Pakistan in red list over low testing and sequencing rates: UK govt

• UK's health minister wrote a detailed letter to the Chair of All Parties Parliamentary Group on Pakistan.
• Health minister says Pakistan's testing and sequences rates are relatively low.
• Says lower testing & sequencing mean it is not possible to know the full genomic makeup of their current wave.

LONDON: The British Government has said that it decided to keep Pakistan on the travel ban red list because the true number of COVID-19 cases is likely to be much higher than reported across Pakistan, a leaked letter written by Britain's health minister revealed Sunday.

In the letter, Britain’s Health Minister Lord James Nicholas Bethell and the Parliamentary Under-Secretary of State for Innovation from the Department of Health and Social Care explained in detail that Pakistan’s testing and sequencing rates are relatively low (1.8 per 1,000 over the last seven days) and lower testing and sequencing mean it is not possible to know the full genomic makeup of their current wave. Therefore, they said that the true number of cases is likely to be much higher than reported.

“The national testing rate varies considerably across regions. For example, in Punjab — Pakistan’s most densely populated region — with the highest number of active cases, testing is below Pakistan’s average rate and is the second-lowest in the country,”  Lord Bethell wrote to Yasmin Qureshi MP, the Chair of All Parties Parliamentary Group on Pakistan.

The letter from Lord Bethell was passed to this correspondent by a source.

Lord Bethell said that the Joint Biosecurity Centre (JBC) produces public health risk assessments to inform ministerial decisions on red, amber and green list countries and territories, and the associated border measures.

“Following the latest assessment, the JBC continues to rate inbound travel from Pakistan as high-risk. The limited sequencing data available from Pakistan would suggest that they are currently experiencing a Delta wave, however, given the limitations in the available data, we could not be reassured that the outbreaks are due to known variants such as Delta, or if a novel cluster(s) of new or high-risk variants are developing and/or driving the epidemiology in Pakistan,” he wrote.

Lord Bethell said that there was "no reason other than Pakistan’s drive against the pandemic that Pakistan is on the red list."

He said: “The UK Government is engaging constructively with the Government of Pakistan to explore ways that we can improve data availability and confidence and consequently our understanding of the current epidemiology within Pakistan. I met with Pakistan’s High Commissioner to the UK earlier this week to discuss these issues and we have established an expert working group to enable further technical engagement between senior public health officials and Pakistan’s senior health advisors."

"This will enable us to better understand the strategies employed by Pakistan, their understanding of the pandemic and establish stable and long-term access to the outcomes of Pakistan’s in-country genomic surveillance and sequencing."

“We appreciate the efforts the Government of Pakistan is making throughout the pandemic and will continue to work closely together. We are supporting their response to the pandemic, including through COVAX and through the development of Pakistan’s genomic sequencing capability. Through the New Variant Assessment Platform (NVAP) programme Pakistan will be able to draw on UK expertise and support to detect, analyse, and respond quickly to new, and potentially more dangerous, variants of COVID-19.”

Lord Bethell said the UK government understood the impact of the decision on British Pakistanis but he said: “it is right that the Government takes all available measures to reduce the risk of new strains of COVID-19 being imported into the UK”.

The minister further explained the decision was based on the recommendations made by the Joint Biosecurity Centre (JBC) which produces public health risk assessments. 

“Ministers will take the JBC risk assessments into account alongside wider public health factors to inform watchlists and make their decisions. As with all our coronavirus measures, we keep these lists under constant review and our priority remains to protect the health of the UK public.”

The health minister informed that JBC analyses a range of qualitative and quantitative indicators to assess each country.

“The vast majority of data used to inform the risk assessment is in the public domain; however, some data cannot be published due to the privacy risks that disclosure may have on individuals or groups. To support decision making, JBC focuses the final assessment around three main criteria so that Ministers know where the risks lie: genomic surveillance capability; COVID-19 transmission risk; and variant transmission risk.”