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In a rapidly evolving global health landscape marked by climate instability, infectious disease outbreaks, and natural disasters, the concept of health preparedness has moved from the periphery to the center of national security agendas. For Pakistan, this paradigm shift took a significant leap forward with the successful convening of the 1st National Health Preparedness and Resilience Conference, organized by the National Institutes of Health (NIH), Islamabad. Held under the banner of innovation and collaboration, the conference marked a historic step toward institutionalizing resilience and proactive health security in the country. It brought together a cross-section of key stakeholders, including public health experts, disaster management professionals, policymakers, and academics, to identify actionable strategies in building a health system that can anticipate, absorb, and adapt to both sudden and sustained health emergencies. The conference did not merely reiterate the importance of being prepared for emergencies, it emphasized the need to embed resilience as a foundational component of the health system. The distinction is critical. Preparedness often implies readiness for known threats, while resilience denotes a system's capacity to absorb shocks, continue functioning, and emerge stronger from crises.1 By framing the agenda around both preparedness and resilience, the NIH Islamabad signaled a shift toward holistic health governance one where emergency response is integrated with long-term planning, community engagement, and systems strengthening. Among the focal areas, diarrheal diseases often regarded as endemic but controllable were given center stage. These illnesses, typically linked to poor sanitation, unsafe water, and limited health education, are not only preventable but serve as indicators of wider systemic vulnerabilities. As climate change increasingly disrupts water quality and food safety, diarrheal outbreaks are becoming more frequent and harder to contain, especially in underserved regions.2 One of the most impactful aspects of the conference was its cross-sectoral and inter-institutional approach. Representatives from the Ministry of Health, National Disaster Management Authority (NDMA), academic institutions, and international partners contributed to dialogue sessions, highlighting the essential role of collaboration. This model mirrors international best practices such as those embedded in federal emergency management agency’s Prep Toolkit or the United State National Response Framework where preparedness is treated as a shared national responsibility.3 In Pakistan’s context, where bureaucratic silos and resource limitations often hinder timely response, this open and inclusive approach is not just necessary it is transformative. The conference also emphasized the importance of innovation and capacity building in preparedness efforts. From investing in early warning systems and digital surveillance platforms to enhancing laboratory networks and emergency logistics, discussions reflected a forward-looking mindset. Equally important was the emphasis on human resource development. Capacity building at all levels community health workers, local responders, clinicians, and planners is critical for transforming policy into practice.4 Preparedness cannot reside only at the top; it must be active and operationalized on the ground. Pakistan’s health system has faced numerous stress tests in recent years, from the COVID-19 pandemic to devastating floods. These events exposed not only resource gaps but also coordination failures and weaknesses in local infrastructure.5 The conference leveraged these hard-earned lessons to propose more integrated models of risk reduction, disaster response, and public communication. A notable example was the discussion around community engagement as a pillar of preparedness. Educating citizens on hygiene, vaccination, and disaster response enhances not only the reach of health systems but also public trust a commodity often overlooked but critical in crisis moments. The success of this inaugural conference should not remain symbolic. For the momentum to continue, several follow-up actions are essential, including institutionalize annual preparedness drills, dedicated budget lines for health resilience, decentralize response capacity, monitor progress through benchmarked indicators, foster academic and research partnerships.6 Conclusively the Conference has laid a crucial foundation for reshaping how Pakistan approaches health security. However, resilience is not built in a day or a single conference. It requires a long-term, multisectoral commitment one that integrates science, policy, public engagement, and sustained investment. As the NIH and its partners move forward, the true measure of success will be how effectively these strategies translate into safer, healthier, and more prepared communities across Pakistan.

To determine the economic burden of thalassemia on parents of thalassemic children. Descriptive nonprobability, purposive sampling done in PHRC Research Centres of Multan, Lahore, Islamabad, Karachi, Peshawar and Quetta from July 2013 to June 2014. After taking informed written consent, parents/guardians of thalassemia major children were interviewed. All information was recorded on the pre-tested questionnaire. Data was entered and analyzed using SPSS version 11. A total of 600 guardians/ parents of the thalassemic children were included in the study. There were 57% boys and 43% girls with a mean age of 9.40 + 5.66 years. Among them, 47.8% were from rural and 52.2% from urban areas. Almost 71% children were transfusion dependent. The family history of cousin/interfamilial marriage was present in 78.2% while parental consanguinity was present in 72.8%. Only 1.7% parents got premarital screening for thalassemia. In private sector 56.8% had to pay nothing while others had to pay from Rs. 500 to Rs. 2000 per visit. Expenditure per month in private thalassemia centres showed that 57% had to bear no cost at all, 12.2% had to spend up to Rs. 1000, while 24.8% Rs. 1001 to 5000 and 6% had to pay more than Rs. 5000. In the government sector cost per visit in 35.5% was up to Rs. 500 while others had to pay between Rs. 501 to more than Rs. 2000. Monthly cost at government sector almost doubled. Total expenditure (private and government sector) per month was Rs. 9626 for each patient. Total cost (both direct and indirect) for the management of thalassemia was quite high and this cost puts significant economic burden on the affected thalassemic families. This disease puts social, financial and psychological impacts on suffering families, so prevention-based strategies like premarital screening, prenatal diagnosis and genetic counseling should be adopted in Pakistan. A national screening project for thalassemia is the need of the day.

Anti HCV is transferred from positive mother to her newborn. To prevent this transfer of anti HCV, many health care providers stop the mother from breast feeding and recommend the checking of the newborn for anti HCV. If found positive, they take it as a chronic infection and recommend treatment of the child as soon as possible. Prohibition from breast feeding not only pushes these neonates towards nutritional deficiencies but also make them prone to infections. The testing also stigmatizes the mother and her newborn for life. The literature proves that this antibody transfer is passive and clears in majority of cases without any residual disease. Mother to infant transfer of anti-HCV and its natural course in Pakistani population is not known. To determine the frequency of anti-HCV positivity and its natural course in infants born to anti-HCV reactive mothers. Anti-HCV reactive mothers were registered from gynecology department and labor room of Nishtar Hospital Multan from 07-10-2010 to 07-04-2011, using non probability purposive sampling. The ALT of mothers was also checked. The babies born to these mothers were checked for antiHCV by ELISA and ALT at 0 day (at the time of birth) and then at 6, 12, 18 and 24 months using venous blood samples. Data was entered and analyzed using SPSS-11. Out of 35 anti-HCV reactive mothers; only one had ALT above the upper limit of normal (> 40 IU/L). A total of 35 babies were born to these mothers, out of whom 34(97.1%) were reactive to anti-HCV at the time of birth and only one was non reactive. At 6 months 2 babies had expired and 3 were lost to follow up, leaving 30 babies. Out of these 30 babies 11 became non-reactive and 19 were still reactive for anti-HCV at 6months. At 12 months, all 19 anti-HCV reactive cases became non reactive, indicating passive transfer of antibodies from the mother to these neonates which they lost by 12 months. ALT of all babies except 3 was raised at 6 months (> 40 IU/L) which became normal during the subsequent visits. Almost all children born to anti-HCV positive mothers were reactive at the time of delivery but they all became non-reactive by the age of 12 months indicating passive transfer of anti HCV from the mother to the neonate.

Household contacts of sputum positive pulmonary TB cases are at a high risk of getting infected with tuberculosis therefore symptomatic or vulnerable individuals should be screened and treated early. To determine the prevalence of pulmonary tuberculosis in the households contacts of index patients having pulmonary tuberculosis infection using standard diagnostic tests and refer the positive cases to DOTS program for treatment. This national descriptive study was conducted in seven Centers of PMRC throughout Pakistan form November 2010 to March 2012. A total of 580 index adult patients suffering from pulmonary tuberculosis, being treated at DOTs Centers of major tertiary care hospitals of Karachi, Lahore, Multan, Peshawar and Quetta living within 5-8 kilometers of the hospital, who consented to participate in the study were selected from the DOTs centres. Generally one but occasionally two close contacts of these index patients (spouses, parents or siblings) were called to the hospital for screening of TB using chest X-ray, smear microscopy and tuberculin skin test. Out of 800 contacts screened, 125 (15.6%) were positive on sputum smear examination while 113 had infiltration on X-rays along with positive tuberculin skin test (Indurations of >10 mm) making a definitive diagnosis of TB. Calcified lesions were seen on X-rays in another 91 cases giving evidence of past infection, however 26 of these were AFB positive indicating either the relapse of disease or active lesion. Low grade fever and weight loss were the most significant findings in contacts that were positive on sputum smear and radiology. Almost 15.6% household contacts of pulmonary tuberculosis patients have pulmonary tuberculosis. Health care providers in general and DOTs staff in particular should be trained to inform all index cases that their close contacts especially those suffering from weight loss and fever should be screened for tuberculosis and treated if required.