During the height of the COVID-19 pandemic, I had the rare privilege of presenting genomic surveillance data and other laboratory insights at Pakistan’s National Command and Operation Center (NCOC). It was more than just a professional milestone—it was a front-row seat to one of the most remarkable crisis management operations in the country's history. The NCOC wasn’t just a command center; it was a game-changer, transforming fragmented efforts into a unified national strategy. Pakistan’s ability to tackle the pandemic—and now the Mpox threat—didn’t happen by chance. It was the result of a centralized, data-driven approach that many still don’t fully appreciate.

When COVID-19 first hit Pakistan in early 2020, the nation stood at a crossroads. With a fragmented healthcare system and governance challenges stemming from the 18^th Amendment, which devolved health responsibilities to the provinces, a coordinated response seemed nearly impossible. Yet, against all odds, Pakistan emerged as one of the few countries that managed to navigate the crisis with remarkable efficiency. The secret weapon? The National Command and Operation Center.

As the nerve center of Pakistan’s pandemic response, the NCOC became a beacon of centralized decision-making and data-driven governance. It transformed what could have been a chaotic, disjointed effort into a streamlined and effective national strategy. And now, as Pakistan grapples with a looming threat in the form of Mpox (formerly monkeypox), the NCOC’s legacy continues to shape the country's response.

A Blueprint for Crisis Management

When COVID-19 struck, developed nations with robust healthcare infrastructures faltered. Pakistan, despite its resource limitations, took a different approach: it established a unified command. Using constitutional provisions to bypass bureaucratic bottlenecks, the federal government created the NCOC in April 2020. This body did what few expected—it brought all provinces, health agencies, and security forces onto the same page.

Led by the Minister of Planning and Development, with military leadership providing operational expertise, the NCOC crafted policies that balanced public health and economic stability. Unlike blanket lockdowns that paralyzed many economies worldwide, Pakistan introduced smart lockdowns—a targeted strategy that restricted only high-risk areas. This approach not only curbed the virus’s spread but also kept businesses afloat, mitigating economic devastation.

The NCOC’s achievements were staggering. COVID-19 testing capacity skyrocketed from just four laboratories to over 170 nationwide. Daily testing rose from 500 to an impressive 65,000. The “Test, Trace, and Quarantine” strategy helped contain outbreaks, while aggressive vaccination campaigns, backed by real-time data analysis, ensured effective immunization coverage. One of the hallmarks of the NCOC during the COVID-19 pandemic was its ability to make quick

decisions. I remember advocating for genomic surveillance and the need to strengthen next- generation sequencing (NGS) facilities at NIH. Given the high costs of NGS technology, securing funding seemed unlikely. However, to my surprise, the proposal was swiftly approved by the Special Assistant to the Prime Minister (SAPM) on Health—who, being an infectious disease expert, recognized its critical importance. With these funds, NIH was able to report variants and their spread in real time to the NCOC, significantly aiding data-driven decision-making. Additionally, the NCOC played a key role in shaping public behavior through strategic communication. Initially, many citizens underestimated COVID-19’s severity, but by mid-2020, the NCOC’s multi-platform messaging—through media campaigns and mobile phone alerts— helped drive compliance with mask-wearing and social distancing. By the time the NCOC wound down operations in April 2022, it had successfully steered Pakistan through six waves of the pandemic.

NCOC 2.0: Taking on Mpox

While many saw the NCOC’s closure as the end of an era, its operational framework proved too valuable to retire completely. In 2024, as Mpox cases surfaced worldwide, Pakistan was quick to react. The NCOC was reactivated (this time led by National Institute of Health (NIH), leveraging its pandemic-tested model to preempt a full-blown crisis.

Despite initial WHO recommendations against screening travelers at entry points, Pakistan took a proactive stance. Border Health Services, under NCOC directives, implemented early screenings, leading to the timely detection of imported Mpox cases. Public health laboratories across the country, in collaboration with the NIH, ramped up diagnostic capacities, while the polio environmental surveillance network was repurposed to track Mpox outbreaks. These measures allowed Pakistan to detect and contain 14 cases as of March 2025—before the virus could spiral into an uncontrollable epidemic.

Genomic surveillance, another NCOC hallmark, has played a crucial role in tracking Mpox mutations. Scientists at NIH have successfully sequenced and identified imported viral strains, helping public health officials anticipate transmission patterns. Meanwhile, isolation protocols and containment strategies, similar to those deployed during COVID-19, are ensuring that Pakistan stays ahead of the curve.

Lessons for the World

Pakistan’s handling of COVID-19 and now Mpox underscores an invaluable lesson: centralized coordination works. The NCOC model—grounded in data, rapid decision-making, and inter- agency collaboration—has proven that even countries with limited resources can effectively manage global health crises.

While international recognition has poured in, with WHO commending Pakistan’s pandemic response, the real victory lies in the blueprint it offers for future public health emergencies. Whether it’s a resurgence of COVID-19, another viral outbreak, or an unforeseen health crisis, Pakistan now possesses a tested and scalable mechanism to respond.

As global health threats continue to evolve, perhaps it’s time for other nations to take a page from Pakistan’s playbook. The NCOC didn’t just help Pakistan survive a pandemic—it set a precedent for how nations can turn adversity into opportunity through strategic, science-backed governance.

Dr. Massab Umair Presenting Genomic Surveillance Data on SARS-CoV-2 at NCOC: Informing Pakistan’s Pandemic Response.

By ISID Emerging Leader, Dr. Massab Umair

The author is a virologist and public health expert with a focus on disease surveillance and health systems strengthening (massab.umair@yahoo.com).