Data from the World Health Organization (WHO) show a collapse in routine immunization coverage of children in Myanmar (Burma) between 2020 and 2021. We talk to a representative of a community-based partner organization supported by Community Partners International (CPI) about the situation she is experiencing on the ground in conflict-affected areas of southeast Myanmar, and the potentially devastating impact this could have on vulnerable communities.
World Health Organization (WHO) data show that child immunization coverage plummeted nationally by more than 50% for many key diseases including tuberculosis (TB), diphtheria, measles, and polio. For Japanese encephalitis, it dropped by more than 90%. Coverage has been most severely affected in conflict zones where supply and access issues are preventing urgently-needed vaccines from reaching communities.
Prior to the military coup in February 2021, nascent cooperation agreements between the Myanmar Ministry of Health and Sports (MoHS) and ethnic and community-based health organizations established a flow of vaccines, procured and donated to the Myanmar government through international mechanisms such as Gavi, to communities in contested areas of Myanmar under the expanded program on immunization (EPI).
“We follow the national plan and focus mostly on pregnant women and children under 12 months,” explains Dr. May*, a representative of an ethnic health organization in southeast Myanmar supported by Community Partners International (CPI). “We provide 10 vaccines that protect against 13 diseases including diphtheria, whooping cough, influenza, tetanus, hepatitis B, polio, measles, TB, Japanese encephalitis, and the HP virus that can cause cervical cancer.”
While the COVID-19 pandemic put pressure on vaccine distribution in 2020, WHO data show that distribution mechanisms remained remarkably resilient at the national level.
“In early 2020, COVID-19 was the main obstacle to routine immunization,” confirms Dr. May. “We temporarily suspended vaccinations in accordance with MoHS guidelines and resumed vaccination in about August 2020. We faced many difficulties in getting in and out of the villages due to strict local lockdowns but we were still able to function.”
Since the military coup in February 2021, however, the suspension of cooperation agreements and the rapid escalation of conflict across Myanmar has dealt a crushing blow to vaccine distribution. Vaccine supply is now a critical challenge.
“We haven’t received any vaccines since 2021,” confirms Dr. May. “Last year, we were able to use our remaining vaccines for routine immunization but now the cold chain fridges only contain COVID-19 vaccines. If we can’t find more vaccines for routine immunization this year, coverage could drop to zero.”
Dr. May and her colleagues are deeply concerned about the potential impact of an immunization program shutdown on the communities that they serve. “I am worried about disease outbreaks. We are seeing rising levels of migration and displacement in our coverage areas and the populations in internal displacement sites are increasing. Some of our health workers have had to flee because of armed clashes. I fear that we could see measles outbreaks that could spread quickly in the camp settings. I am also concerned about diphtheria which can be very deadly for children.”
Dr. May’s organization is urgently seeking alternative vaccine supply sources but Myanmar’s political crisis and spiralling conflict are making this difficult. “I hope we can resolve the vaccine supply issues soon. If not, the impact of disease outbreaks could be very serious. We don’t have enough medicines to deal with them. We no longer have links to national laboratories to send blood samples for investigation. We used to refer patients to government hospitals locally but now they are not well-functioning and have very limited capacity.”
For Dr. May, the lack of vaccines is deeply personally affecting. “As a doctor, I feel that vaccines are a fundamental right in a healthcare system. I feel sad for the communities that rely on us.”
But solutions to the crisis are not immediately obvious. “It would be better if vaccines could be supplied at scale through international mechanisms directly to ethnic health organizations in Myanmar,” confirms Dr. May. “But that’s not the current model so it is difficult.”
Ethnic and community-based organizations are working with international partners including Community Partners International to find alternative vaccine supplies. However, significant barriers remain to ensure an adequate and uninterrupted vaccine supply chain. The key question now is whether replacement vaccines will arrive quickly enough, and in large enough quantities, to prevent major disease outbreaks.