Sana (a pseudonym), a transgender person in their early thirties, did not want to leave Pakistan. They wanted to live. At thirty-two, they are on a transplant waiting list at the Pakistan Kidney and Liver Institute in Lahore (PKLI), their liver failing from a hepatitis B infection they never knew could be prevented. “If anyone had told me about the vaccine,” they said, “my life would not be hanging between hospitals and hopelessness.” Nobody had told them. That omission – quiet, ordinary, nationwide – is killing people at scale.

Across Pakistan, a peculiar kind of emigration is accelerating. People are not leaving only for jobs or opportunities. They are leaving for their lives – fleeing a health system that too often meets them at the emergency room rather than at the clinic door. It is a profound indictment of a country that has, in its pharmacies and its public hospitals, the same tools that transformed life expectancy in the wealthy world. The tools exist. The communication does not.

The gap is measurable. The WHO puts Pakistan’s life expectancy at roughly 68 years – five years below the global average, more than a decade behind high-income countries. The distance between those numbers is not, in most cases, explained by geography or genetics. It is explained by four medical discoveries, made between 1796 and 1987, that rich countries systematically told their citizens about, and that Pakistan has not.

Four medical breakthroughs — vaccination, insulin, statins, and antibiotics — added three decades to human life expectancy in the twentieth century. Pakistan largely missed the lesson. A new metaphor, the ‘Health VISA’, may finally offer a way to teach it.

Four medical breakthroughs — vaccination, insulin, statins, and antibiotics — added three decades to human life expectancy in the twentieth century. Pakistan largely missed the lesson. A new metaphor, the ‘Health VISA’, may finally offer a way to teach it.

“The medicines exist. The science exists. What is missing is consistent awareness and trust.” As a health communication aspirant, I have given that gap a name, calling it the missing Health VISA: Vaccination, Insulin, Statins, Antibiotics. Together, they form an acronym – VISA. In a country saturated in the vocabulary of departure – visa queues, immigration forms, foreign dreams – it reframes the question. What if the passport to a longer life were available locally? What if it had always been here, waiting to be recognised? The metaphor does not propose a new policy or product. It offers a way to simplify complex medical science into a message that resonates with ordinary people. Each “stamp” represents an opportunity for prevention, dignity, and survival – without leaving home.

The First Stamp: VACCINATION (1796/1974)

Edward Jenner administered the world’s first vaccine in 1796. It took the WHO until 1974 to formalise the Expanded Programme on Immunisation (EPI) that would carry vaccines systematically to the developing world. The half-century of data that the EPI generated is now in. Writing in The Lancet in 2024, Shattock and colleagues modelled fifty years of the EPI and arrived at a figure that should silence every vaccine sceptic: 154 million lives saved. Not projected. Not estimated in the abstract. Saved. Vaccination was directly responsible for 40 per cent of the global decline in infant mortality – and in Africa, that figure climbed to 52 per cent. Nine billion life-years were gained. One medicine – the measles vaccine alone – accounted for 60 per cent of those deaths averted. The science of vaccination did not merely prevent disease. It rewrote the story of childhood survival.

Yet in Pakistan, vaccines remain entangled in mistrust, misinformation, and political resistance. Habib Asghar, a UNICEF-Pakistan official steering its social and behaviour change campaigns, described the challenge candidly: “The science is clear. What complicates our work is misinformation and a lack of information. Every rumour weakens trust and delays eradication.” The science of vaccination is not contested. The communication is. Pakistan remains one of only two countries in the world where polio persists, and recurring outbreaks of measles and hepatitis B continue to surface, particularly in underserved communities. Sana – still awaiting a transplant – was never told that a vaccine existed that could have changed everything.

The Second Stamp: INSULIN (1922)

On 11 January 1922, a fourteen-year-old boy named Leonard Thompson received the first human injection of insulin at Toronto General Hospital. He had been wasting away on a starvation diet – the only treatment available for Type 1 diabetes at the time. Within days, his blood sugar normalised. The discovery by Frederick Banting and Charles Best transformed a uniformly fatal diagnosis into a manageable condition. It is one of the most dramatic reversals in the history of medicine.

One century later, the crisis insulin was meant to solve has returned in a different form – and at a global scale. In 2023, The Lancet published the findings of the GBD 2021 Diabetes Collaborators – a team that analysed data from 204 countries – and their conclusion was stark: by 2050, more than 1.31 billion people will be living with diabetes. The vast majority will be in low- and middle-income countries. In Pakistan alone, current estimates suggest over 33 million people are living with diabetes – roughly one in eight adults – with millions more undiagnosed. The researchers were blunt: without expanded access to insulin, this crisis will compound, draining economies, overwhelming hospitals, and cutting short lives that could have been lived in full.

Khalid Anjum, recovering from a diabetes-related amputation, reflected on what he did not know. “I did not understand that high sugar destroys the body quietly,” he said. “I thought wounds heal on their own.” By the time he reached the hospital, the infection had progressed beyond control. “Insulin works,” said Dr Khalid Jamil, a physician treating diabetic patients at Mayo Hospital in Lahore. “The failure happens when diagnosis comes too late, and patients are not educated.” The medicine has existed for over a century. The crisis is one of awareness and communication, not invention.

The Third Stamp: Statins (1987)

In 1971, Japanese biochemist Akira Endo isolated the first statin from a petri dish of bread mould. The clinical journey from petri dish to patients took another sixteen years. In 1987, the FDA approved lovastatin – the first commercially available statin – and quietly launched what would become one of the most consequential preventive medicines to treat heart attacks/strokes ever manufactured. Cardiovascular disease is now the leading cause of death in Pakistan, overtaking infectious illness. What medicine has known for years – and what far too many Pakistani patients have never been told – is this: a small, inexpensive pill taken daily can significantly reduce the risk of a first heart attack or stroke.

In 2025, a landmark meta-analysis in Health Technology Assessment reviewed 139 randomised trials covering more than a million participants and ranked every primary prevention strategy available. Statins topped the list. A separate analysis in JAMA Internal Medicine sharpened the picture further, finding that statins prevent a first major adverse cardiovascular event in adults aged 50 to 75 within just 2.5 years of starting treatment. Two and a half years. For a country where patients routinely arrive at cardiac units only when surgery is the last option, that window is not a medical footnote. It is a missed opportunity measured in lives.

“A large proportion of the heart surgeries we perform could have been prevented if statins had been started early,” said Dr Umer Iftikhar, a senior cardiologist at the Punjab Institute of Cardiology, Lahore. “Despite being inexpensive and widely used in high-income countries, statins remain dramatically underutilised here, where preventive care consistently loses to emergency intervention.”

THE FOURTH STAMP: ANTIBIOTICS — 1928 / 1935

The antibiotic era has two births. The first came in 1928, when Alexander Fleming returned from holiday to find that a mould — Penicillium notatum — had contaminated a petri dish and killed the surrounding bacteria. Fleming noted the phenomenon but could not stabilise the compound. It was not until 1940 that Howard Florey and Ernst Chain purified penicillin for clinical use, and its mass deployment began during the Second World War. The second birth came earlier in practical terms: in 1935, German bacteriologist Gerhard Domagk introduced Prontosil — the first sulfa drug — as the first synthetic antibiotic therapy, earning him the Nobel Prize in Physiology or Medicine.

Jayachandran and colleagues, reconstructing 20th-century mortality data in the NBER Working Paper Series, found that sulfa drugs cut maternal mortality by up to 40 percent, reduced pneumonia deaths by up to 36 percent, and added nearly a full year to average life expectancy — all within a few years of their introduction in the late 1930s. Antibiotics, when they reach people in time, do not merely treat illness. They transform the baseline of survival. The New England Journal of Medicine later documented a 17 percent fall in child mortality in rural Niger simply from twice-yearly azithromycin distribution. The medicine existed. The delivery made the difference.

In a Basic Health Unit near Lahore, a mother named Samina (a pseudonym) recounted how her daughter died after a home delivery handled by a traditional midwife. Severe post-partum bleeding followed, but no qualified care was sought. “No medicine was given,” she said quietly. “The midwife said the bleeding would stop.” It did not. A timely antibiotic and basic obstetric intervention could have saved her daughter’s life.

Yet antibiotics in Pakistan tell a more complicated story: they are simultaneously overused and underused — available without prescription in urban pharmacies, yet absent where they are most urgently needed. The WHO now classifies antimicrobial resistance as one of the gravest public health threats of this century. The challenge for Pakistan is not simply access. It is the right antibiotic, for the right patient, at the right time — and a public that knows when to ask for one.

A RIGHT, NOT A LUXURY

There is a right that rarely makes headlines but quietly underpins every other right we claim to value: the right to know. Article 19 of the Universal Declaration of Human Rights guarantees every person the freedom to seek and receive information — and when that information concerns their health, denying it is not a bureaucratic failure. It is a matter of life and death. The WHO and UNICEF have long recognised that health literacy saves lives as surely as hospitals do. The UN Human Rights Committee has gone further, affirming that governments bear an active obligation to prevent preventable deaths, including those caused simply by ignorance of what medicines exist.

Pakistan’s Constitution, under Article 9, guarantees the right to life. But a right to life that does not include the right to know about a vaccine, a blood sugar test, a cholesterollowering pill, or an antibiotic is a right only on paper. “What people are really searching for is assurance,” said Dr. Usman Ghani, a social and behaviour change specialist working with international agencies. “If health feels unattainable at home, they will look for it elsewhere.” And they are. Pakistan consistently ranks among the top countries of origin for medical migrants — people who leave not for ambition, but for survival.

Longevity should not depend on geography. Nor should survival depend on a visa queue.

Longevity should not depend on geography. Nor should survival depend on a visa queue.

Vaccination, insulin, statins, and antibiotics. Together, these four discoveries added an estimated 25 to 30 years to life expectancy in industrialised nations over the twentieth century — not through accident, but through deliberate public investment in telling people what science had made possible. The United Kingdom did not merely discover penicillin; it built a national health service to deliver it. The United States did not merely approve statins; it embedded them in primary care guidelines and insurance coverage. Longevity in wealthy countries was not the gift of science alone. It was the reward for choosing to communicate.

Pakistan now stands at a similar crossroads. The ‘Health VISA’ is not a document issued by any authority. It is a reminder that the tools to extend life already exist — and that the real work is communication. International agencies such as the WHO and UNICEF, provincial health departments, national health education programmes, local NGOs, and digital content creators all shape how health information circulates across the country. Aligning their messaging around simple, evidence-based narratives could strengthen public understanding and, in time, shift the migration calculus — not by closing borders, but by making home worth staying in.

If Pakistan invests in telling its health stories clearly and truthfully, it may discover that the strongest passport is not stamped at an embassy, but offered at a clinic — quietly, locally, and in time.

If Pakistan invests in telling its health stories clearly and truthfully, it may discover that the strongest passport is not stamped at an embassy, but offered at a clinic — quietly, locally, and in time.

© Daily Times