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By Inaction, Pakistan Looks To Be Choosing Herd Immunity As Coronavirus Response

A health worker gets the blood sample of a person during door-to-door testing and screening campaign in Islamabad on June 15.
A health worker gets the blood sample of a person during door-to-door testing and screening campaign in Islamabad on June 15.

With rapidly rising confirmed coronavirus cases and limited testing, Pakistan seems to be on a trajectory toward herd immunity despite no official acknowledgment that this is the country’s default approach to combating the coronavirus pandemic.

A month after the government effectively ended a lockdown in favor of special operating procedures involving hygiene, distancing, and face masks to combat the spread of the highly infectious coronavirus disease, senior government figures are now projecting alarming scenarios.

“Since recording the first cases in late February, we have now reached some 150,000 confirmed cases,” Asad Umar, planning and development minister, told journalists on June 14. “Our experts expect this number to rise to 300,000 by the end of the month.”

Umar said the number could increase exponentially by the end of July. “If we don’t change anything, this number could rise to 1 million or 1.2 million,” he said.

There is no clear indication of whether the government is in denial about the extent of the pandemic or is hoping that if a large majority of Pakistanis contract the virus they will achieve herd immunity or collective protection against COVID-19, the disease caused by the coronavirus that has so far killed more than 430,000 people globally. Herd immunity against various diseases has been achieved through vaccinations but a coronavirus vaccine might still be months if not years away.

Pakistani officials seem to be preparing people to brace for a higher death toll.

“Total cumulative deaths due to Covid-19 on 14th May: Pakistan 770, India 2,649,” Umar tweeted on June 14. “Cumulative Covid deaths on 14th June: Pakistan 2632, India 9,485. Increase in deaths last month: Pakistan 242% India 258%,” he added. “There is much we are still learning about Covid spread and mortality.” As of June 15, the total number of deaths had reached 2,729, according to government figures.

The actual number of cases, however, is likely much higher. The country of 220 million people conducts around 25,000 tests daily, according to the government. But anecdotal evidence from across the country and the fact that authorities are proactively shutting down neighborhoods and markets suggest the infection rate is much higher than official figures show.

“Many people are not reporting coronavirus infections,” journalist Talat Hussain said on June 15. “They think that if they report coronavirus cases, they will be forced to quarantine and their neighborhoods will be sealed.” Some Pakistanis are also worried about the protocol for funerals of coronavirus victims, with relatives not allowed to handle the dead during funeral rites.

Some 100 federal and provincial lawmakers among roughly 1,200 have tested positive for the coronavirus, which suggests that infection rates are high. All MPs were tested as part of a government effort to stop the spread of infections during parliament sessions. Anecdotal evidence suggests that many Pakistani families have been through a mysterious illness involving well-known coronavirus symptoms such as fever, cough, body aches, and sore throat. But such sicknesses are not reported, let alone tested and tabulated into the official figures.

On June 15 Yasmin Rashid, health minister in the eastern Punjab Province, ordered neighborhoods in the provincial capital, Lahore, to close down for two weeks. She hinted at a new government approach that now focuses on blaming the public for not following official directives on social distancing and other measures that were part of the strategy for easing the lockdown in April and eventually ending it in May.

“People have been blaming the PTI government for failure to control the cases and have been comparing us to countries such as New Zealand and Taiwan,” she told journalists, alluding to her ruling Pakistan Tehreek-e Insaf political party by its acronym.

In May a government letter showcasing the results of “smart sampling” said some 670,000 Lahore residents out of 11 million had likely contracted the coronavirus. “The population of New Zealand is half of that of Lahore’s,” Rashid added. “Controlling the virus there is much easier than controlling it is in an immensely populated country like ours.”

For weeks, senior Pakistani officials have been hinting that herd immunity might be their only choice while others have specifically ruled out such a course.

“The disease is here, and it will continue to spread,” Zafar Mirza, the Pakistani prime minister's special assistant for health, told Dawn News, an independent news outlet, in early May. “We are not aiming for zero transmission of this disease,” he added. “Actually, it is better for the future if it spreads to a certain level because it will provide immunity to the people.”

No country has successfully achieved collective immunity against the coronavirus. Britain quickly abandoned the approach earlier this spring. In Sweden, the strategy backfired after infection rates and deaths soared despite social distancing and hygiene practices.

Javed Akram, vice chancellor of the Health Sciences University in the eastern city of Lahore, said it is too early to speculate on the possibility of herd immunity. “What we know is that there is variable host response to this virus – meaning how individuals respond to an infection,” he told Pakistan’s ARY television.

“The government appeared to give ownership of this disease to the people by letting traders and transporters reopen [in May] in return for promises to adhere to the standard operating procedures,” he said. “But what we saw was that the public didn’t take any ownership, and no one followed the SOPs [standard operating procedures].”

For now, there is no sign that authorities are considering any mitigation effort to radically change the country’s response to the pandemic. For millions of Pakistanis, this could mean they must only rely on their own immune response to the coronavirus.