So far Pakistan has fared well in its fight against COVID-19. In a country with over 212 million inhabitants, to date roughly 303 000 cases have been recorded and the curve of new infections has flattened since its peak in May and June.
For a developing country facing other crises, this has been a welcome relief.
At the heart of the country’s battle has been Dr Palitha Mahipala, WHO Representative and Head of Mission, originally from Sri Lanka and based in Islamabad, who has been working around the clock seven days a week since the beginning of the pandemic.
“WHO focuses on different aspects of the COVID-19 response in each country. But in Pakistan, the Organization has been involved on every level and has had a significant impact”, says Dr Mahipala.
WHO had been working on many fronts in Pakistan during the pandemic even before the country recorded any cases.
Policy engagement and expert support
Dr Mahipala acknowledges that he wouldn’t be able to lead WHO’s crucial work without the support of Pakistan’s Ministry of Health, with whom he meets “every day or every other day”.
Working with the Government on high level advocacy and policy dialogue is the first level of WHO’s multi-faceted approach to fight COVID-19 in Pakistan.
“What are the measures the government is taking? What is the highest level of commitment we can have?” These are some of the questions that drive the doctor’s work in the policy area.
Technical assistance is another area of WHO’s work plan.
“From early January, the moment WHO headquarters sent us the technical guidance, I was working the same day with the Minister of Health on our response strategy. At that time, we didn’t have a single case. We didn’t have testing capacity. The first thing we did was to draw up a national action plan according to the pillars identified by WHO,” says Dr Mahipala.
On 23 April 2020, Pakistan launched its Strategic Preparedness and Response Plan, prepared by WHO, as a global online event and platform where it was able to raise US $595 million from donors around the world. The plan and the funds got Pakistan off to a strong start in its fight to stop the spread of COVID-19.
Strengthening points of entry and testing
When Pakistan didn’t have any cases of the new coronavirus, and neighbouring countries such as Iran were recording high numbers, controlling points of entry was crucial. WHO played a strong role in trying to slow the arrival the disease.
In mid-January, WHO and the Ministry of Health began screening potential cases and distributing information pamphlets about the risk of the disease to arriving passengers at Islamabad airport. To protect airport staff, WHO provided training and distributed personal protective equipment (PPE). After working on securing Islamabad airport, Dr Mahipala and WHO teams assessed and strengthened other airports as well as isolation and quarantine centres with the Ministry of Health.
When asked about Pakistan’s biggest gaps, Dr Mahipala says that in the beginning of the crisis Pakistan could only test about 200 people per day. But WHO quickly helped the country ramp up its testing capacity.
“Within six to eight weeks we were up to 30 000 tests per day. We expanded that further and now we can do more than 50 000 tests per day,” he says.
Once again WHO was involved in all the areas of strengthening Pakistan’s testing capacity. WHO obtained tests, supported the hiring and training of staff to carry out testing, and assessed labs all over the country. The Organization has also been providing staff with PPE, transporting test samples and adding PCR machines to the country’s testing system.
Protecting frontline health workers
WHO has been committed to protecting frontline health workers throughout the crisis and Pakistan is no exception, although sadly there have been casualties.
At the time of speaking, Dr Mahipala says that he knows of more than 6 000 doctors, nurses and paramedics who have been infected as well as some deaths.
To support those who also work to protect the rest of the country population, WHO and the Ministry of Health created the WECARE program, which so far has trained 100 000 health care workers on safety practices. In addition to training, the program supplies PPE and motivational support through videos, TV and radio programs.
Acknowledging the crucial role of health workers, Dr Mahipala says: “We need to recognize them as frontline heroes looking after patients and putting their lives at risk.”
Another stream of WHO’s work in Pakistan is research and development, which has involved undertaking large scale studies of COVID-19 cases by staff in Pakistan and supported by WHO colleagues in Geneva. “That will add knowledge not only to Pakistan but also globally,” the doctor points out.
The groundwork WHO and Pakistan have laid on combatting other diseases has been a decisive factor in limiting the severity of the COVID-19 outbreak so far.
From the beginning of the crisis, polio staff carried out surveillance and provided training to frontline health workers. “The polio infrastructure we have and related campaigns were fully utilized for COVID-19,” says Dr Mahipala.
WHO Director-General Dr Tedros Adhanom Ghebreyesus had previously commended how the country capitalized on its previous work on polio: "Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children have been utilized for surveillance, contact tracing and care."
This success has also helped WHO in Pakistan raise further funds.
With cases at a low level, another problem is arising—complacency among the population in cooperating with public protective measures.
In the current phase of the outbreak, Dr Mahipala and his colleagues are focusing more on communications as a key aspect of the response.
“We really built on communications channels we set up for polio. Radio penetration is high and so is social media, which we were already using for polio.”
Mobile phone communications has also been key. “Here even people who have barely anything have a mobile phone, or more than one,” he explains.
WHO has also worked with religious groups and scholars to get their messages out in Pakistan.
Despite relative success in the fifth most populous country in the world, COVID-19 has been a formidable challenge.
Dr Mahipala realizes how fortunate Pakistan has been so far and recognizes the dedication of the people who have helped tackle COVID-19.
“There are people who are totally steadfast devoted, who haven’t been home since January.”
But the work goes on, he says.
“We change our strategy as the pandemic evolves. We change our plans as cases rise and fall.”