence of the hoarding of surplus vaccines by rich western countries. However, that does not excuse Pakistan's dismal vaccine rollout thus far. Pakistan has the lowest per capita vaccination rate in all of South Asia, even lower than the average in the content of Africa, and it has yet to vaccinate 1% of the population months into the campaign."
He added that far more populous and poorer countries have vaccinated greater shares of their population than Pakistan has.
Failure to secure vaccine on time
The government has been under criticism for failing to procure Covid vaccine on time. Pakistan Muslim League - Nawaz (PML-N) supreme leader and former prime minister Nawaz Sharif in a tweet posted on Monday, said that the government's failure to procure Covid vaccines in time to protect the lives was a case of criminal negligence.
https://twitter.com/NawazSharifMNS/status/1386739730629410820?s=20
Pakistan People's Party (PPP) Chairman Bilawal-Bhutto Zardari had earlier expressed the same sentiment about Pakistan's vaccine drive, saying that the government failed to secure vaccines in time and that "Prime Minister Imran Khan would have to account for every single rupee of the Coronavirus Relief Fund".
Over-reliance on donations
Ammar Rashid says that the government decided to rely heavily on donations from China and WHO’s COVAX facility and failed to undertake any serious procurement in advance. "Now that COVAX supplies have slowed amid the new global upsurge, Pakistan has been left without many options. Issues of both vaccine supply and demand need to be addressed," he adds.
Calling for greater transparency about vaccine decision-making, Ammar said that questions need to be answered about the current status of public vaccine procurement and the state of the government's demand generation efforts, which have thus far failed to dent widespread vaccine hesitancy and contributed to low uptake.
Transparency International Pakistan Managing Director Adil Gilani lamented that Pakistan has not begun to manufacture Covid vaccine locally, which is a failure on the part of the government. The long term solution is to enhance our own vaccine production capacity, but the authorities do not seem to be doing nothing on that front, he told Naya Daur Media.
Private sector importing vaccine -- economic apartheid
The decision to allow private sector to import the vaccine raised eyebrows, with several quarters expressing concerns that the selling of vaccine may deepen social inequality and that it should be provided free of cost. In March, Transparency International (TI) Pakistan Vice Chairperson Justice (r) Nasira Javed Iqbal wrote a letter to Prime Minister Imran Khan, urging him to review the policy of allowing private sector to import the vaccine.
Adil Gilani says that the pharmaceutical industry in Pakistan is acting as a mafia by trying to use the pandemic to make money. Terming it a classic case of state capture, he claimed that the industry bigwigs used their influence to convince the government to allow private import of vaccine.
"Pakistan became the first country to allow private import of Covid vaccine and initially the government even let the pharmaceutical companies decide the price on their own," he said. Gilani says three days after the proposal [to let private sector import the vaccine] was approved by the federal cabinet in January this year, the government finally realised that the price needed to be fixed. But the pharmaceutical industry still managed to set the price unfairly, he said.
Private vaccine out of reach for most Pakistanis
The price of private vaccine in Pakistan is at least 30 per cent higher than the international market price. Two doses of the Sputnik vaccine in Pakistan currently cost 12,000 PKR, which is four times the international market price for the vaccine. Majority of Pakistan's population cannot afford this amount.
According to Pakistan Bureau of Statistics, monthly income of an average household in the country is Rs.41,545, which means a single vaccine's price is almost 30 per cent of an average Pakistani's income.
Adil Gilani says that nowhere else in the world is the private sector being allowed to exploit the situation for profit. He also said that the companies were over-invoicing imports, which is tantamount to stealing. "Putting a price tag on vaccine means declaring the affluent class's lives more valuable than the poor," he said.
Corruption in vaccine rollout?
The Transparency International Pakistan MD further said that the involvement of private sector, which is only concerned with making money, has made the vaccine rollout process prone to corruption and money laundering. "Going by the state of affairs and how matters are handled in Pakistan, there is a possibility that the private sector will even try to acquire the free vaccine available at government hospital through fraudulent means," he said.
The Transparency International, Gilani says, wrote to NCOC Chairman Asad Umar and Special Assistant to the PM Dr Faisal Sultan, seeking removal of the age restrictions for vaccine registration. In a recent statement, Asad Umar announced that vaccine registration will open up for all citizens after Eid ul Fitr. It is however unclear how the government will arrange administration of vaccine at a large scale in such a short timeframe given lack of logistical planning.
"Until the vaccine rollout process is made fully transparent, Pakistan will not be able to succeed in its vaccination drive," Adil Gilani said.
No vaccine for the stateless?
Since the vaccine registration is available to CNIC-holders only, those without the national identity card are not part of the vaccine rollout program. A large number of women, especially in Pakistan's rural areas in Khyber Pakhtunkhwa (KP) and Balochistan do not posses CNICs due to the overall lack of awareness in these areas.
Trust for Democratic Education and Accountability (TDEA), a non-profit organisation, had revealed in a 2019 report that over two million women in Pakistan have no identity documents. The government does not seem to have addressed this barrier to vaccine access.
A Federal Health Ministry spokesman, Sajid Hussain, told Naya Daur Media that there is no vaccine policy in place for those not holding CNICs. "One has to have a CNIC to get the vaccine," he says, adding that the requirement for CNIC is 'clear'.
Vaccine hesitancy: No plan to counter anti-vaxxers
Skepticism among the public about the vaccine is another factor that may impact the success of Pakistan's vaccine programme. Head of the infectious diseases department at the Aga Khan University Hospital, who conducted a survey about vaccine hesitancy in Pakistan, told Al Jazeera in an interview in March that the most common reason for this skepticism is concerns about safety.
According to his research, people fear vaccine because they mistrust the government data and consume (often false) information about its side effects from social media.
Social media, particularly Whatsapp, is rife with posts casting doubts on the effectiveness of the vaccines being administered in Pakistan. Some also term the 'foreign funded' vaccine a conspiracy to cause infertility among Muslims, and in the absence of a robust awareness campaign about the vaccine, citizens are susceptible to this misinformation. The government has made little effort to counter the propaganda and conspiracy theories about the vaccine.
33-year-old Komal Ahmad, who teaches undergraduate students at a private university in Lahore, says that more than half of her students are hesitant to get vaccinated due to various conspiracy theories floating on social media. "Awareness campaigns are needed if we are to counter the effects of this misinformation," she says.
In February, Punjab Health Minister Yasmin Rashid had said during a press conference that citizens should get vaccinated 'at their own risk', a statement that ended up strengthening rumours about the vaccine.
With the third wave of Covid wreaking havoc on the healthcare system, these loopholes in Pakistan's vaccine rollout need urgent attention.
The number of oxygen-requiring patients in Pakistan currently stands at over 4500, which is 30 per cent higher than the peak of pandemic in June last year.
In a joint statement released on Saturday, oxygen producers warned that bulk of oxygen produced in Pakistan is being used for treatment of Covid patients. They expressed the fear that if Covid cases continue to surge, there may be a shortage at the hospitals because oxygen producer companies are currently working at their maximum capacity.
Islamabad hospitals filled to capacity
The situation in the federal capital appears to be particularly grim. All scheduled surgeries at Islamabad's two major hospitals, PIMS and Poly Clinic, have been postponed for an indefinite period due to the latest surge in Covid cases. The PIMS administration wrote a letter to the Health Ministry on Friday announcing that it has run out of beds for Covid patients. The letter called on the government to 'ramp up' other facilities to cater to Covid patients because PIMS has reached its maximum capacity as several Covid patients await treatment in the 'Emergency Room'.
With a complete lockdown not on the cards anytime soon, the government appears to be relying on the public to take precautionary measures on their own.
Saadia Izhar, a resident of Lahore and one of the many parents who are concerned about their children appearing in the ongoing Cambridge exams, points out that the government is warning about exhaustion of healthcare system and severity of the situation on one hand, and refusing to cancel physical exams on the other. "This mixed messaging is not helping," she says.
O/A level students had petitioned four different high courts in the country, seeking cancellation of physical examinations and use of the method involving school-assessed grades. A social media campaign was also run for the cause with several celebrities and politicians lending support to the students. However, all four petitions were rejected and the exams are being conducted as per routine.
An examination centre for Cambridge students. More than 85,000 students are taking O/A level exams in Pakistan amid the third wave of Covid.
It was expected that the meeting of the NCOC held last week will address the concerns raised by students, but the government decided that the exams are to be held as per schedule. Around 85,000 students sat for the first day of Cambridge exams on Monday, and reports indicate the social distancing arrangements were not up to the mark.
"I will not send my child to the crowded examination hall even if it means he lags behind his peers after missing the exams. Safety of my child comes before his education," says Saadia.
Awami Workers Party (AWP) activist and researcher Ammar Rashid, talking to Naya Daur Media, said that all kinds of exams which require students to gather need to be called off, just like they have been cancelled all over the region. "Moreover, risks of large gatherings for celebrations and shopping in Ramzan and Eid-ul-Fitr present a huge risk as we witnessed last year," he said.
Ammar added that Education Minister Shafqat Mehmood insisting on physical exams and Prime Minister Imran Khan suggesting that Covid-19 in Pakistan did not spread in mosques is deeply unhelpful. "It goes against what the evidence tells us. People must be convinced to spend much of their Ramzan and Eid at home, or we will have a far worse repeat of the disaster that occurred after Eid-ul-Fitr last year," he said.
Is deployment of army the answer?
Pakistan Army's deployment to ensure Covid SOPs compliance has generated a debate on social media, with people questioning as to why the Corona Tiger Force, formed by the prime minister in April last year to help the administration implement Covid SOPs, is not being put to use.
Ammar Rashid says the deployment of the military 'in matters that should be the domain of civil law enforcement' was a hasty move. "The potential for abuses of marginalised and working class communities in the process of enforcing covid SOPs – even while religious groups and powerful industries continue to flout the law at will - is a very real one," he said.
Ammar thinks implementation of Covid SOPs should remain with civil law enforcement with support, under civilian oversight, only in moments when it is absolutely necessary.
In a televised address last week, Prime Minister Imran Khan ruled out the possibility of a complete lockdown on the grounds that it would negatively impact the working class. But the reluctance to go for a complete lockdown begets the question if enough steps are being taken to mitigate the spread of the virus.
"There are plenty of steps that can be taken before lockdown, including enforcing mass masking (which we’re currently far from), an emergency-based mass communication effort, shutting down indoor gatherings and limiting mosque attendance," says Ammar Rashid.
Ammar added that if the government decides to do a full lockdown, it needs to be accompanied by another large scale cash transfer mechanism that builds on the lessons of the Ehsaas Emergency Cash program, as the current inflationary crisis has already pushed millions under immense economic stress.
Where are the vaccines?
With the third wave of pandemic rearing its head, unclarity surrounds Pakistan Covid vaccination program. The vaccine rollout is marred by lack of planning and accessibility leaves a lot to be desired. The country has so far been relying on donations from other countries.
1.6 million Pakistanis have so far been vaccinated since the commencement of vaccine rollout in March, which is not even 1 per cent of the population.
Courtesy of Our World in Data
According to a report by The Economist, Pakistan will be able to vaccinate 60-70 per cent of its population by early 2023 if the present pace of vaccine administration continues. India, according to the same report, will achieve this milestone by late 2022.
Pakistan is currently vaccinating the following groups: healthcare workers, citizens over 60 years and those over 50. While the vaccination process for 60+ group seemed fairly efficient, many individuals in the 50 or 50+ age group who registered for the vaccine are yet to receive confirmation for the date and location of the vaccination centre.
Following a meeting of the NCOC on Monday, Asad Umar announced the decision to open vaccine registration for citizens aged 40 and 40 plus from today (Tuesday) onwards. Walk-in vaccination of citizens over 50 who have registered for the vaccine will also begin today.
However, since the vaccine rollout is based on age and not medical conditions, even immunocompromised and high risk individuals belonging to younger age groups still await their turn.
Slow per capita vaccination rate of Pakistan -- lowest in all of South Asia
Experts fear slow procurement of the vaccine may have consequences. Pakistanis may have to face restrictions on international mobility if the country's vaccination drive fails to keep up with the rest of the world.
Commenting on Pakistan's vaccine policies so far, Ammar Rashid said, "There is of course a global supply shortage and shameful evidence of the hoarding of surplus vaccines by rich western countries. However, that does not excuse Pakistan's dismal vaccine rollout thus far. Pakistan has the lowest per capita vaccination rate in all of South Asia, even lower than the average in the content of Africa, and it has yet to vaccinate 1% of the population months into the campaign."
He added that far more populous and poorer countries have vaccinated greater shares of their population than Pakistan has.
Failure to secure vaccine on time
The government has been under criticism for failing to procure Covid vaccine on time. Pakistan Muslim League - Nawaz (PML-N) supreme leader and former prime minister Nawaz Sharif in a tweet posted on Monday, said that the government's failure to procure Covid vaccines in time to protect the lives was a case of criminal negligence.
https://twitter.com/NawazSharifMNS/status/1386739730629410820?s=20
Pakistan People's Party (PPP) Chairman Bilawal-Bhutto Zardari had earlier expressed the same sentiment about Pakistan's vaccine drive, saying that the government failed to secure vaccines in time and that "Prime Minister Imran Khan would have to account for every single rupee of the Coronavirus Relief Fund".
Over-reliance on donations
Ammar Rashid says that the government decided to rely heavily on donations from China and WHO’s COVAX facility and failed to undertake any serious procurement in advance. "Now that COVAX supplies have slowed amid the new global upsurge, Pakistan has been left without many options. Issues of both vaccine supply and demand need to be addressed," he adds.
Calling for greater transparency about vaccine decision-making, Ammar said that questions need to be answered about the current status of public vaccine procurement and the state of the government's demand generation efforts, which have thus far failed to dent widespread vaccine hesitancy and contributed to low uptake.
Transparency International Pakistan Managing Director Adil Gilani lamented that Pakistan has not begun to manufacture Covid vaccine locally, which is a failure on the part of the government. The long term solution is to enhance our own vaccine production capacity, but the authorities do not seem to be doing nothing on that front, he told Naya Daur Media.
Private sector importing vaccine -- economic apartheid
The decision to allow private sector to import the vaccine raised eyebrows, with several quarters expressing concerns that the selling of vaccine may deepen social inequality and that it should be provided free of cost. In March, Transparency International (TI) Pakistan Vice Chairperson Justice (r) Nasira Javed Iqbal wrote a letter to Prime Minister Imran Khan, urging him to review the policy of allowing private sector to import the vaccine.
Adil Gilani says that the pharmaceutical industry in Pakistan is acting as a mafia by trying to use the pandemic to make money. Terming it a classic case of state capture, he claimed that the industry bigwigs used their influence to convince the government to allow private import of vaccine.
"Pakistan became the first country to allow private import of Covid vaccine and initially the government even let the pharmaceutical companies decide the price on their own," he said. Gilani says three days after the proposal [to let private sector import the vaccine] was approved by the federal cabinet in January this year, the government finally realised that the price needed to be fixed. But the pharmaceutical industry still managed to set the price unfairly, he said.
Private vaccine out of reach for most Pakistanis
The price of private vaccine in Pakistan is at least 30 per cent higher than the international market price. Two doses of the Sputnik vaccine in Pakistan currently cost 12,000 PKR, which is four times the international market price for the vaccine. Majority of Pakistan's population cannot afford this amount.
According to Pakistan Bureau of Statistics, monthly income of an average household in the country is Rs.41,545, which means a single vaccine's price is almost 30 per cent of an average Pakistani's income.
Adil Gilani says that nowhere else in the world is the private sector being allowed to exploit the situation for profit. He also said that the companies were over-invoicing imports, which is tantamount to stealing. "Putting a price tag on vaccine means declaring the affluent class's lives more valuable than the poor," he said.
Corruption in vaccine rollout?
The Transparency International Pakistan MD further said that the involvement of private sector, which is only concerned with making money, has made the vaccine rollout process prone to corruption and money laundering. "Going by the state of affairs and how matters are handled in Pakistan, there is a possibility that the private sector will even try to acquire the free vaccine available at government hospital through fraudulent means," he said.
The Transparency International, Gilani says, wrote to NCOC Chairman Asad Umar and Special Assistant to the PM Dr Faisal Sultan, seeking removal of the age restrictions for vaccine registration. In a recent statement, Asad Umar announced that vaccine registration will open up for all citizens after Eid ul Fitr. It is however unclear how the government will arrange administration of vaccine at a large scale in such a short timeframe given lack of logistical planning.
"Until the vaccine rollout process is made fully transparent, Pakistan will not be able to succeed in its vaccination drive," Adil Gilani said.
No vaccine for the stateless?
Since the vaccine registration is available to CNIC-holders only, those without the national identity card are not part of the vaccine rollout program. A large number of women, especially in Pakistan's rural areas in Khyber Pakhtunkhwa (KP) and Balochistan do not posses CNICs due to the overall lack of awareness in these areas.
Trust for Democratic Education and Accountability (TDEA), a non-profit organisation, had revealed in a 2019 report that over two million women in Pakistan have no identity documents. The government does not seem to have addressed this barrier to vaccine access.
A Federal Health Ministry spokesman, Sajid Hussain, told Naya Daur Media that there is no vaccine policy in place for those not holding CNICs. "One has to have a CNIC to get the vaccine," he says, adding that the requirement for CNIC is 'clear'.
Vaccine hesitancy: No plan to counter anti-vaxxers
Skepticism among the public about the vaccine is another factor that may impact the success of Pakistan's vaccine programme. Head of the infectious diseases department at the Aga Khan University Hospital, who conducted a survey about vaccine hesitancy in Pakistan, told Al Jazeera in an interview in March that the most common reason for this skepticism is concerns about safety.
According to his research, people fear vaccine because they mistrust the government data and consume (often false) information about its side effects from social media.
Social media, particularly Whatsapp, is rife with posts casting doubts on the effectiveness of the vaccines being administered in Pakistan. Some also term the 'foreign funded' vaccine a conspiracy to cause infertility among Muslims, and in the absence of a robust awareness campaign about the vaccine, citizens are susceptible to this misinformation. The government has made little effort to counter the propaganda and conspiracy theories about the vaccine.
33-year-old Komal Ahmad, who teaches undergraduate students at a private university in Lahore, says that more than half of her students are hesitant to get vaccinated due to various conspiracy theories floating on social media. "Awareness campaigns are needed if we are to counter the effects of this misinformation," she says.
In February, Punjab Health Minister Yasmin Rashid had said during a press conference that citizens should get vaccinated 'at their own risk', a statement that ended up strengthening rumours about the vaccine.
With the third wave of Covid wreaking havoc on the healthcare system, these loopholes in Pakistan's vaccine rollout need urgent attention.