Handling crises

WHAT is the likelihood that Pakistan will ban visitors to and from China during the coronavirus outbreak? Nil - and this is probably proportionate in light of what we know about the virus and the Chinese response. But make no mistake, this decision will be driven by political considerations rather than public health concerns. And given the health challenges that the 21st century holds in store, Pakistan has to move beyond a realpolitik approach to crisis management.

Reports surfaced over the weekend about a Chinese man admitted to a Multan hospital with a suspected case of coronavirus. There are more than 20 flights in and out of Pakistan from China each week. An estimated 1,500 Pakistani traders travel to China frequently, and there are 28,000 Pakistani students in China.

To its credit, Pakistan pre-empted the first suspected case by screening passengers boarding inbound PIA flights in Beijing and installing thermal scanners at major airports. There have also been the stirrings of coordination on how to tackle a coronavirus outbreak between the health ministry, the NDMA and the Army Medical Corps. But we aren't prepared to handle a major outbreak of a communicable disease. A booming population, rapid urbanisation, city sprawl, and poor health literacy among the public create a toxic mix. Recent dengue outbreaks have highlighted the lack of collaboration between health administrators and environmental, sanitation or public works departments.

How prepared are we to deal with disease challenges? The healthcare system is too fragmented to deliver a coordinated response to an outbreak. There's the split between alternative and medical care (i.e. hakeems vs clinics) and the divide between public and private sector healthcare, with the latter reporting minimally to the former. Within the public sector, health administration is arbitrarily carved up.

Such bureaucratic failings can be addressed. Indeed, we saw them being overcome during last year's response to the dengue outbreak in Islamabad and Rawalpindi, during which a high-level cross-departmental and interdisciplinary team launched a coordinated response. This included medical interventions and monitoring, hotlines, disease tracking, garbage clearance and spraying.

But our undoing in the face of any public health crisis will occur as a result of intrinsic flaws in our democratic culture, not just gaps in political administration.

The overall disdain for transparency is the greatest challenge. Petty bureaucrats prefer to suppress bad news rather than face accountability or criticism. This is what happened in Wuhan, in China's Hubei province, where the coronavirus outbreak began. Local officials initially underreported the disease, delayed providing updates on cases of human-to-human transmission, and tried to quash online discussions on the topic. Rather than let on something was amiss, Wuhan officials allowed a public gathering of more than 40,000 households in January, even after China had reported the outbreak to the WHO.

This cover-up mentality would have persisted if President Xi Jingping had not delivered a strong message on state television prioritising public health. The world is now praising how China's mega-bureaucracy is responding to the outbreak. Few are discussing how a strongman approach to politics allows crises to fester, as local officials become paralysed, prone to passively awaiting information and direction from the top, rather than taking any initiative lest it impact their ability to curry favour. We should also not be naive about the chilling effect of top-down demands for better service delivery or crisis management. While the messaging is right, the authoritarian dynamic creates a counterintuitive approach. Burea-ucrats begin to fear punishment for failings, and cover up what they can. Demands for accountability only work in the context of transparent institutionalised systems, data sharing and incentives for responsiveness.

Pakistan would also suffer due to the media's lack of credibility in the event of a public health crisis. Responsibility for this lies both with the state that has sought to undermine an independent media, and with the industry itself for chasing ratings at the expense of integrity. But the consequences of what has so far been political jockeying could be severe. Since the public now defaults to conspiracy theorising and dismissing all content as ' fake' or ' bought' news, there are no channels available for an effective public information campaign.

During a public health crisis, the most important control factor is the community- or household-level response in terms of reporting and sanitation. We need to build up credible platforms that can disseminate public health information at short notice.

Pakistan likes to learn from China, and will focus on the heavy-handed coronavirus crackdown. But we stand to learn more from our friend's failings, and should dwell instead on what came before.