When the first wave of COVID -19 struck countries around the globe: strengths and gaps in readiness became quickly evident. As the world looks to the horizon of coming months and years to prepare for how COVID-19 may continue to impact health, economies and societies—it is crucial to reflect on the lessons learned thus far and to anticipate potential future scenarios. Knowledge learned through After Action reviews of real-life and fictional scenarios can be used to update planning documents and improve response to pandemics—even as they are unfolding. On behalf of Ending Pandemics, Sandia National Laboratories (SNL) led a COVID-19 readiness and resiliency During Action Review (DAR) for Pakistan in partnership with Pak One Health Alliance (POHA), from November 2020 – January 2021.

Through utilization of a participant-led analytic approach, the DAR ensured that findings were relevant and accurate for Pakistan. DAR incorporated an assessment reviewing the response to-date and a tabletop exercise (TTX) to assess resiliency for challenges that may lie ahead. Within health emergencies, different critical emergency response functional roles are engaged. In order to appreciate the depth of insights within each of these roles, to identify any differences in perspectives, and to review overall coordination, questionnaire and TTX were conducted in a role-based format. On 26 February 2020, the first two cases of COVID-19 were confirmed in Pakistan. As of 18 February 2021, Pakistan continues to experience community transmission with 567,261 cumulative cases, 530,597 cumulative recovered, 12,488 cumulative deaths with a Case Fatality Rate of 2.2% and 93.5% recovery rate, according to the World Health Organization.1 The VOC 202012/01 or ―UK Variant‖ variant of concern has been verified in Pakistan.