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Dawn Editorial 11 May 2020

Healthcare lessons

PARTS of the world are beginning to emerge from the worst of the coronavirus pandemic. Battered and bruised they understandably are, but in the long run what will sustain them and all the others who are still in the thick of the crisis are the lessons learnt from the horror they have lived through, and their willingness to act on them. On Wednesday, at a virtual briefing in Geneva, the World Health Organisation chief Tedros Ghebreyesus said as much when he urged countries to invest in their healthcare systems rather than scramble for solutions when the next pandemic arrives. “We cannot continue to rush to fund panic but let preparedness go by the wayside,” he observed. The world, he added, spends around $7.5tr annually on health — amounting to nearly 10pc of global GDP — but had for too long neglected investment in preparing for emerging pathogens.
Pakistan is far from out of the woods, and the next few weeks could be critical. All eyes are on the country’s creaky health infrastructure as it comes under increasing, unbearable strain. The pandemic has been a rude wake-up call for the country’s leadership and its skewed priorities that have always placed security concerns above all else. Health is chronically underfunded, far below 6pc of GDP recommended by WHO. Planning is shambolic: a substantial chunk of even the inadequate health budget often lapses by the end of the fiscal year. Several chronic medical conditions — exacerbated by cultural practices, lack of access to quality health services and often ineffectual public awareness campaigns — are endemic to the population. These ailments, among others, include hepatitis C (one of the highest prevalence rates in the world), tuberculosis and of course polio, where we stubbornly remain among the last two countries where the disease is yet to be eradicated. Sporadic, seasonal outbreaks of dengue, measles, Congo-Crimean haemorrhagic fever, etc add further to the disease burden and the toll on the economy through lost working days. Moreover, because Pakistan has been so remiss on the health front, challenges thrown up by the pandemic could make us fall behind still further. Reports suggest that the lockdown has adversely affected children’s routine immunisation as well. And two WHO reports indicate that disruption to health services because of the contagion could cause a 20pc increase in TB incidence over the next five years.
After the coronavirus storm finally passes, it should not be business as usual. Pakistan’s ramshackle public health sector must get the funding and the priority it deserves. Instead of a fragmented approach that leans towards firefighting, there must be holistic, multi-sectoral preventive health programmes engaging a wide range of stakeholders. It is also time to kick-start the country’s moribund population planning programme. This once-in-a-century pandemic should be accompanied by the realisation that health must be treated not as a privilege, but as a right.


A divided world

ON Friday, UN Secretary-General António Guterres condemned the “tsunami of hate” that is being witnessed in the midst of the novel coronavirus pandemic. There may indeed be a spike in the number of hate crimes and xenophobia globally, taking a uniquely ugly shape in each country it poisons, but much of these resentments were already in place before the pandemic unleashed itself. The seeds of division were planted long ago, and have seen the sudden rise of populist leaders who capitalised on divisive sentiments to come to power. As people now search for scapegoats to pin the collective blame on, racism and paranoia have only intensified. In particular, Chinese and Asian-descent people have been the target of verbal harassment and physical assault. In the US, a man from Myanmar and his young children were stabbed by a teenager who thought they were “infecting people with the coronavirus”. In Australia, a video surfaced of an unruly woman kicking and spitting at two sisters of Asian descent. In Italy, racist graffiti appeared overnight, and in one video, an elderly Asian couple are being followed by a man with a camera, calling them “filthy” and “disgusting”. On the other hand, in China itself, African immigrants were subjected to racism after being accused of carrying the virus. In India, Muslims have been repeatedly targeted, attacked, humiliated, and in some instances, barred from entering their homes and villages. In Bulgaria, the Roma community cited discrimination after facing stricter lockdown measures.
To make matters worse, the misuse of technology and the rapid spread of disinformation and conspiracy theories have led to minority groups being singled out for violence. Mr Guterres particularly voiced his fears about the increasingly rabid anti-immigrant sentiments, Islamophobia and anti-Semitism, but also extended his concerns to various professional communities who are on the front lines of the battle against the virus: journalists, healthcare practitioners, human rights activists and aid workers. Then there is the stigmatisation of sickness, with Covid-19 patients being subjected to cruel and careless words and ‘jokes’, increasing their sense of isolation and helplessness. With the virus continuing to claim victims at an alarming scale, it is shameful that, even in these desperate times, better sense has not prevailed. The pandemic presented an opportunity for unity, collective action and the recognition of our shared humanity. Instead, the world is as divided and unkind as ever.


The informal challenge

INFORMAL workers everywhere are the most threatened by the situation arising out of the Covid-19 pandemic. An ILO report has acknowledged this fact as it builds a case for maximum possible protection for the 1.6bn informal-sector workers across the globe. The report focuses on the double-edged sword that these countable, yet in so many ways unrecognised and exploited, workers have been exposed to thanks to the dangerous virus that targets both lives and livelihoods. These informal workers ie fruit vendors, domestic help, doorstep salesmen, gardeners, etc, whose jobs have been insecure even in better times, are perhaps the earliest economic martyrs of Covid-19. Already many of them — men as well as a large number of women with almost invisible jobs — have received the bad news that a world with closed doors cannot support the type of trade or service they offer. The numbers all over are going to rise before policymakers go back to the drawing board to redesign the world along the lines of hopefully more humane economic principles.
Health and exposure to disease has been one area of concern for those trying to steer the informal workers towards some kind of security. The ILO report hints one more time at the grave health risks that come with informal work, such as domestic labour for example. Denied any kind of formal medical cover, people working as domestic help or in small-scale informal industries or at a limited level on their own cannot afford medical care. And given their particular circumstances they are most likely to be asked to perform chores that force them to intermingle and take them deep into danger zones — for instance, kitchen workers who may be exposed to infections their employers are afflicted with at a particular time. Small shopkeepers, plumbers and tailors working diligently to complete Eid orders all populate the informal sector. Covid-19 is a reminder that they too need to be protected from both the infection and economic hardship.


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