An Open Letter to the Prime Minister of Pakistan, Imran Khan.
Dear Prime Minister,
Your time as the premier has been dotted with three big challenges thus far. The first came your way when you took the helm of affairs, you were faced with the worst fiscal deficits in the history of our country. You and your team managed to sail us through those stormy waters.
The second challenge came from our (un)friendly neighbour, Modi’s India. You managed to see our country through that tumultuous time as well and dare I say scored a resounding win in that encounter through unconventional leadership, magnanimity and grace.
COVID-19 is the third big challenge of your time. This challenge is unique. The enemy is not visible, the enemy is not known and this shrouds it in a cloud of fear. Opinions are many and varied.
With this letter, I would like to share with you my view on this. It differs from general public health opinion thus I would like to pen my thoughts down. I am a public health physician, trained and educated in business principles and I spend my time-solving problems in healthcare through entrepreneurship.
Point 1: In this time of uncertainty, the evidence is scarce; make decisions based on value systems.
You’ve spoken about standing with the poor and building a state reminiscent of the Prophet’s Medina. At the core of that state were compassion and care. The decision to lock down or not should be taken using the same compass of values too. The death toll to this day is 2600. The first death occurred on the 18th of March. It’s been 4 months. Every single death counts, many epidemiologists are suggesting an astronomical increase in death tolls. The only trouble is these predictions have been coming through since March. Yet, for some reason yet to be proven, we have managed to have a low death toll.
If we close the country down, the push towards poverty, the economic collapse would cause the death of not a few thousand but many more. The locust attacks on our farms in Punjab and Sindh are frankly worrying me more. What will the 200 million in our country do when faced with famine.
Point 2: Generate more data — Prevalence studies and not number of positive cases
Every day wherever I look, the number I see being reported is that of COVID positive cases. To me, that number is meaningless if not misleading. The more effective the testing ability of a country or a province, the higher the number of positive cases we would see. Take for example two equally COVID-19 prevalent regions one has 50% testing the other has 25%. The one with higher testing would show a higher number of positive cases thus making it seem like the virus spread is much higher. This kind of inference is dangerous & will lead to misallocation of resources.
Here are two numbers we need to track religiously — the number of (accurate) COVID-19 deaths and randomized prevalence studies using antibody testing in each of the urban centres of Pakistan. The prevalence studies will give us an idea of the spread. With this number, we will be much more certain about how far along we are on the feared bell curve.
Point 3: Decision-making panels — Economists, Public Health practitioners, sociologists & philosophers
I have largely been in alignment with you on how you’ve dealt with making decisions during this crisis. However, hearing from you more often during this time of crisis would’ve been reassuring. There must have been many things on your plate so I could understand how this might have slipped through.
Now to decision making. this is perhaps the time to centralize decision making, times of crisis are not dealt with very well by the hurdles of bureaucracy. Having worked with the government in times of crisis in the past. I am sure there are several special committees in place. On those committees, it’s possible that there are many public health practitioners. Here’s a few more people that should also have a seat at the table.
Economists: For obvious reasons, this pandemic is a public health & an economic challenge; you might have those already
Sociologists: These unprecedented times will require an expert in human behaviour to predict the best possible ability for how events would cause people to react. Extraordinary times mean the masses will react in unusual ways.
Philosophers: This last one I wonder how many of merit we really have in our country but if we do, let's use them to help us make wise & bold decisions. Let them question our thinking on logic rather than mere emotions.
With these diverse panels to make decisions with our response would be wholesome, human-centred and rational. We would avoid the pitfalls of reactionary decision making and inshallah we will sail through this challenge like we did with the past two you faced during your prime minstership.
All the best with this challenge. I am doing a few things in my own capacity to make your work easier and the lives of our people safer.
Best,
Mohsin
