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The following interview was conducted on April 24, 2020.

Uzair Younus:

Hello and welcome to today’s webinar focusing on Pakistan’s response to the COVID-19 pandemic. Also, Ramadan Mubarak to all those observing this Holy month. Our guest today is Minister Taimur Khan Jhagra who is the Health and Finance minister of Khyber Pakhtunkhwa (KPK) province. We hear a lot in Pakistan about the need for younger, more dynamic politicians in the country and I think that Minister Jhagra represents the very best of this new generation of politicians in Pakistan. He’s a member of the Pakistan Tehreek-e-Insaf party led by Prime Minister Imran Khan and has been a member of the KPK provincial assembly since 2018. Prior to joining politics, he was a partner at McKinsey and Company.

Thank you for joining us today. I understand these are crazy times and you are extremely busy and I really appreciate you taking out the time today. I wanted to begin by just going over and having your perspective in terms of the situation on the ground in Pakistan and in particular in KPK province. Last time I checked, there are about 11,500 confirmed cases in Pakistan and over 1,500 of them are in your province with about 250 deaths in total across the country.

When this crisis and pandemic began testing was a major issue and we’ve seen in the last two weeks alone that KPK’s testing capacity has grown by about 12 times. There are about 1,200 tests being conducted a day, which is still a little low, but it’s an impressive growth and ramp up over the last few days. I would love to hear your thoughts around the situation on the ground and the province and the progress that’s been made in the last few days and what is working well for you and the administration and what you think needs to be improved further as Pakistan grapples with this pandemic.

Minister Taimur Khan Jhagra:

So a lot of questions here and thank you for having me on. As I was telling you when we were chatting informally, the reason that I think this is important is, for me personally at least, to try and get to the influencers who shape the debate. I think that is critical. I may not get too many people on the street listening to this in English, but I think a lot of people who actually informed the opinion indirectly or directly on the street do so I hope that some good comes out of this within Pakistan, not just to inform the debate worldwide. I’ll start with the situation in Pakistan and then zoom in very quickly on the situation in KP. 

The virus hit Pakistan late because we are less connected to the rest of the world. So as you can imagine, as it was quietly making its way through places like New York and London and Northern Italy and Spain, there would have been fewer cases coming from abroad into a place like Pakistan, which has fewer flights, and on a relative basis, fewer connections to the rest of the world. Although, of course, we probably have something like a hundred flights a day connecting Pakistan to the globe. We really only got our first case at the end of February in Pakistan. We actually only got our first case in the province in Pakhtunkhwa in mid-March. And as you said, since then, we’ve now got over a thousand cases. We have, until yesterday, reported 85 deaths in the province. We are seeing between 50 and 70 cases reported per day.

We can see the increase for Pakistan. The figure is 500 plus or so right now. So, you know, as with the virus everywhere else, there is this increasing quantity of growth. Of course, there is this debate on what should and shouldn’t be done, what’s been done successfully, what hasn’t been done successfully. It’s one of those situations where you’re facing an international crisis like perhaps no other time since World War II; nothing that I remember in my life. You have to take decisions in a great amount of uncertainty and open yourself wholeheartedly to criticism because there is no right or wrong, whatever you do, there is no perfect information for decision making. You asked about what’s gone well, what hasn’t gone well. I’ll try and briefly say that and then I’ll get to the testing question that you asked, which is one of those key areas for the debate where you are continuously open to criticism.

The first thing is, I think what has gone well and I’ll talk about the province specifically is we tried to react early. There are a couple of articles printed. There’s an article by Thomas Poyo. The moment we got a hold of that, we actually shifted a couple of gears. I talked to a couple of ex-colleagues, I talked to a couple of international experts and within a day we had gone from treating the virus threat. The way much of the world was to think that this is going to affect us in a big way. We need to take quick steps. And within 48 hours we had closed schools and universities. This was a day after WHO declared this a pandemic. We started to take action quickly. Beyond that, I think if I look at the last four weeks, of course we’ve built up capacity not just in testing, but also in terms of tuning the amount of manpower we have.

We’ve rapidly put in place a locum scheme to give back-up to medical staff, which has attracted over 18,000 applications in less than a week. We have got more space in terms of beds than the rest of the country does. Although we are a third the size of the largest province. We’ve tried to be very, very transparent about this. You know how information in a place like Pakistan can flow bureaucratically. What I felt under the Chief Ministers at a time of crisis is that you have to leave politics aside and try to not point score; neither beat your chest nor play sort of the wounded animal and just be out there and be open. We’ve gained the trust of the public and different stakeholders, but that’s still always a volatile slope, you know, because what happens is you gain the trust for a week until the first death happens. And then everyone will say, you mismanaged this situation. You try and explain that this was going to happen. You show what you’re going to do next and you gain the trust for another week. Again, you then try and calm the emotions down and you go on and then you perhaps gain the trust of the public again for a week until the first couple of healthcare workers get infected. So it’s not like you can ever say that you can work to either find perfect solutions or to consistently be in a situation where fingers won’t be pointed at you out of anger, out of frustration, out of genuine concern. But you just have to keep on plowing and keep on doing whatever you will.

Two of those issues, as far as our province is concerned. First, we’ve had the greatest number of deaths and I believe that is really because our province, in terms of its labor mobility, is the best connected to the region and to the world than the rest of Pakistan. And so, when I look at the figures, we have had the greatest number of international travelers come back into the province between January and March, and we got the quickest spread across each of the 35 districts in the province; then, our larger neighbors did. I think what that resulted in is a larger number of latent cases. I think that shows the geographic spread of the virus. And I believe that something that has contributed to the greater number of deaths that we’ve had. I also don’t know whether we have a uniform reporting standard because like the US we are a Federation and provinces are largely free to do what they want, which has a lot of advantages, but which also has some complications in terms of how we report, how we react and so on.

I can tell you what we’ve done is that we’ve tried to report every day according to WHO standards. We have reported 15-plus deaths where we’ve taken swabs after the patient has passed away because we believe that has been the best way of trying to depict the real picture, not just to the public, but to give ourselves the best information for decision-making. Now that has exposed us to huge pressure around Is the fatality rate higher over here? And I’m tired of explaining to people that we can’t actually see the fatality rate because forget Pakistan, forget Pakhtunkhwa, all over the world the denominator, which is the total number of cases that is required for the fatality rate, is something that no one has. But think of making this argument not in an environment where you’re talking to people who understand statistics, but to the general media, to the general population, where they see a total number of reported cases and the total number of deaths and you very quickly need to absorb a certain amount of pressure that I think leadership calls for, that we have to absorb.

The other thing that this has led to is the question you asked around are we testing enough. But I think what people confuse is, by the way, the answer to that is however much we test, we probably won’t test enough because what I’d ideally like to do is to carry out 35 million tests in the population of the province in a day, isolate everyone who’s positive, and within 14 days we should have control of the virus. But I don’t know of any country that has perhaps made 35 million tests from the time the virus has begun. Right? So, there’s no way we can do it as a poor province in a developing country. But a lot of people associate the number of deaths we’ve had to the number of tests we’ve done. And I think the reason they do that is they look at the mathematical equation and say if there were more tests and more positive cases, the apparent fatality rate would be lower. What is important to understand is that the number may be lower, but it wouldn’t result in lower deaths, right? Because those deaths are a function of the number of people that actually have the disease. And the reason that you need to have more tests is not to lower our fatality rate, but actually to be able to screen more people to be able to make better decisions.

Now, the challenge with this, and we’ve actually ramped up capacity from zero to 1,200 in a month, so whereas you say it has increased 12 times in the last two weeks, it has actually increased from zero in four weeks and from 20 in a couple of days minus four weeks. And again, I think that we’ve done this originally at a time when there are limited test kits in the country. Originally, at a time when there was only one lab that was capable of doing this, we now have five in the public sector. We’ll have five more shortly and today opened the financial bids for a proposal to actually take on as much private sector capacity as we can. So, I will actually double this in a week. My worry is that we start playing politics and media headlines on this. Everyone wants to see more testing numbers without thinking about whether we are testing the right people, whether we are analyzing the results correctly, whether we are taking the right action after testing people. And it’s very easy for me to win the testing rat race by just testing more, right? It’s very easy for me to try and test as much as possible and simply say, look, my fatality rate is down. But what is really important over here is that I have no upper limit for testing. And the reason I have no upper limit for testing is neither to bring the apparent fatality rate down, nor to win the argument on the media on whether we are testing enough or not. If I am able to test more, if I’m able to combine exploratory testing as we actually did in one union council, when we got one of our first outbreaks and greater testing of contact than I can do today, I’ll be able to get smarter on other elements of my virus response that I’m also continuously improving. So yes, it is important to improve testing. The quantity of testing, the innovation that we bring into testing.

I’m proud to say, we are the first province to successfully conclude trials of pool testing where we actually test a batch of samples together. So, if they’re negative, you actually save both time and speed. If they’re positive, you carry out the individual tests. This is particularly advantageous. For example, when you get a flight of past passengers where you expect no prevalence rates and so you can actually do a lot more testing. It increases your capacity, it saves time, it saves tests and I’m proud of the effort that our scientists, our doctors are making on this. But what is important, as with every other aspect of this, is to recognize the uncertainty within every decision to recognize the complexity within every decision and recognize the pressure that we put on decision makers right through the public debate that continuously goes on and how it’s important to actually encourage decision makers to take the right decisions and absorb the pressure rather than by reacting to pressure.

Uzair Younus: 

That’s very incisive and insightful. I agree with you that the testing strategy is far more important than the number of tests. You need not follow a shotgun approach to that. My follow up question to you on this is the trust deficit or the trust issue that you mentioned. You build trust and something happens, and trust goes away. We’re seeing this trust issue on the economic front and the public health front, not only in Pakistan, but in the United States as well. I’m sure you’ve seen and others who are in the audience have seen videos of protests in the United States to open up the economy. From your perspective as health minister, what are some of the things that you will be looking for before you decide on loosening the economy or loosening the lockdown in your province? As you said, Pakistan is a federation, so you have a lot of leeway on that. And so, what are you watching out for and what is your point of view in terms of what’s ahead in the future in terms of ending the lockdown or easing some of the restrictions in your province?

Minister Taimur Khan Jhagra:

I think the most important thing that we can do is to ensure that we take these decisions not because of pressure, not because of the optics, but because, given the circumstances, the best decisions that we can take. Knowing that whatever decision we take, we’ll have a downside and we have to be brave enough to accept the potential consequences of those downsides or even accept that once we’ve taken decisions in good faith, that they can work out differently to the way we think of them and be prepared to backtrack and do something else. The way that we are faced with these decisions in Pakistan is actually fairly similar to what I believe is happening across the US. And I’ll tell you why. In a devolved federal setup, there are multiple factors that actually play into anything that you decide. So first and most important, we want to save the lives of people. But as we think of saving the lives of people, right, we have to sort of define the problem precisely that way. It is saving the lives of people or the maximum lives of people that we can. It’s not just optimizing that for Corona response only. And what do I mean by that? I’ll give you two or three examples. Number one: we have multiple other health challenges over here, like polio. Pakistan is one of the two countries where polio is still not eradicated. Routine immunization which again is incredibly important in terms of building up the immunity of kids, not just to this but to other potential outbreaks. The ability of hospitals to treat patients for other potentially fatal risk diseases. So, if you only just look at this from a saving lives perspective, there’s decisions such as in the short term, should the polio campaign continue or not. And we had to shelve one cycle of the polio campaign at a time when the most important thing seemed to be to maximize the lockdown. You could point the finger at that, but at that point it was perhaps the most important thing.

A second decision is do you keep the outpatient facilities of hospitals open because patients access these, do you close them or restrict them? Because at this point, the most important thing is keeping healthcare workers healthy. And, as you’re building up testing capacity in hospitals’ screening capacity, you don’t know who’s entering and whether they’re actually potentially inadvertently, asymptomatically, being a threat to a doctor or medical staff. We for a couple of weeks had these OPDs closed and we’ve now issued instructions to hospitals to only open them if they feel that they are comfortable in taking the relevant precautions that they need to take if hospital staff are short of having the PPE that they need to have. So you can just see through the two or three examples that I’ve given you that you can critique any of these decisions just from a health perspective because you’re potentially putting lives at risk either way while you have a down. We had the most focused lockdown that we could have between around the 23rd of March and the 14th of April. While you have a lockdown you potentially have pregnancies at home where you, again, put the lives of mothers and newborns at-risk. Again, these are incredibly difficult decisions. I’m sure they are difficult in the US, they are even more difficult in a developing country context where you actually have to make these decisions under uncertainty: knowing the limits of capacity that you have now, add the additional complexity.

I heard the word economy. In a country like Pakistan where there’s lots of daily wage and as I heard a week back about 6 million people claiming unemployment in the US I’m not sure, but I heard that figure today is now in the double digits, 20 million people. Think not just of the potential people that you are impacting who are below the poverty line for which the Prime Minister was very proactive in scaling up our very effective social safety net program called Ehsaas; think of the, what we would call mom and pop shopkeepers, of the small retailers, of the small SMEs and businesses who suddenly feel huge financial pain. And until they don’t see the scale of death on the street, by which time it is already too late to react, that they’re not actually going to understand and they’re actually just going to go out on the street and protest. That potential risk, which we have been very, very successful in controlling over here in Pakhtunkhwa, by trying to take everyone along, by solving those issues of trust as they come along, we somehow have to see that inadvertently as we try and minimize social movement, that we don’t create conditions where the very thing that we’re trying to stop spreads.

Every place where we’ve seen large clusters of people being infected is where people are together. Do you remember what happened with the Taftan quarantine next to the Iran border? We had a bunch of drivers who clustered together on the Iran side of the border, and came into Pakistan. We found a quarter of them being positive, simply through non forced social contact close to the border. We are seeing from flights that are now entering Pakistan as stranded Pakistanis abroad come in that there are flights where there is almost no one infected. But as people come from the likes of labor camps in the Middle East, we’re seeing large rates of infection and that’s very similar to the outbreak in Singapore that has recently expanded. In each of these, you see that clustering people together exponentially increases the risk of outbreak. So now, think about urban centers like Peshawar, Lahore, Karachi where you have slums, where you have large agglomerations of people in dense conditions. Think of what a lockdown actually does in the slums of Islamabad or Karachi. It actually brings a lot of people at risk very, very close together, right? And we can’t decide perfectly on any of this, but we have got to consider all of this even if we just consider a health perspective. I can tell you it is an incredibly difficult decision to make. We get abused on social media. We get finger pointing on the media that I understand. I must actually give credit to a lot of the opinion makers within the media who seem to have understood that this is a time where we need to go beyond the conventional rules in the conventional relationship between media and government to try and fight on the same side to educate people and to make people aware.

It’s almost like a war-like situation. But you do still get large chunks of the media who are looking to scandalize while looking to point fingers at apparent decisions where you could always think of a different course of action being taken. Those are things that are all trust. So, one example, and then I’ll stop on this, which has been an incredible challenge, has been to provide PPE to doctors to help the healthcare community. I’ll tell you what we did on that. The first thing we did was we imposed an emergency. We put together a procurement team and we said, at any costs, provided we are doing this in good faith,we want to procure as much as possible because we want to protect every health worker. Whether that is through prioritized access to testing, whether that is to give them all the relevant PPE that they need. But think of this from the perspective of the healthcare worker. Whatever PPE we give them, it’s not going to give them perfect protection. As we’ve seen in the world. There will be healthcare workers who will be at risk, in the same way, perhaps not in the same way because I can’t imagine, I don’t feel that level of risk, but I go out and meet people because it’s my job and I have to accept that increased risk because I have been given a job, a duty to do, for the people of my province for this part of the country.

Think of what happens when a single journalist takes an individual case of PPE not reaching a hospital and broad brushing that and saying the government of Pakistan or the government of Pakhtunkhwa is not providing PPE to doctors. If I were a doctor, I might myself start to develop the feeling of resentment of not being taken care of because I’ve got high emotions, I’m exposed to extra risk, right? And think of what a few irresponsible statements can do at a point where everyone who’s on the front line needs to actually act like a soldier, right? Be prepared to help the country fight this battle, right? What is true is that small inadvertent errors of judgment, in terms of communication over here, can impact trust, can erode confidence, can erode the will to fight and can actually put the sort of incredible government pressure on us that makes us try and optimize decisions incorrectly.

I’m very proud to say that our government, under the leadership of Chief Minister Mahmood Khan, has resisted to the best of its ability. But within that context, when you think of decisions on lockdown, what is also true is that, as you think of how aggressive your lockdowns down is, it’s not just about finding a balance between the economy and the lockdown, but about seeing how much your population is willing to accept, what some of the side effects of what you’re doing are and whether the side effects actually are greater than the original pain that you’re trying to solve for. What is your capacity to implement? This is not Dubai where everyone has an app and everyone that wants to go to the grocery store can actually just register on the app, get permission, be given permission within minutes. It just won’t happen. So, our decision making has to be in the context of the situation that we’re in and the implementation capacity that we have.

Uzair Younus:

So you mentioned the economy and you also mentioned that Khyber Pakhtunkhwa is perhaps the most interconnected province, not only in Pakistan, because of the labor that works everywhere else, particularly Karachi, but also in the Gulf and they’re coming back and we’ve seen the oil war between the Russian and the Saudi Arabians collapsing the price of oil and remittance slows according to the World Bank and other estimates will probably decline by a significant margin in the coming months. That adds to the economic complexity you described earlier. So my question to you now is you’re also the Finance Minister, and so what is the administration looking at in terms of stimulus measures, measures to help not only those at the poverty line or below the poverty line, but the small and medium enterprises that are shut down or affected. And in particular, how will you deal with the lack of remittance flows coming into your province to keep the economy chugging along for the foreseeable future?

Minister Taimur Khan Jhagra:

Indeed, I think what is true is that this will be a relatively major global recession and it will be a very peculiar recession where the recession isn’t because of a credit crunch or because of speculation, because of any sort of dotcom bubble or any other sector growing too hot, it is because literally the world as we’ve built it over the last 2,000 years, certainly over the last 100, 200 years where the world has just shrunk to connecting the remote part of Pakistan to the wealthiest part of the US or anywhere else. That world is struck. The airline industry is decimated, global travel is decimated because effectively the very fundamental ethos of the global village, which is around connectivity, is what increases the risk of spread of this pandemic. And hence, connectivity, whether that be in terms of trade, whether that be in terms of the movement of people, has stopped. What is clear is we will go through a difficult time. And what is certainly clear, if we’re going to go through that difficult time, is suddenly that we as a province, start thinking out of the box and act responsibly. Certainly, federations like Pakistan do the same and suddenly the world also realizes that you can’t just think of eliminating the virus in the US.

What we’ve seen between February and the middle of April is that it’s reached 200 countries. In the beginning of February, remember we all thought this was in one region, in China and that’s it. Only 60 days later, there isn’t a part of the globe that isn’t affected. So remember, that while connectivity may have worsened, the world is in this together and I hope it acts together. 

Our challenges aren’t just remittances, I think it’s also going to be one of resources because if you think of the way resources (and by that I mean financial resources) are structured in Pakistan, a large chunk of what the provinces get or spend is through the federal divisible pool because the large bulk of revenue collection is managed by the center. There are three big buckets of revenue that the federal government depends on: income tax, sales tax and customs. There is going to be pressure on all because you’ll have suppressed economic activity, you’ll have suppressed consumption and you’ll have suppressed exports and imports because the world is in lockdown to begin with and then is going to be in recession afterwards. And obviously it’s something we need to look at. But what that means is, I expect that there will be significant pressure on government budgets and in particular on provincial government budgets because we don’t necessarily get the leeway from the debt deferment that the federal government gets. 

So, what that means, and I think this is a big statement I’m going to make, is — you know Uzair as a Pakistani, you’ve seen, I’ve seen — we’ve talked of financial reform, government reform for the longest time. We know the sort of things that need to be done. Whether that is looking at the pension challenge or the pension crisis that we potentially face, whether that is to look at the cost of government, whether that is to look at the allocation model of public sector funds to infrastructure that will spin the wheels of the economy. And I’ll tell you something, I think here in lies the one silver lining in this, but also the one thing that we really ought to test ourselves as a nation by, if through this crisis, we cannot start the wheels rolling on meaningful financial reform and we’re going to attempt to do that in the province, but we need ideally to do it across all federating units. People can do it at a different pace or in slightly different matters. But if we do it together, some of the more difficult reform becomes easier because it is something that everyone is doing. And I talk of things like we fund pensions out of the budget, right? We have unfunded pensions and we’ve talked for decades about this. I think this is a question for all of us. Are we going to look at this and are we going to look at this at the speed that we need to? I think that a similar decisions on how government spends money, how government hires and you know what if in a pandemic, which is putting massive pressure on the fiscal space that we have, if we don’t take the big bold decisions that we need to, I don’t know whether we’ll ever be able to do that in Pakistan. And I think that is actually one thing that we ought to both educate the public, educate and inform stakeholders and really hold ourselves to account by, because I think it is clear is that unless God wills so this virus isn’t going anywhere soon and if it isn’t going anywhere soon, then we better adapt how we actually use the resources we have at our disposal to show leadership and to minimize the economic pain. I think that can actually happen.

There is so much scope to actually clean up the way they bring efficiencies into the way that the government spends money. If we can even do some of that, the way that the scale at which the government invests in development can largely stay uninterrupted. And if it stays uninterrupted, you know, what happens in the recession where the government spends on infrastructure, the government spends on a large building program is something that we can get to. I think that is one big challenge, but it is largely dependent on how we actually optimize the cost of government because without that we’ll be stuck in a situation where we will spend but not spend on the things that we need to. As part of that there’s one priority to certainly fund the poorest which we’re doing in conjunction with the federal government. I think along with that, the best way of actually providing the stimulus to society at large is by trying to spend money in the right way through the right public works program, through the right investment in infrastructure. It’s very clear if this is here for a year, we can’t stay locked down for a year. We’re going to have to develop a new model. And if we develop a new model, we have to make the wheels of the economy run at some point, after best protecting the population and after best protecting the healthcare workers. But as we do that, the one silver lining that I believe truly can make a new Pakistan emerge, forced by this crisis, is one where if our generation actually tries to take the leadership role, I have to do it as a representative and people like you have to do it by putting the right pressure on us rather than asking me why my tests are only two thirds of Punjab whereas my population is one third of Punjab. Because if I’m spending half my time answering the wrong questions, I’ll get away scot-free in the places where you ought to put pressure on me. And I ought to be taking bigger and bolder decisions, but I’m not. I hope that starts to answer your question.

Uzair Younus:

That’s important. And I have a couple of questions from the participants here. The first one was if you could really quickly just explain group testing and where in the world hasn’t been implemented and what does it work like? And the second question was, you alluded to it a bit just now. How do you see the end of this pandemic or this crisis in Pakistan? And what does the crisis containment model look like when you have a grip on this and what do you see as the future looking like because this virus is here to stay for the foreseeable future. But just those two questions, if you could quickly answer that.

Minister Taimur Khan Jhagra:

I can tell you of the Pakistan that I hope to see a merging of this crisis. I’ve got to be very honest. You know, the uncertainty that we in it is one that is going to test our resolve as a nation as never ends. And I hope that we can during this learn to agree to disagree, learn to agree to keep some of our emotions in check. Learn to understand, to come together as a nation, celebrate our diversity and be prepared to accept, look, we are a nation that is very human, that makes a lot of mistakes like any other nation does. So I don’t know why when we speak publicly, we want ourselves to be perfect. We should try to be as best we can be and we should try and reassure ourselves that each one of us is trying to be the best we can be. Pakistan, I’d like to imagine to see the other side is one that is suddenly emerging on the new normal. And whereas for many other countries, that new normal is one that may actually cause a financial blip ,if we get it right, if we start to rethink economic development, if we start to rethink the role of government, the size of government, the dynamism of government, if we start to rethink how we actually use the private sector to unleash the potential of growth in this country. And the best example of that is we’ve raised our capacity to 1,204 weeks as far as testing is concerned. But with one contract with the private sector, I know I can actually increase it to 7,000 in a week if I want to. If we can start to think that the private sector is the ally of the government in terms of trying to unleash economic growth or unleash whatever economic potential is in the country, even within a pandemic. We will start to think we get beyond that tipping point that Pakistan could have gone beyond anywhere after the 60s to unleash our potential on the world’s stage. We’ve never done it because it feels every time we’re about to do so we find a way to stop ourselves.

I think the one other thing I’d like to add to that is through the crisis, I’d also like to see a Pakistan that learns to be a little bit more humane, a little bit more accepting of the frailty of humankind, a little bit more accepting of every aspect of society. As the Prime Minister says let’s not just think of the lockdown for ourselves because you know, we live in these big homes and can actually relate to places like New York and London. But let’s think of those seven or eight or nine people who are cooped up in a one-bedroom house and what the lockdown means for them. And when we figured out the solution, figure it out for every Pakistani and give ourselves and give this nation the space to actually think of everyone and not just the haves. I think that as we get towards that journey, we’ll feel pain, we’ll feel criticism, we’ll feel hostility to each other. But I hope that some of that challenge that we are undergoing and will continue to undergo at least in the short term, can bring out the best within us. As I know that was as, I know that just that challenging couple of weeks with India did last year, as the 2005 earthquake or the 2010 floods day where we started to be there for each other. I think that is really important.

Uzair Younus:

I was going to ask about the group testing on the group testing.

Minister Taimur Khan Jhagra:

A group test is where you actually test a number of samples together. We have tried to do this in batches of three or five. So, think of conducting the PCR test on three or four samples that are grouped together. What will happen is if you do it right, that all the samples, if each of, if you test five individuals as a group and all of them are negative, the group results should also be negative. What that means, for example, you were actually sampling population, where this could work well is that you can test five at a time or 10 at a time and know that all those five or all those 10 or all those 20 are actually negative. It saves you time, it saves you costs.

Most importantly, it brings scale and speed. Now what will happen if you take the three or the five if one of them is positive, your group test results should also be positive. And what you do that is if you take a sample of three, you actually test each one then individually because you don’t know which one of the three is positive. So, let’s say if you do 10 groups and nine of them are negative and one is positive and you had groups of five, you’ve actually tested 50 people, right? For 45 of them, you only needed to do nine tests. For the last five, you needed to do six tests. So you’ve actually tested 50 people with 15 tests. And what is most important is that will save you more than three X the time as carrying out 50 individual tests. So, it’s an incredibly important innovation. This has been around for a long time, uh, but it’s an incredibly important innovation to get right in this context because it allows us to use more limited capacity at a larger scale. Countries like Germany have done it. I know countries in the Middle East have attempted it. I know India is attempting it. I’m incredibly proud that the young five or six kids, the young scientists and the young team that we have at Khyber Medical University has managed to successfully conduct the 27 test trial of this, got a hundred percent congruence in their trial results and is now able to do this for example, for the 200-250 people that we get in a flight or when we’re going to do some sampling within the population for information.

Uzair Younus:

That’s very impressive. I have a couple of other questions. I think it’s been on the media as well over the last couple of days, but it’s also here as well. And like your quick comments on that. One is what is happening in KP around closing mosques, particularly since it’s ramadan time and how are you engaging with the local clergy? And the second one is also related to that at the local level, the clergy has connections with communities, particularly in rural areas. So how are you working and engaging with them to build again the trust that trust that you alluded to earlier?

Minister Taimur Khan Jhagra:

I would say that there is perhaps no country in the Muslim world that takes it attachment to religion more seriously than Pakistan does. And let’s take the context of any decisions we take in terms of mosques. And so, in the context of the respect for our religion overall and the social dynamics of that. Certainly, Pakhtunkhwa is a province where if anything, there is an incredible amount of faith, an incredible amount of attachment to Islam that drives the way that we live in the daily lives of almost everyone who lives in this province. So for us as we take the decisions on something like this, we’ve got to be incredibly careful that the sort of things that happened in an unfortunate manner in other campaigns such as where, you know, the some confused actions on something like polio start to be mixed with foreign agendas or so don’t create the violent reactions that try and destroy the good that you do. What has happened in mosques over the last couple of weeks, we were able to successfully limit the prayers and mosques to very small groups of people in line with the national consensus. We have done two things first on this and I think it is incredibly important that whatever we do, we do it with the national consensus because it stops the finger pointing, it stops the competition. And the national consensus on mosques was one that was built a few days ago with representation from all four provinces, around creating a set of standard operating procedures for whoever chooses to go to mosques in Ramadan for encouraging people not to go to mosques of their own freewill. And the third thing that we do with that in this province is we’ve tried to give an incredible amount of authority to local decision making within the 35 districts that we have to the deputy commissioners and the local leadership.

Because I think again, we have an incredibly diverse population with incredibly different geographic and density characteristics within the district. And it is important that we try and empower locals to build on that national consensus in a stricter or a slightly more fluid manner, both relative to the risks that they face and relative to the local sentiment. The national consensus talked about revisiting this decision at any point that it feels like the standard operating procedures aren’t being met and that the risk from the virus, not necessarily the results, but the risk from the virus is spread. Fortunately, or unfortunately, after the national consensus, one province has decided to go its own way. I would have personally preferred the way. I would have done it slightly differently. It’s important that at such a time we try and again, bridge differences rather than build them. But the reason I would have done it differently is that I think it is important where on something as emotive, as religion, that we act together, that if people feel differently that we try and change that national consensus rather than create conditions where there’s going to be finger pointing about someone doing it better, someone doing it worse. But anyway, that is what it is. That comes with living in a Federation. I’m sure it was done, with the best intent and in the best interests, but it is what it is. This will be a difficult time in Ramadan. This is a time of prayer. This is a time of closeness to God. My message to everyone is it is our duty to protect others. It is our duty, both as individuals and as government to try to save as many lives.

But it is also our duty to try and understand that there are different points of view on this and if we’re going to take all of society along then whether we personally agree or disagree, right, we’ve got to do the best we can within the context of the society that we live in and sometimes it may take a couple of days for the right consensus to emerge, but if that is the price for getting to the right result, I’m willing to accept that price rather than to try and get to a stage of acrimony where we break the consensus that has been built over the last month and the feeling of togetherness that at least to a large extent has been bent in the last month.

Uzair Younus

Thank you so much for your time and I couldn’t agree more. I think building that consensus is very important. I would just add, like you said earlier, that this is probably the worst crisis the world has faced since world war two. I would add in the context of South Asia, this was the worst crisis since perhaps the partition in 1947. And I think having that perspective and understanding that these are unique times and building that solidarity for these unique times is very important, both in Pakistan and internationally. I thank you for your time and wish you all the best. Again, Ramadan Mubarak, stay safe and hope that we get out of this together really quickly.

Minister Taimur Khan Jhagra: 

Thank you. Thank you.

Speakers

Taimur Khan Jhagra
Provincial Minister of Finance and Health
Khyber Pakhtunkhwa Province, Pakistan

Uzair Younus
Nonresident Senior Fellow
South Asia Center 

Please note that this is a virtual event on Zoom. Instructions for access will be emailed upon registration.

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