The worldwide shock inflicted by COVID-19 had the making of a “perfect crisis:” the kind that should not be wasted. Indeed, it could serve as an opportunity to initiate major reforms. Unfortunately, Pakistan, like virtually all other countries, has permitted the opportunity to go waste. Pakistan may be just as woefully unprepared for the crises to come, economic or other. But the time for remedial action is not past. Pakistan can choose to defer necessary reforms and hope that with luck and external assistance it can muddle along; or it can decide that the time has come to grasp the nettle.
There is a lot that needs to be fixed in Pakistan. The COVID-19 pandemic underscored the inadequacy of the public health system. To safeguard the public from future disease outbreaks and to improve the quality of human capital, public health system reform deserves to be prioritized along with the needed infusion of resources. But there are at least six other crises, two of which have been on the radar for some time: (i) rising public indebtedness, the result of long running fiscal deficits and the inability to mobilize sufficient revenue; and (ii) sluggish growth caused by the declining share of the manufacturing sector and of exports in GDP and weakening productivity.
Four crises of the slow burning, more stubborn kind, have received less attention; however, continued neglect could bring the nation to its knees within the next two decades. These four crises are: (i) income inequality and socio-political polarization; (ii) inadequate state planning, policymaking, administrative, and mobilizational capabilities; (iii) high fertility and population growth; and (iv) the mounting threat from climate change.
The first two crises have festered for years and have been managed ineffectually by short-term fixes. The others, such as demographic pressures and the effects of climate change, have been slowly worsening over time and their damaging consequences are becoming more apparent.
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 Although the number of reported cases as of end 2021 (1.287 million, 29,000 deaths) did not reach the levels in some of the neighboring countries (35 million cases, 3.2 million deaths in India) and Europe, the threat from new variants of the virus remains. P. Jha et al. (2022) Covid mortality in India. https://www.science.org/doi/10.1126/science.abm5154
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