“Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it’s the only thing that ever has.” — Margaret Mead.
AS a nuclear state and the sole arbiter of global peace trying to avoid World War III, we need to pay equal attention to the precarious situation of the people of Pakistan, especially the most vulnerable — poor women and children. Pakistan’s global optics are great today and the government deserves kudos, but the real development has to be inside out.
From a submerged and swelling mountain of poverty, disease and consistently declining human development, the latest tip of the iceberg emerged from Taunsa in the form of the HIV transmission among children . Yes, the tip of the iceberg, since the major drivers of HIV are prevalent across the country, ie, unsafe medical practices, including the reuse of contaminated syringes and unscreened blood for transfusion. To be precise, in Taunsa, a joint mission of WHO, Unicef, UNAIDS and Punjab’s Department of Health and Population was conducted in April 2025, covering the period since December 2024.
Until then, 120 cases had been recorded, out of which 75 per cent of infections occurred in children under the age of five years. The mission’s report says that “Analysis of reported modes of transmission shows that blood transfusions (48pc) and contaminated needle use (48pc) are the primary contributors to the outbreak”. It rightly concludes that the paediatric HIV outbreak in Taunsa is not just a local health crisis — it is a powerful reflection of broader systemic vulnerabilities within our healthcare system. A BBC Eye documentary had recorded the same unsafe practices in the same hospital some weeks ago. By then, the recorded number of cases had swelled to 331.
This is a horrendous situation, to say the least. The official attitude among provincial bureaucrats, programme managers and health professionals in the public sector is still hush-hush. The public healthcare system in Pakistan is badly broken. Instead of admitting the problem and assuring people of immediate and visible remedial actions, there is a strange numbness and a shrug of resignation as if nothing has happened. As innocent children of poor families are being infected for life by the healthcare system itself — almost a death sentence — the discussion in many official circles is that since the Global Fund doesn’t give money to the government, what can we do! For God’s sake, these are our children and we should take the financial responsibility to care for them. Have we become so callous and thick-skinned that nothing affects us anymore?
Citizens must be more involved in health affairs that affect them and those around them.
The real problem is that these are children of poor people. Had they been children of rich and influential people in Islamabad, Lahore and Karachi, the response would have been swift and very different. As long as elite families are not affected, nobody is bothered. This is the harsh reality of the Islamic Republic of Pakistan.
But we cannot give up even in the face of these harsh truths. There is a state failure in healthcare, but then what is a state? It comprises not just institutions but also citizens, without whom there would be no concept of a state. And citizens have to become active in critical matters of life and death.
As I wrote in my last column on these pages, ( ‘Cure or curse?’, May 1, 2026 ) the public health crisis in Pakistan today is a collective failure of successive governments and its reform is a collective responsibility of the state and society.
Citizens have to come together for better healthcare in the country, delivered by both the public and private health sectors. Citizens have to become more aware and involved in health affairs that directly affect them, their loved ones and the people around them. What happened in Taunsa may appear remote, but if not effectively stopped, it will spread to our near and dear ones.
There should be a well-connected informed citizens’ network across the country — a voluntary network, free of any external funding strings, driven by a commitment and sense of responsibility that we have to play our role in making healthcare better and safer in Pakistan for everybody. There are two simple, but not simplistic, underlying principles: it is every citizen’s right to have access to safe and quality healthcare without any discrimination; and nobody is safe until everybody is safe. Viruses and bacteria don’t require visas to enter the human body. They don’t differentiate between the rich and poor, urban and rural, man and woman. If you find this difficult to understand, remember Covid-19 and its spread. Yes, different diseases have different natural histories, different incubation periods, modes and spread of transmission and lethality (case fatality rate), and so on. But in the case of communicable or infectious diseases, nobody is safe until everybody is safe. Hence, playing an active role as relatively informed citizens in effective control of communicable diseases is as much an act of self-preservation as it is of helping others.
Imagine the state and society working together for better and safer healthcare for everybody — governments making a serious and sincere effort to improve healthcare governance, relevant institutions, funding, accountability and supplies in the public sector and stringent regulation of the private health sector by regulatory agencies. Active citizen groups in each of the 160-plus districts, monitoring the delivery of health services in a systematic way and pointing out problems to the authorities as they arise, and responsible officials taking immediate action to rectify these problems. And citizen groups raising awareness about safe healthcare while also representing those with weaker voices.
Some would say I am dreaming. In contemporary Pakistan, this is sheer audacity of the imagination. I would say, don’t kill the dream. Instead, become part of it. Health is too important to be left to governments.
The writer is a former SAPM on health with ministerial status, adjunct professor of health systems and president of the Pakistan Association of Lifestyle Medicine.
Published in Dawn, May 15th, 2026
