As the world enters mid-2021, the Covid-19 pandemic continues to rage. With 177 million cases and 3.8 million deaths worldwide, nearly all of us have seen loved ones suffer from Covid-19. The tragedy has been as personal as societal. For nations, the choice has been stark. Either lock down schools, offices and public places with dire economic consequences or see hospitals fill up and deaths swell to unimaginable levels. However, this shared misery has also united mankind uniquely and even the poorest of countries have generously offered to help.
The availability of vaccines though has been a ray of light. Since early 2020, nearly 50 candidate vaccines have been developed and tested, and currently 17 different vaccines are in public use worldwide. Although the process of vaccine development and deployment has been superfast by historic standards—10 to 12 months for Covid vaccines compared to the typical 8-10 years it takes—the testing has been rigorous. Each marketed vaccine has been tested in nearly 50,000 or more volunteers to evaluate if it limits the seriousness of infection.
Indeed, this is the largest adult vaccination exercise in human history. Approximately 2.2 billion people have been partially inoculated and 480 million have been fully vaccinated globally. This rapid process has also led to global production capacity struggling to meet demand. Affluent countries had safeguarded themselves by ordering vaccines even before their approval. This is a risky and costly option as Australia found out. It had ordered 160 million doses of the vaccine being developed by New South Wales University. The vaccine wasn’t approved and the Australian government lost its investment of billions of dollars. Developing countries like Pakistan could not afford to order in advance for unapproved vaccines and found that there is very little vaccine to buy in the open market. Not surprisingly then, only 15 percent of all Covid-19 vaccines have been administered in developing countries.
Nevertheless, Pakistan undertook an ambitious programme to procure and vaccinate its population. It has had to buy vaccines from multiple sources as only limited quantities have become available from any one manufacturer. In fact, around 75 percent of vaccine doses that have arrived in Pakistan so far were purchased. We also received vaccine donations from China and COVAX (the global vaccine support facility for developing countries). However, this has meant that there are currently 6 different types of vaccines in use in Pakistan, which has created logistical complexities. Although Pakistan has long had a programme to immunise children, an adult vaccination programme is a novelty.
A system was created to register individuals by their National Identity Card numbers. A person can send their identity card number via SMS and the system then assigns them a location from the over 2200 Covid vaccinations centres established nationwide. The system also ensures that individuals receive both doses (most require 2 jabs) of the same vaccine after a predetermined interval, sends reminders of appointments and missed appointments, accommodates if a person walks in at a different location and issues a vaccination certificate at the completion of the prescribed course. Behind the scenes, each vaccine has different storage requirements, including the use of superfreezers for the Pfizer vaccine and the ability to expand a cold chain to equip the 2200 adult vaccination centres across the country.
This system is working extremely well. Nearly 400,000 doses are administered daily free of cost, making Pakistan 21st on the list of daily vaccinations. Overall, more than 12 million doses have been provided while over 3 million people are fully vaccinated. However, there is always potential for hiccups given the complexity. Every day, some appointments are assigned late or not at all (so people are not recognised by the system when they show up for their jab), or their certificates are delayed. These problems have been extremely rare and all are tracked individually and resolved in real time. Supply poses the greatest threat to the system. Given that there aren’t sufficient vaccines to buy globally, the national supply is managed on a month-to-month basis. Therefore, the vaccination effort is being expanded with half a breath held, as future stocks are only guaranteed for 1-2 months at the current rates.
The vaccination effort comes in the backdrop of reasonably successful overall management of the epidemic. To date, Pakistan has managed to limit the worst effects of the epidemic. As of today, a little less than a million cases have been identified and 21,874 deaths have occurred due to Covid-19. While there is always concern that testing underestimates actual disease prevalence, as is true for every country, there is good evidence that the overall trend is reasonably well tracked with existing data. This data system was built upon existing resources. Now, reports from nearly 5000 hospitals and 3000 field testing teams are collated, analysed and shared publicly at covid.gov.pk daily.
So while things aren’t perfect for a country with limited resources, Pakistan has and continues to manage a pandemic that has devastated even many developed countries. However, the past is no guarantee of the future. Only continued vigilance and cooperation by the public will help.