The critical ingredient that remains missing from Pakistan's Covid response strategy

Dr Faheem Younus 

The focus in Pakistan must shift from policy to mass education, from analysis to practice.

 We drive cars but don’t venture to fly a plane. Why? Because we are not trained pilots.

That’s how it is. Managing our personal Covid realities is like driving a car; carrying a nation through a mercurial pandemic requires trained pilots. But when non-professionals try to fly planes, nations end up with confusion and chaos.

That’s what may have happened with Covid-19 in Pakistan where June 5, 2020 marked the 100th day of the outbreak. And during those 100-days, who educated the country about the disease? Politicians, anchors, doctors, bureaucrats, and others. And what was the focus of those communications? Policy debates, boilerplate analysis, and a potpourri of treatment plans. Our national discourse largely revolved around a single word: lockdowns.

This needs to change. The focus must shift from policy to mass education, from analysis to practice. This requires a panel of experts endorsed by the government and the local medical bodies. They should study the evolving science of this novel coronavirus, then communicate its symptoms, diagnosis, treatment, and preventive strategies to laypeople, daily. The goal is to train a nation on how to tackle this pandemic.

Imagine if, during those first 100 days, a panel of experts answered questions from the general public every night on TV? Instead of fueling conspiracy theories or allowing folklore to muddle the conversation, imagine if these experts were regularly dispelling myths? How far along would Pakistan be?

That’s public health 101. Outbreak breed rumors. Having managed many outbreaks, I know why calm, honest, communication is vital. Sadly, on February 15, as the World Health Organisation (WHO) was warning the world about the risks of an "infodemic", Pakistan was veering into one.

Today, Covid-19 is going viral, literally. The total number of cases has crossed 120,000. And since our testing is almost 20 times less than many developed countries, it's plausible that the real number of cases might be manifold.

So, where do we go from here?

I believe a unified messaging about Covid-19 itself should be a top priority. Some may argue that it’s too late; the virus is already widespread. I disagree. According to the WHO, coronavirus might never go away — i.e., we don’t know how many 100-day cycles Pakistan will face. Others believe so many educational campaigns already exist, through apps, websites, TV ads, social media. I agree. But it's one-way communication. People don’t have a forum to ask their questions and see the experts. When armies attack countries, people find solace in hearing from their generals. Why shouldn’t Pakistanis hear from an expert medical panel during a pandemic?

Here is a suggested structure: based on competence, this three-person expert medical panel should constitute of specialists in epidemiology, infectious disease, and outbreak management. They should be coached in principals of mass communications and then provided with an hour on prime-time TV, across all channels, daily. TV channels should solicit questions from viewers ahead of time and allow the experts to give rapid-fire, data-driven answers. Be bold to reject urban legends. Be kind while listening to a difficult situation that may not have a solution. A good session should answer around 50 questions/hour. Let this panel become the face of Covid-19 defence in Pakistan. The idea is not to compete against the existing health structure but to complement it.

This system works. We implemented it in our hospitals after experiencing the first Covid-19 patient. Every day, we answered 30-40 questions from our team members on a 30-minute conference call. Despite being in an affluent country, we struggled with tests and supplies, but we never struggled with messaging. Witnessing our 3500+ strong team quickly adapted to a new reality was like watching a teenager quickly learn to drive.

And drive we must because nations cannot remain under lockdowns. Just like we learn the rules and risks of the road before getting our license, we should learn the rules and risks of driving through this pandemic. Accidents will happen, but they won’t paralyse us. With time we will become safe drivers. The panel should also be cognisant of four things: politics, trust, credibility, and expectations. Remain apolitical. Don’t lionise the government and/or criticise the opposition (or vice-e-versa). Earn people’s trust that the effort is sincere and not self-serving. Anchor your recommendations with WHO wherever possible. This will infuse discipline and credibility in the process. Yes, WHO has made some controversial decisions, but its core strategy has allowed many countries to contain the virus. Set the expectation that this panel will make errors, that they will backtrack some of their statements. That’s the nature of evolving science.

Gradually, this may shape a culture where mass communication practices deference to expertise. It costs very little. The government should opine on policy, economists should explain financial risks, and medical experts should talk about the virus itself.

People say, "how can a large resource-limited country like Pakistan win against Covid-19?" I ask, how did Vietnam — a third world country of nearly 100 million people — stop the pandemic in its tracks by limiting the number of infections to 332? How come they had zero Covid-19 deaths? Because they trusted the science, effectively communicated, and mounted a unified defence against a unified virus.

Maintaining the status quo will breed more confusion in the coming days. Misinformation loves a vacuum. Fill it with expertise or accept chaos. Each case, each death will fuel further panic.

If this plan is executed correctly, the next 100-days may look like this: Millions become engaged and educated through a daily question-answer session on TV. Within 1-2 months, they learn the rules of this disease and start following policies, instead of debating them. Pakistan’s economy opens, and Pakistanis carefully drive through this pandemic until we reach the destination of mass vaccination.