Since the declaration of pandemic on March 11, 2020, COVID-19 has been spreading to
almost every country across the world, leading to a rising tally of more than 14 million
cases, and half a million deaths [1]. The pandemic which originated in China, slowly
made its way to its neighbouring countries including Cambodia, Laos, Thailand, and
Myanmar. With a fragile health system exacerbated by long ongoing civil wars and conflicts,
Myanmar is especially vulnerable to the spread of COVID-19 because of its 2227-km
porous border with China where workers and migrants cross daily; as well as borders
shared with Bangladesh, India, and Thailand, all of which reported higher number of
cases. With the announcement of Myanmar’s first two laboratory-confirmed cases on
March 23, 2020, it ushered its entry to the countdown of the spread. As of August
27, 2020, there were 580 confirmed cases across Myanmar with 6 deaths (male, 67%)
and 345 recoveries [2]. In this commentary, we provide a quick analysis of the current
state of COVID-19 pandemic in Myanmar and the country’s efforts to address it and
its impact.
Myanmar responded early to the impending COVID-19 breakout with the formation of the
Inter-Ministerial Working Committee a few days before the World Health Organization
(WHO) declared it as a global health emergency. This was followed by the setting up
of the National Central Committee to prevent, control and treat COVID-19, chaired
by the State Counsellor Aung San Suu Kyi. It aimed at smoothing out and fast-tracking
activities at the central level such as case investigation and management, providing
community awareness and disseminating updates regarding the pandemic, and securing
funding, procurement of essential medicine and equipment in time. Although this may
be considered as a timely and bold move by a developing country, concerns were raised
with such a centralized command and control approach.
Following the first two cases, strict containment measures were put in place which
included travel restrictions, partial lockdowns, closure of major businesses such
as factories and shopping malls, quarantining incoming travellers, banning gatherings
of five or more people, imposing stay-at-home orders, and curfews in some major cities.
Closing borders and enforcing mandatory quarantine, either in a state-sponsored facility
or a charity-based one, were also intensified. State Counsellor Aung San Suu Kyi,
appeared constantly on television, encouraging the public to bravely face the pandemic
and urged them to follow the public health advice provided by the Ministry of Health
and Sports (MOHS).
The most remarkable decision by the government was to impose the lockdown during the
country’s ten-day long symbolic traditional New Year holidays in April, known as “Thingyan”
[3]. Due to lack of strict adherence or poor enforcement of such measure, case numbers
almost quadrupled, with majority of cases coming from residents of Yangon, the most
populous city in Myanmar. Despite the ban on mass gatherings, a cluster of 50 cases
were linked to a religious event, resulting in legal action against a few prominent
religious leaders and bifurcation of public opinions amidst the pandemic. These events
were further fuelled by an increase in cases during and after a large influx of more
than 15 000 Myanmar migrants who returned home by government-sponsored relief flights
from Thailand, China, Malaysia and the United Arabs of Emirates. While facility-based
or community quarantines were planned in areas with returning migrant workers, some
were missed by the system and subsequently overwhelmed the health system which complicated
contact tracing, leading to ineffective and inefficient control.
Myanmar’s health sector is already challenged by common health problems faced in developing
countries, including shortage of skilled health care workers and underfunded health
infrastructure. It has a population of just over 54 million, and a population density
of 83 per square kilometre. Myanmar’s health care consistently ranks the world’s lowest
and it was included in 57 countries facing critical health workforce shortages. Majority
of its States and Regions are well below the WHO recommended minimum number of 1 per
1000 population for medical doctors: with a wide range of disparities in the number
of urban to rural doctors. There were 6.7 doctors, and 10 nurses and midwives per
10 000 population in 2018 [4]. In early 2020, there were about 600 critical care beds
and 180 ICU beds across the country, which is roughly 1.1 bed per 100 000 people.
Testing capacity was initially limited to only two facilities, but later extended
to another three facilities including that of the military sector. All these rendered
a huge blow on the frail health system and limited the response to COVID-19. The same
health system is already struggling to cope with the conventional health demands.
Thus, careful consideration should be given to resource re-allocation, alleviating
health system exhaustion and upgrading health staff capacity.
The health care workers have been affected heavily by COVID-19 compared to other professions
as they are directly responsible for the well-being of patients. Health workers are
challenged by issues, such as exhaustion due to heavy workload, inadequacy or lack
of personal protective equipment (PPEs) and the fear of getting and/or spreading the
infection [5]. In Myanmar, 14 health workers have been infected with COVID-19. The
shortage of health staff and the increasing social tension they are exposed to, the
increased level of verbal aggression, social stigma, violence and even attacks aggravate
the situation. Fortunately, due to the cultural norms and social positioning of health
workers within the community, Myanmar has not yet seen such violence during the pandemic.
Though COVID-19 is a public health threat mobilizing the public health sector, politics
and humanitarian vulnerabilities are also playing vital roles in responding and acting
on the public health priorities. The current centralized “whole-of-government” approach
taken by the Myanmar government may likely be a challenge since there are various
political players and scenarios that come into play, as well as different degrees
of peace, security, non-governmental control, and conflicts across Myanmar [6,7].
Although many ethnic armed groups in Myanmar appear willing to put aside differences
and work with the central government to help address the pandemic, conflict is still
escalating in northern Rakhine State which is beyond the control of the Myanmar central
government. In 2019 alone, 80 000 people have been displaced due to conflict and violence,
making the total number of internally displaced populations at 457 000 [6]. Despite
the domestic and international calls for a ceasefire, fighting continues in Karen,
Shan, Rakhine, and Chin states amidst COVID-19. This situation places health workers
at serious risk to health and conflict. The situation at the border with Bangladesh
convolutes the risky situation [8]. Hence, the need for a nationwide ceasefire during
this pandemic. A tailored approach for each area should be figured out through coordination
and cooperation among the government, non-government groups, and humanitarian agencies
[9].
Photo: From the author’s own collection, used with permission.
Civil society organizations (CSO) can play an important role in addressing COVID-19
in Myanmar. A large spectrum of such CSOs are operating across the country, particularly
at the grassroots and villages level. They are organised and formalised with linkages
to the larger township or regional networks. CSOs take the form of religious or ethnic
solidarity groups. Despite their significant number, they have yet to be tapped. They
may have limitations in terms of finance, scale of operation, service coverage, and
capacity, but they have the advantage of strong community-level engagements. It is
proposed that mitigation efforts may use these organizations so as to localize approaches,
while the central government provides support and the coordinating role. This community-based
approach would be an advantage amidst Internet blackouts and media shutdowns in states
like Rakhine. These information outages have detrimental effect on the public in accessing
vital public health information. The effects can be lessened by utilizing and coordinating
the efforts of existing CSOs inside such areas. Community awareness of public health
initiatives, sanitation and hygiene practices and disease prevention strategies can
be supported more efficiently and effectively through person-to-person CSO-led communication
augmented by the radio [10]. Sustainability of these initiatives should be considered
as these are largely influenced by livelihood, economic and social conditions—factors
which had negative effects on some COVID-19 measures.
CONCLUSION
Many countries in South-East Asia, including Myanmar, are still facing a slow-paced
pandemic and yet to face its full impact. The current actions of the government of
Myanmar are hinged on sustaining the current benign situation, while taking precautionary
measures against the further spread, health system exhaustion, public complacency
of preventive measures, and livelihood instability and insecurity due to the long-term
economic shutdown. Myanmar is performing, so far, seemingly well in its task in tackling
COVID-19. The country may use this opportunity to fortify the call for peace across
the country and strengthen the resilience of the health system. This situation pushed
Myanmar to revisit its investment in health. There is no doubt that the health sector
of a nation can be revitalised in times of great adversity. Myanmar joins the world
in looking forward to an effective treatment or vaccine. Until that time, all stakeholders
in Myanmar need to put aside differences, unify and continue to strengthen its efforts
in containing COVID-19.