Pakistan's Phased Vaccination Rollout

Like many other countries across the world, Pakistan too has begun a national vaccination drive for Covid-19. In Pakistan, the National Command and Operation Centre (NCOC) is coordinating and syngerising the national response towards Covid-19, including the phased vaccination rollout.

In early February 2021, Pakistan commenced its national vaccination drive by providing Chinese Sinopharm vaccines to registered health workers across the country. However, this first phase has not been as successful as anticipated due to a number of reasons. One major reason for low rates of successful vaccinations is the lack of registration of health workers. Without being registered with the provincial health departments, these health workers were unable to get vaccinated. Moreover, due to general misconceptions and distrust in the vaccine, the registration rate for healthcare workers further plummeted. On 17 March 2021, the vaccinations for healthcare workers were abruptly halted, only to be resumed on 18 April 2021. As of 19 April 2021, approximately only 18%of registered healthcare workers across Pakistan had received both doses of the vaccine.

The second phase of the national vaccination campaign began on 10 March 2021 and was targeted towards the elderly – those above 60 years of age. Subsequently, in early April, the NCOC announced walk-in vaccinations for those above 65 years of age as well. Meanwhile, on 17 March 2021, Pakistan allowed the first consignment of privately imported Russian Sputnik V vaccine. Private laboratories and hospitals were thus allowed to administer doses of privately imported vaccines from Russia and China so as to expedite the vaccination rates in the country. These private vaccines are open to everyone, regardless of age, exposure levels and/or immunity levels. However, this policy received flak from various segments of the country. For example, Transparency International Pakistan urged the Prime Minister of Pakistan to review the policy of privately imported vaccines. It was argued that the price for two doses of these privately imported vaccines was approximately 160% higher than their international commercial price. The high cost of private vaccines is feared to create inequality in access to vaccination as the price range is unaffordable for a large proportion of the population. Moreover, the private vaccination drive has been haphazard in terms of following the standard operating procedures. It has been reported that there are immensely long waiting lines to get registered for private doses and that the waiting time for the vaccine to be administered is also quite long and uncertain.

In the third phase of the national vaccination drive, registrations have been opened for registered citizens above 50 years of age since 30 March 2021. As of 26 April 2021, the fourth phase of the vaccination rollout was announced by the NCOC for all those above 40 years of age. It was also announced by the NCOC that all those above 50 years of age could also avail a walk-in vaccination facility and did not necessarily have to get registered through text message first.

In the planned fifth phase of the vaccination rollout, it has been announced that after Eid-ul-Fitr (a public holiday which is expected to fall on 13 May 2021), all citizens above the age of 18 will be allowed to avail the government-procured vaccinations. It was also decided that citizens above 80 years of age would be vaccinated at their homes.

The provincial government of Sindh also began a vaccination drive for its prison population on 6 April 2021, for those prisoners above 50 years of age. It has been estimated that only around one thousand prison inmates have been provided the first dose of the vaccine in these prisons so far since the announcement. Similarly, in the province of Punjab as well, similar orders for vaccination of prisoners above 50 years of age were issued. However, the numbers of successful vaccinations are currently bleak, especially considering the extent of vulnerability of the prison population to Covid-19.

As is evident from the five-phased (so far!) government vaccination drive, the priority groups have been disaggregated solely on the basis of age. There is no indication of priority being given to immunocompromised citizens, in addition to those in vulnerable age groups. Moreover, the planned mass vaccination for all above 18 years of age set to begin this month raises serious logistical concerns. It remains to be seen whether the government will be able to adequately manage an influx of vaccination registrations, and also the extent to which designated vaccination centres will strictly abide by standard operating procedures in catering to virtually the majority of the population.

Finally, the issue of vaccine inequality stemming from the simultaneous availability of private vaccines is important. While this raises questions about constitutional guarantees of non-discrimination and equality for all, perhaps in practice this inequality might be bridged when the government vaccination drive opens up for all citizens above 18, the upside being that the private vaccination rollout would lessen the burden on the government. It would enable the government vaccines to be utilised by those unable to afford the private vaccines, although there is no guarantee that one will be preferred over the other by those who can afford the cost of private vaccines.

Ultimately, the success rate of the national vaccination drive depends on the degree of public trust and assurance in the vaccine, which it is reported has been currently lacking, and that has translated into low registration rates for the vaccination. The government has attempted to deflect religion-based skepticism of the vaccine by announcing a religious decree (fatwa) declaring the vaccine compliant with Shariah law and further stating that it is binding on individuals to get vaccinated. The federal and provincial governments should fast-track a mass awareness-raising campaign to bust commonly propounded myths about the Covid-19 vaccine and encourage the masses to get vaccinated at the earliest. In Punjab, for example, awareness material on standard operating procedures to prevent Covid-19 was included in almost all orders of the provincial health department. Similar attention needs to be paid to creating and diffusing effective awareness-raising content regarding the Covid-19 vaccines to enhance citizens’ trust in them.