More than two months after the World Health Organisation declared Covid-19 a “public health emergency of international concern,” world leaders are still trying to make sense of the outbreak. South Asia, with its many political divisions as well as lack of health infrastructure, is facing a particularly tough set of challenges.
The number of reported cases in South Asia remains relatively low but given the limited and questionable quality of diagnostic testing with limited health response capacity of each country, questions have been raised about the epidemiological stage of the outbreak and the region’s preparedness to handle the Covid-19 outbreak.
Nevertheless, the crisis may also provide an opportunity for the countries of the South Asian Association for Regional Cooperation (SAARC) – Afghanistan, Pakistan, India, Maldives, Nepal, Sri Lanka, Bhutan, and Bangladesh – to fight the pandemic together. As part of the joint collaboration India has pledged USD 10 million, Pakistan has pledged USD 3 million, Sri Lanka has pledged USD 5 million, Bangladesh has pledged USD 1.5 million, Nepal and Afghanistan have pledged USD 1 million each, Maldives has pledged USD 200,000 and Bhutan has pledged USD 100,000.
Zofeen T. Ebrahim spoke to Zulfiqar A. Bhutta, a member of the Pakistani Prime Minister’s health task force and WHO Pakistan’s advisory committee on Covid-19 response, and asked him why it is important for SAARC to join forces.
Are the South Asian scientist and medical communities capable of dealing with the pandemic?
Yes, we are, but only if we put our differences aside and work together. This cannot happen if there is vitriol and xenophobia dividing people of the region. Unlike politicians, Covid-19 does not discriminate on the basis of [political] boundaries or religion and affects everybody equally. The government of each country can begin by first valuing its own fraternity of scientists and public health practitioners. They are hardly ever called upon for guidance, but even for those individuals who do manage to make it to the inner circle, their advice is often not taken seriously and suggested measures remain unimplemented.
We know the governments have a hard time cooperating and confiding or sharing information. Does the scientific fraternity also suffer from this problem?
This global outbreak is a perfect example for all to see how dysfunctional the SAARC secretariat has been with regard to public health measures and outbreak preparedness. After a belated leadership level meeting it has taken over a month to even get the health ministers to talk to each other. There has been no concerted effort to bring public health leaders and scientists together, even virtually. This is affected by regional politics and mistrust. The scientific community is likely to be less bigoted but not immune from nationalistic hubris and pressures. Now is the time that governments lifted restrictions placed on people-to-people and university-to-university exchanges to address one of the greatest public health challenges of our generation.
Is there time still to develop a centre where information can be gathered, ideas weighed and solutions developed? Where would this centre be? Who would staff it?
Absolutely, and SAARC secretariat should facilitate this. If not now, when we face this existential threat, then when? There should be a repository of information and exchange on the latest epidemiology, assessment of risk factors, approaches for prevention and treatment and facilitation of basic research. The region’s exposure in terms of relatively poor quality of care in health systems, especially in rural areas is enough justification to work towards addressing this in unison.
Why is it necessary to join forces?
We have a common enemy that does not require a passport and can move invisibly from one country in the region to another. If the larger region is to avoid a public health catastrophe similar to the influenza epidemic of 1918-19, which had killed an estimated to 6-18 million people in British India, we must work in unison, share information, develop a database of results and come up with a standardised approach for prevention and treatment.
Do you have a step-by-step plan?
The first step is confidence-building and the creation of a common resource and communication hub. I am trying to make a case for this. The way I see it, the key is collaboration at different levels and breaking down unnecessary silos. Collaboration can be between students, academics and researchers within the region. There can be both country-level as well as regional level linkages – three-way collaboration between entrepreneurs/start-ups (local enterprises), the state (that can provide a security plan), and the industry (like biotechnology, pharmaceutical).
It also requires coordinated engagement between the centre and provinces. The benefit of such collaborations is that the region has advanced pharmaceutical and biotechnology manufacturing platforms so it is possible to quickly come up with low cost but high-quality diagnostic systems and over time, vaccines and therapeutics.
It is the third set of collaborations that is presently difficult both within and between countries [the connect between the federal and provincial levels]. The communication between the centre and provinces within a country such as Pakistan should not be limited to video conferences alone between ministers of health, government functionaries and development partners in health, but also include experts from finance, education, science and technology among others.
You may well come up with the solution, but what about the finances? What about the equipment, and the trained human resources needed for this?
This will be a step-by-step process and I am convinced that there are adequate resources to support good ideas. The first step is a portal where we can combine intellectual efforts and resources. This can be financed with existing funds and time and others can add to this. I think SAARC has reasonable resources therein and then there is always global support available to facilitate. Remember money follows ideas, not the other way around.
What does the future hold for this regional cooperation?
We need to be better prepared. This is just a trailer of what might follow in future; more of this will happen. We need investments today to deal with such threats tomorrow. Covid-19 should be a wake-up call to invest in healthcare preparedness [that is often seen as an “unnecessary”] expense. Right now, there are tremendous gaps and the virus has exposed these. For example, there is no infectious disease surveillance and control system. There is not a single health think tank or academic centre with epidemiological expertise [in the region], say like London’s Imperial College, that guided policy both in the UK as well as the US.
Can South Asia play a special role? While the vaccine is being developed can a cure be found using plasma from an infected person for treatment of those critical through passive immunisation?
It is still early days for SA as the Covid-19 epidemic has not hit us like it has hit the UK, the US and Europe. It would be very presumptuous to say we can find the solution. More important matters at hand are to sort out our own backyard, crease out differences, promote peace within the region than try to teach the world what to do.
As for the plasma treatment, it is too crude yet. The Chinese have now developed additional antibody concentrates (from plasma) to treat patients but these are still under trial. I am afraid in Pakistan many people tend to take advantage of mass fear and the situation to peddle half-baked and unproven treatments. Plasma therapy for Covid-19 infections may have its protagonists but there is a step-by-step process for scientific validation. At this time in Pakistan, there is insufficient experience and evidence from Covid-19 patients with a certain severity of illness for us to recommend this beyond research.
Zulfiqar A. Bhutta holds directorships at the SickKids Centre for Global Child Health (Toronto, Canada), and the Centre of Excellence in Women and Child Health at Karachi’s Aga Khan University. He is chair of noted international organisations and editorial advisor to medical journals like the Lancet and the British Medical Journal (BMJ). Last month, he co-authored an editorial on the Covid-19 situation in South Asia in the BMJ with inputs from Nepal, Bangladesh and India