Q. In what ways do you think Pakistan’s response to Covid-19 can translate into long-term healthcare evolution that will help mitigate future infectious disease outbreaks?
Dr Sultan: COVID-19 has taught us many valuable lessons that will play a vital role in ensuring that we are better prepared and equipped to tackle future infectious disease outbreaks.
One of the fundamental interventions was to create a national coordination and command centre, which will evolve and merge into a full-time structure to deal with pandemics and other such emergencies.
In Islamabad, we built a 200-bedded infectious disease hospital and most of the provinces have put in similar enhancements in capacity, so that the capability and capacity in the country has been boosted to cope with the current and future burden.
We have implemented several measures to strengthen our laboratories as well as our surveillance and tracing capacity. Furthermore, our PCR testing capabilities have significantly grown, with over 100 new labs.
Now we are looking at where the synergies are and the strategies from our COVID-19 response that can be implemented for polio, hepatitis C and other diseases.
Related read: Accelerating Access in a Pandemic
Q. What can emerging nations do to overcome challenges such as lack of resources in testing, to still manage outbreaks?
Dr Sultan: Prioritisation and investment in the healthcare sector is key. When an infectious disease impacts low- and mid-income countries where you have a persistent level of infectious diseases like hepatitis, TB, polio and malaria, it not only influences health outcomes, but also negatively impacts the economy.
Understanding the severity of the issue is essential for policymakers as it leads to appropriate prioritisation which helps to determine the kind of investment that needs to be made, for example investing in testing.
In a country like Pakistan, if we had adequately invested over the last few decades then the fight against COVID-19 would have been easier. In the midst of the pandemic, we had to innovate and do things that we had never done before, and to some extent this applies to all countries.
What COVID-19 has taught us is that health cannot be a second priority. Resources will always be limited but targeted prioritisation can still be effective when directed towards building and strengthening much-needed infrastructure such as laboratories.
Lastly, we must look at health not just as health outcomes but also as health security and the wider impact of such outbreaks on our society.
Pakistan is learning from its experience with COVID-19. We are reforming our health security institutions along with our public health institutions. There is a sense among all that this is necessary.
Q. How would you describe the role of diagnostics in Pakistan’s epidemic prevention strategy?
Dr Sultan: Accurate diagnostics has been one of the key pillars of Pakistan’s epidemic management strategy. Testing provides critical information and data which is essential for all interventions and for appropriate care delivery.
Without that, you cannot prevent, mitigate or suppress the pandemic. Quite simply, if you don’t know where the outbreak is, you can’t tackle it.
Pakistan was among the first countries in the sub-continent to acquire diagnostic capability against SARS-COV-2 and we have consistently increased our diagnostic capabilities. More is always good in this situation, but we have been able to scale up to a point where a strategic deployment of testing has served our needs well. One clear lesson is that it is quite difficult to scale up testing capability during a pandemic which is why the investment in healthcare must think beyond today and how we can address future outbreaks and pandemics. Equally important is a unified national response. To do this, we established a National Coordination Council for COVID-19 in Pakistan which is chaired by the Prime Minister and its operational entity, the National Coordination and Operation Center (NCOC).
Q. What’s next in terms of your eradication efforts for other diseases?
Dr Sultan: Pakistan is one of the two countries that still has the transmission of polio but we are committed to its eradication. The COVID-19 pandemic hampered our efforts and the timeline of our Polio Eradication Programme, but we are now back at full speed and recently launched a campaign.
Our country is also about to embark on one of the most ambitious hepatitis eradication programmes in the world. The Prime Minister’s Hepatitis Elimination Programme aims to screen and test over 100 million Pakistanis and treat everyone infected.
There are synergies in our efforts against infectious diseases; for instance, hepatitis and our response against COVID-19. As the testing methodology for hepatitis C is also PCR-based, a lot of the testing can be interchangeable.
However, progress has not been satisfactory when it comes to our work against HIV, TB and malaria. COVID-19 has shown us that Pakistan can tackle infectious disease effectively and with the interventions we are putting in place, I am confident we will see positive results over the next few months and years.