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roll them out. By late summer 2021, the country was vaccinating roughly a million people a day,
a much higher share of its population than most other lower-middle-income countries.18
Bringing it all together with logistics
Countries that had recently been running large polio campaigns--as both Pakistan and India had
done--had another advantage: their national and regional emergency operations centers. (You
may remember these nerve centers of public health campaigns from Chapter 2.) When COVID
hit, these EOCs were a natural model for coordinating COVID-related activities.
In Pakistan, for example, health officials paused polio vaccination campaigns early in
2020 because of the transmission risk posed by vaccinators moving from one community to
another. In March, though, they saw an opportunity: set up an emergency operations center for
COVID modeled on the one for polio.
Within a few weeks, more than 6,000 health workers who had been trained to watch for
signs of polio were taught about COVID symptoms as well.19 A call center that had been set up
to take reports of possible polio cases was repurposed for COVID; that anyone in the country
could call a toll-free number to get reliable information from a trained professional. The EOC
also logged case numbers, coordinated contact tracing and genetic sampling, and used its
existing data-transmission systems to share this information throughout the government--all
functions that had been built up during the polio campaign. The maps, charts, and statistics
pasted all over the walls now counted COVID.20
This brings me to a criticism that I've been hearing for years. Trying to eradicate a
disease is what people in the field call a vertical approach--that is, it goes deep on trying to end
one disease. By contrast, a horizontal approach is one that can drive progress across many