Islamabad: Pakistan’s already fragile disease surveillance system is facing a serious credibility crisis as Punjab and even health institutions continue to withhold data on mpox and other infectious diseases from the National Institute of Health (NIH), despite repeated requests, undermining national outbreak response and public health planning, senior officials and experts say.
A senior official at the NIH told this correspondent that the federal disease surveillance body was “extremely perturbed” by Punjab’s repeated reluctance to share timely and complete data on mpox cases, including evidence of local transmission, warning that it was impossible to formulate a coherent national response when the country’s largest province withholds information.
“How can a national policy be framed when Punjab does not share outbreak data with the NIH? Mpox cases and evidence of local transmission in Punjab are being kept from federal authorities despite repeated requests. This is not just an administrative lapse. It is becoming a national health security issue,” the official said, requesting anonymity due to the sensitivity of the matter.
The official said the problem was not confined to Punjab alone. “Even public and private hospitals in Islamabad and in other provinces do not routinely share complete disease surveillance data with the NIH. Many facilities report selectively, late or not at all. This means we are often working with partial or distorted information,” the official added.
The latest weekly Integrated Disease Surveillance and Response (IDSR) bulletin issued by the NIH, which compiles suspected cases of a wide range of communicable diseases reported by provinces and regions, itself reflects major gaps in reporting.
For Punjab, data for multiple disease categories is marked as ‘NR’ (not reported), including acute diarrhoea, influenza-like illness, malaria, respiratory infections, tuberculosis, typhoid and several vaccine-preventable diseases, highlighting a chronic failure to feed routine surveillance data into the national system.
Public health experts warn that such gaps severely weaken Pakistan’s ability to detect outbreaks early, allocate resources, and design evidence-based interventions. “Surveillance data is the backbone of outbreak preparedness. If provinces do not share what is happening on the ground, the federal system becomes blind,” a senior epidemiologist said.
The NIH official disclosed that the problem of data withholding is not limited to provincial health departments and hospitals. “The situation is even more worrying because in some cases, researchers within the NIH itself are not sharing data with their own leadership,” the official said.
In one instance, the official said, a female researcher at NIH Islamabad who is working on Candida auris, a highly drug-resistant and potentially deadly fungal infection spreading in hospital settings, has not shared concrete data with senior management. “Without reliable data, we cannot sensitise hospitals on infection prevention and control, nor can we issue public advisories. We know Candida auris is emerging in hospital environments, but we are unable to quantify the scale of the problem because the data is not being shared internally,” the official said.
Senior experts said Pakistan’s disease surveillance system suffers from deep structural flaws, including weak reporting obligations, lack of accountability, and an absence of data-sharing culture across institutions. They warned that the consequences go beyond domestic public health.
“Pakistan does not even consistently share its disease surveillance data with the World Health Organisation. Polio data is shared, but for many other diseases, reporting is patchy or delayed. This undermines international confidence and hampers global risk assessments,” a former health ministry adviser said.
Officials said similar concerns exist around HIV surveillance. The Common Management Unit, which is mandated to compile and coordinate HIV data nationally, does not routinely share detailed infection data with senior officials in the federal health ministry, while several provinces and service providers remain reluctant to release disaggregated HIV figures.
This, experts warn, weakens planning for prevention, testing, and treatment programmes at a time when HIV infections are rising in multiple parts of the country.
The withholding of mpox data from Punjab has particularly alarmed federal officials because of the risk of silent community spread. “When provinces sit on data about local transmission, the window for early containment closes. We are left reacting late, when clusters have already expanded,” the NIH official said.
Public health specialists argue that Pakistan urgently needs a legally enforceable disease reporting framework that compels provinces, hospitals, laboratories, and research units to share standardised, real-time data with the NIH. Without this, they warn, the country will continue to stumble from one outbreak to another, unable to build a credible national picture of emerging and re-emerging infectious threats.
“This is not just about technical reporting. It is about political will, institutional discipline, and national responsibility,” a senior expert said. “Without transparent data-sharing, Pakistan cannot protect its own population, let alone meet its international health obligations.”
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