This blog was first published in Brookings Future Development Blog, December 1, 2020. The authors are Ashwini Deshpande, Khaing Thandar Hnin, and Tom Traill.
During the first wave of the coronavirus pandemic, from late March to early August, Myanmar recorded just 360 cases and 6 deaths. Early in the crisis, the government rapidly implemented measures to contain the virus. Just as it started easing them though, the country was hit by a major second wave in mid-August. Daily cases increased from less than 10 per day in early August to over 1,000 per day in mid-October. This wave has overwhelmed Myanmar’s inadequate and understaffed health infrastructure. By November 20, there were 76,414 confirmed cases and 1,695 deaths (Figure 1).
Figure 1a. Cumulative active confirmed cases, discharged patients and deaths
Figure 1b. COVID-19 cases by region
Source: Ministry of Health and Sports, Myanmar.
Note: Data as of November 20, 2020.
In the November 2020 national elections, Myanmar civilian leader Aung San Suu Kyi’s party won comfortably to stay in power. The government now faces the task of stemming the rapid increase in cases. What can the country do to quickly contain COVID-19? Duke University’s Center for Policy Impact in Global Health and Community Partners International in Yangon analyzed Myanmar’s pandemic preparedness and its policy response to provide an answer to this question. Besides summarizing the current situation of the COVID-19 pandemic, our recent policy report identifies policy gaps that the new government has to plug.
Weaknesses: Testing capacity, health infrastructure, income security, and domestic stability
A day after the World Health Organization notified governments about the unexplained pneumonia cases in Wuhan in January, Myanmar set up surveillance at points of entry to the country. Since March, it has implemented domestic and international travel restrictions while issuing guidance on personal hygiene, COVID-19 symptoms, and social restrictions in public spaces (Figure 2).
Figure 2. Timeline of the policy and coordination measures by the Myanmar government
Key: blue indicates public health policies; green indicates social and economic measures; orange indicates health system response
Inadequate testing capacity. Since the start of the pandemic, the government took steps to expand its testing capacity. In early October, it could conduct over 10,000 tests daily, a substantial rise from the 380 tests per day in March. But this is not enough to keep pace with the soaring second wave. Since mid-October, the rate of positive tests has been about 10 percent—implying that the confirmed cases represent only a small fraction of infected people. As of November 22, Myanmar had conducted 1,998.7 tests per 100,000 people. Limited availability of detection systems, dependence on other countries for testing kits, and shortages of human resources such as trained laboratory technicians and logistics and data managers are some of the main factors compromising laboratory testing.
Unprepared health system. According to the 2019 Global Health Security Index, Myanmar was least prepared in terms of the availability of health systems to treat the sick and protect health care workers. Myanmar had just 6.7 physicians per 10,000 people in 2018, significantly lower than the global average of 15.6 physicians per 10,000 people in 2017. Besides, it only had 10.4 hospital beds per 10,000 people. In March 2020, Myanmar reported just 0.71 intensive care unit beds and 0.46 ventilators per 100,000 population, which were insufficient to deal with even a moderate outbreak. The government has increased surge capacity by constructing makeshift hospitals, quarantine centers, and clinics; and procuring ventilators and securing funding for ICU units. But these efforts are compromised by the scarcity of medical staff. The government has called upon volunteers to work at state quarantine centers, but mandatory 14-day quarantine and increasing caseloads have stressed volunteers. In addition, some of the quarantine centers are reportedly poorly managed, increasing the transmission risk in centers; 10 percent of the total confirmed cases in the second wave are among health care workers.
Income and food shortages. Myanmar’s economy has been hurt badly by the pandemic, giving rise to income and food insecurity. The sharp decline in remittances due to the pandemic is likely to reduce household income. Eighty percent of Myanmar’s workforce is informal. Scores of day laborers have lost their jobs. Women constitute a majority of the hospitality and garment sectors, so they have been disproportionately affected by factory closures. About 4 out of 5 households reported skipping meals, and others have incurred debt to buy food. The government implemented several measures under the COVID-19 Economic Relief Plan (CERP) such as unemployment benefits to registered workers, targeted cash assistance, and a one-time food distribution to households without a regular income. It established a fund of 400 billion kyat (around $309 million) to support garment, tourism, and small and medium enterprises (SMEs) via soft loans. Soft loans were also extended to farmers, roadside vendors, and the microfinance sector. But the current cash transfer of MMK40,000 per household translates to a daily income equivalent that is below the poverty line. Besides, the CERP lacks policies that target women who have lost their livelihoods due to the pandemic.
Domestic unrest. Conflict between the government and the Ethnic Armed Organizations (EAOs) makes it hard to organize an effective pandemic response. The conflict has led to the displacement of the population as well as the disruption of transport routes and supply chains. In May, the committee that coordinates and collaborates with EAOs to control and treat COVID-19 announced a unilateral ceasefire with EAOs, but the strife between the military and the Arakan Army continues in Rakhine and Chin. As of November 20, Rakhine had the fourth-highest confirmed cases in the country, and they continue to grow. The government has supplied personal protective equipment at campsites for internally displaced persons (IDPs), but congestion and poor living conditions in IDP camps heighten transmission risk.
Solutions: More testing, better quarantine facilities, and critical care in conflict zones
Myanmar is yet to reach the peak of the COVID-19 outbreak, so the full scale of responses to tackle the pandemic is still not clear. But the current state of the pandemic, the government’s responses, and lessons from other countries point to three areas that need attention.
- Increase testing capacity. Myanmar has to build capacity and forge connections with local clinicians and businesses to make affordable testing kits and essential supplies. The state should train nongovernment health care workers to test for COVID-19 and permit nongovernment laboratories to analyze swabs.
- Improve the quarantine facility model. Myanmar might consider incorporating the Fangcang shelter model into new quarantine centers. This model has been proven to provide critical functions of isolation, triage, basic medical care, frequent monitoring, rapid referral, and essential living and social engagement to manage COVID-19 patients effectively.
- Mitigate economic impacts on vulnerable populations. The government is currently drafting the Myanmar Economic Recovery and Reform Plan (MERRP). The plan needs to consider household size, cost of living, and vulnerabilities in determining the transfer amount and frequency. To alleviate food insecurity and circumvent problems related to in-kind distribution, it should include a food allowance in the direct cash transfer. The government also needs to ensure adequate access to loans, grants, or credit to sectors that predominantly employ women.
- Ensure critical health care in conflict regions. The government needs to increase its reach in conflict regions to disseminate vital information on COVID-19. This can best be done by providing more autonomy to Ethnic Health Organizations (EHOs). It needs to improve existing processes for transporting swab samples from the conflict areas to laboratories and regularly exchanging information on testing, contact tracing, and delivery of other essential health services. The government needs to build on the existing cooperation with EHOs and other nonstate actors to plan for large scale vaccination of vulnerable populations in 2021.
- Continue provision of other essential health services. The pandemic has disrupted the provision of other essential health services, including antiretroviral therapy for HIV, the expanded program on immunization, family planning, and maternal health services. The government should seek investments for key health services from public-private partnerships, and international development organizations, increase human resources in the health sector, and consider moving appropriate health services to virtual platforms.
About the Authors:
Ashwini Deshpande (tweets at ashwiniD1610) is a Policy Associate at the Center for Policy Impact in Global Health, Duke Global Health Institute.
Khaing Thandar Hnin is the Director of the Strategy, Technical, Policy and Research Unit, Community Partners International.
Tom Traill (tweets at tom_traill) is a Policy and Research Director, Community Partners International.