ajor infectious diseases and viral epidemics threaten to overwhelm overstretched health systems. However, resource allocation and infrastructure capacity in Pakistan do not indicate and adequate recognition of the danger potential epidemics pose to human lives, health delivery system and, by extension, the national economy.

“In the absence of sound policymaking and budget/ resource allocation, Pakistan is far from prepared to preempt epidemics or develop effective strategies for containing the diseases and harm reduction. This involves planning for setting up systems to raise alerts about imminent epidemics and prepare in advance for adequate response,” says Dr Somia Iqtidar, an associate professor of medicine at King Edward Medical University and secretary general of the Pakistan Society of Internal Medicine.

The International Day of Epidemic Preparedness 2023 will be commemorated on December 27. It was first-observed in 2020 after the Covid-19 pandemic struck the world. It is meant to be a reminder of the importance of being prepared for, and responding to, public health emergencies. The epidemics range from influenza and vector-borne viruses to the spread of antibiotic-resistant infections.

To prepare for epidemics, says Dr Somia Iqtidar, the World Health Organisation urges member countries to strengthen their public health systems and capacities, including surveillance systems, laboratories and the health workforce. Pakistan must cope with imminent threats of viral epidemics and climate change disasters. This involves development of strategies for early detection, rapid response and containment of outbreaks of virus transmission and organism growth during floods, etc.

Dr Iqtidar mentions that the NIPAH virus was first detected in Karachi and other parts of Sindh. A patient was later diagnosed with the locally-acquired virus in Services Hospital, Lahore. “A well-equipped system can identify the suspect water reservoirs for early detection, prevention and containment of such vector-borne diseases,” she says. Containing epidemics and mitigating harm, she says, also requires setting up emergency hospitals, isolation areas and laboratories, as well as research and development for vaccines.

“Global warming has given rise to vector-borne diseases such as dengue fever, chikungunya and Zika virus,” says Prof Leo Yee Sin, a former executive director of the National Centre for Infectious Diseases, Singapore. She says frequent travels around the globe and rapid emergence of mega cities, unable to handle sanitation and environmental needs, as reasons, among others, of spread of these viruses.

In the Punjab, disease surveillance has been conducted since 1980s. The Hospital Management Information System is still the official format approved by the by Health Department. Health care facilities are required to furnish monthly and yearly reports mentioning the number of cases of various priority diseases. The data is entered in the computers at the Directorate General of Health and analysed.

World Health Organisation has established its own Disease Early Warning System and standards for alert generation. Started as a manual system, it has been replaced by a real-time dashboard.

The Punjab Information Technology Board has provided a venue for real time data entry, Disease Surveillance System dashboard and Dengue Tracking System dashboard. The Primary and Secondary Healthcare Department too has a dashboard for Covid-19. It is looked after by the Health Information & Service Delivery Unit).

The data is generated by the primary, secondary and tertiary care hospitals (public as well as private) and laboratories. The data is individual-case based. Most of the variables currently reported are related to disease, its magnitude, distribution, determinants, mortality and measures related to prevention and control of the disease and the monitoring and evaluation.

Though a rudimentary form of sentinel surveillance, these dashboards are closest to a real time passive surveillance data entry system required for appropriate information about disease magnitude and distribution for disease control and prevention.

Currently, the system is not used for alert generation due to presence of the HMIS and the District Health Information System and due to multiple dashboards developed individually by various vertical programmes.

The gap in alert generation and dissemination as well as monitoring and evaluation based on the dashboards is currently filled by the Institute of Public Health, Lahore. “The IPH team of experts provides alert generation/ situation reports on dengue, Covid-19, M-pox and in case of outbreaks of chicken pox, cholera and gastroenteritis, etc,” says Prof Dr Zarfishan Tahir, the IPH dean.

The issuance of epidemiological alerts for a disease depends on three parameters, time, place and person. While WHO guidelines and alert criteria are available, the local health authorities typically set the local parameters by themselves. Reports are prepared and disseminated on daily basis to all concerned.

All tertiary, secondary care and primary healthcare hospitals provide diagnostic and clinical management facilities and update the information on the dashboards.

The hospitals prepare for epidemics through allocation of beds, arrangement of medicine and equipment, training of their healthcare staff under intimation to the authorities.

In the disease prevention and control system in the Punjab, the Directorate General of Health Services is the lead department. The district health authorities are part of this network and provide field staff for such activities.

The chief executive officers of the DHAs are responsible for response generation. They are expected to furnish reports regarding their activities and parameters defined to assess the quality of service. The CEOs retrieve information from dashboards directly as well as arrange visits to the patients at the hospitals/ field.

The prevention and control activities for each epidemic, as defined by a central authority, are implemented by the local health authorities. These activities require training at various levels.

Committees for various diseases, such as Dengue Experts Advisory Group, Corona Experts Advisory Group), M-pox, etc, hold regular meetings for monitoring and evaluation of epidemics and to undertake policymaking and review of currently available international guidelines.

Dr Shahid Malik, a public health expert, says that over a dozen vertical programmes on various diseases and provincial advisory groups for dengue fever, Covid-19, monkey pox, etc, represent a failure to develop an integrated disease surveillance system with a central dashboard. “It’s a waste of resources as it does not ensure the desired outcomes,” he says.

He also calls for use of vaccines approved after local clinical trials.

Caretaker Minister for Primary and Secondary Health Dr Jamal Nasir was not available for his comments despite repeated calls and WhatsApp messages.

The writer is a reporter associated with The News International. An EWC and GIJN fellow, he contributes to various international media outlets. His X handle: @AmerMalik3