On 26th February 2020, Zafar Mirza, then State Minister of Health, confirmed the first two cases of COVID19 in Pakistan. Initial cases came from the passengers who had arrived from Iran and China, until 13th March 2020 when the country witnessed its first locally transmitted case in Karachi. As a result, Pakistan shut its western borders and educational institutes on 13th March 2020. From 21st March 2020, provincial governments started imposing ‘smart’ lockdown, Sindh being the first. On March 18th 2020, Pakistan had its first two COVID19-related deaths. From February 2020 to July 6th 2021, the total number of cases were 964,490 out of which 908,648 have recovered and there are 33,390 active cases. The country currently has a 2.3 per cent fatality rate with the total number of 22,452 deaths.

1. Sinopharm
2. Sinovac
3. Sputnik V
4. CanSino
5. AstraZeneca
6. Pfizer
7. Moderna
8. PakVac

2nd February 2021

The government is leading the vaccination programme and providing vaccines through public hospitals and vaccination centres. Vaccines, administered by the government, is are free and can be accessed through registering at the government site or sending your national identity card number to 1166. After the 18th Amendment, which devolves power to provinces, the local governments in four provinces and two autonomous regions health are responsible and running their programmes.
However, Pakistan has also allowed the private sector to administer two of its approved vaccines i.e. Sputnik V and CanSino. Private hospitals and health centres are charging up to 12,000 PKR (£55) for two doses.

Although Pakistan had pledged to set aside $250m for the COVID19 vaccine procurement, the country depends on foreign donation schemes and commitments. In fact, the government had seemingly no plan to buy vaccines and mainly relied on ‘herd immunity and donated vaccines’ as confirmed by a government official. From the first batch of Sinopharm (500,000 doses), which arrived on 31st January 2021, to the first shipment of AstraZeneca received on 8th May 2021 to 100,000 doses of Pfizer which arrived on 28th May 2021, the government has managed to procure these doses through appeals and diplomatic efforts.

As of July 7th, 18.2 million doses have been administered of which 14.6 million are partially vaccinated and 3.5 million are fully vaccinated.

Pakistan’s vaccine roll out is slow for two key reasons such as vaccine dependency and weak health infrastructure. However, vaccine hesitancy or scepticism is significant and cannot be ignored as one of the factors behind the slow pace. There are two primary reasons which are contributing to hesitancy i.e. misinformation/conspiracy theories and lack of public trust in state authority. One health reporter from Lahore, Punjab, informed that vaccine scepticism, already filled with misinformation, reached its peak when Prime Minister Imran Khan tested positive just two days after his first dose of the vaccine. Also, punitive measures by the government (including provincial) such as stopping salaries, blocking mobile SIM cards or making vaccines mandatory for government and private employees suggest that the government is targeting the prevailing sense of hesitancy among people.

Besides a weak healthcare system, there are three main challenges the country is facing that are effecting, or will eventually affect, its immunisation programme. The first is the dependency on foreign donations. This makes the supply of the vaccine inconsistent and, subsequently, puts the immunisation process on halt. For example, on 20th June, most of the vaccination centres were short of the vaccine and, subsequently, some of them were forced to temporarily shut down. In Sindh alone, there were 90 vaccination centres where the operation was suspended due to the shortage. One may witness this shortage phenomenon across the developing world as they are seeking vaccines through the Covax programme, a scheme that aims to provide 1.8 billion doses to 92 ‘low- or medium-income countries’. The consequence of the shortage may increase the risk of more waves as more than 90 per cent of the population are yet to receive their first dose in these countries including Pakistan.

“countries such as Saudi Arabia—where thousands of Pakistani work and contribute $7b to the country’s remittance—has not approved any Chinese vaccine. Similarly, the EU is yet to approve any Chinese or Russian vaccine… This leaves any country that is dependent on vaccine donation particularly coming from China with uncertainty and puts further pressure on the healthcare system.”

The second issue, which is linked to the first, is vaccine politics and its effect on ‘developing’ nations that are relying on vaccine donations. The majority of doses of vaccines have come from China i.e. Sinopharm, CanSino and Sinovac. The issue here is countries such as Saudi Arabia—where thousands of Pakistani work and contribute $7b to the country’s remittance—has not approved any Chinese vaccine. Similarly, the EU is yet to approve any Chinese or Russian vaccine. As a result, those who already had their two doses are now rushing to get a third dose to travel for work or tourism. This leaves any country that is dependent on vaccine donation particularly coming from China with uncertainty and puts further pressure on the healthcare system.
The third challenge is linked to Pakistan’s roll out strategy. There seems to be a clear focus on the urban population living in Karachi, Hyderabad, Lahore, Islamabad and Quetta. There is little detail available about the vaccine roll out in remote and rural areas where around 60 per cent of the population live. Azmat, a health report associated with Channel 44, shared that people in rural areas still lack basic awareness about COVID19 and are vulnerable to misinformation and conspiracy.

The government also needs to reconsider its top-down approach which mostly includes implementing and monitoring SOPs. This approach fails to build a grassroots narrative that could encourage people to get vaccinated. To address this, it requires an inclusive and community-based approach which should include religious leaders, members of religious minorities and civil society organisations. Although the government had involved religious leaders of the Muslim majority, it has so far neglected engaging minority religious leaders. The religious minorities, particularly Christians and Hindus who live under extreme conditions such as ghettos, limited healthcare, and informal settlement, are more vulnerable given their historic socioeconomic marginalisation. Therefore, a collaborative effort is required to raise awareness through church and temple that could appeal to wider members of these communities.