Kai Ostwald, University of British Columbia
Tun Myint, Consulting Epidemiologist
Many in Myanmar felt a sense of relief in mid-2020, when the impact of COVID-19 remained far more modest than initial worst-case fears. Indeed, Myanmar stood out globally as among the least affected countries in terms of case counts. A second wave of infections only several months later, however, rapidly saw it become one of Southeast Asia’s hotspots. The surge in cases made clear what before was only understood in the abstract: Myanmar faces several distinct challenges—mainly resulting from its simultaneous political, economic, and conflict-related transitions—that make it especially vulnerable to the pandemic and its longer-term impacts.[1]
These challenges fall into three broad categories. The first is economic. Decades of self-isolation left a substantial portion of the population in a state of economic precarity with little to no household savings. That makes them highly vulnerable to sharp economic downturns as well as protracted closures of workplaces due to transmission containment measures. Indeed, reports suggested that by October financial duress was causing a large number of households to skip meals on a regular basis, including in relatively developed Yangon.
Secondly, Myanmar’s public health infrastructure remains relatively weak due to chronic underfunding. Its ratio of medical doctors to population of approximately 1 to 1,500 remains well below the WHO recommended minimum of 1 to 1,000. The ratio is substantially lower in rural areas. Moreover, nearly all of the country’s 38 tertiary hospitals are located in the relatively developed areas of Yangon, Mandalay, and Naypyidaw. While the healthcare system handled the modest first wave of infections well, it showed signs of being at or beyond capacity within a month after the arrival of the second wave.
Thirdly, ongoing conflict in Myanmar’s border areas compounds Myanmar’s pandemic vulnerability. Several hundred thousand internally displaced persons (IDP) live in high-density camps in which mitigation of contagion risks is difficult. Some borders are also porous, particularly where conflict limits the reach of the formal state. Since Myanmar’s neighbouring countries have had high case counts, this has increased the risk of importing cases, particularly as deteriorating economic conditions and tightening population control measures prompted large numbers of Myanmar’s migrant workers to return home.
Given the scale of these challenges and the broader resource constraints facing the state, Myanmar’s response to the pandemic has had several bright spots. Its domestic testing capacity has grown from zero in mid-February to over 10,000 tests per day by mid-October. Measures put into place when the first cases were confirmed in late-March likely helped to stem the magnitude of the initial wave. These include closure of incoming air travel and eventual closure of land borders. In addition, a large portion of returnees were quarantined for two to three weeks in government-provided facilities, which included empty schools, hostels, monasteries, and even stadiums, among other places. Strong community engagement supported the logistical needs of those under quarantine.
Attempts to mitigate local transmissions were rolled out as well. Public health recommendations were widely disseminated and limits on public gatherings imposed. While logistically challenging, many employees were pushed to work from home, including within the government. Shops selling non-essential goods were prompted to close temporarily, as were factories. These measures were generally accepted, though they entailed substantial disruption and economic pain as well: many in the economically vital garment sector, for example, found themselves suddenly without work and unclear about when and if operations would restart. Restrictions on movement, both locally and across Myanmar’s regions/states, further reduced the risk of local transmission, but likewise imposed considerable hardships for some.
The rapid evolution of the pandemic created much uncertainty and proved difficult for governments around the world to effectively address. Myanmar is no exception. Policy reversals, ambiguous instructions, and sometimes contradictory information were widespread, compounding occasional tensions between officials and the general public. Nonetheless, the range of measures, likely in combination with a healthy dose of luck, left Myanmar with fewer than 450 confirmed cases in mid-July, at a time when neighbouring (and highly developed) Malaysia had nearly 9,000. Relatively low testing rates at that point meant that actual counts may well have been somewhat higher, but there is no question that they remained far lower than earlier worst-case fears. In response, numerous measures were relaxed, in part also to soften the economic pain in the run-up to the November election.
An August outbreak, first reported in the western state of Rakhine, would change that. Case counts began rapidly increasing in early September, particularly in densely-populated Yangon. As new cases emerged across the country, numerous restrictions and lockdowns were re-imposed. A sense of crisis returned, though now in more acute form where the number of confirmed cases were high. For many, the months of constrained economic activity triggered by the first wave left them especially ill-prepared to face renewed closures. Numerous relief measures were put into place, but the scale of need for vulnerable communities was such that their effects were modest at best.
The longer-term implications of the pandemic are yet unclear. At the time of writing, the pandemic does not appear to have significantly dampened support for the NLD. Elements of the response, however, have sharpened tensions between the civilian government and military, as well as laid bare the awkward and perhaps ultimately untenable nature of the de facto power-sharing arrangement between the two. Whether the crisis precipitates deeper institutional change, as the Asian Financial Crisis of 1997/98 did in some neighbouring Southeast Asian countries, will become evident in the year ahead. Regardless, the central leadership’s tendency towards relying on meso- and local-level governments to formulate and implement containment measures, rather than imposing them in a rigid top-down manner through the military or military-controlled police, may ultimately be recognized as an important (and largely inadvertent) test-run for greater decentralization.
[1] This memo is based on a forthcoming chapter by Kai Ostwald and Tun Myint entitled “Myanmar: Pandemic in a Time of Transition.” It will appear in Covid-19 in Asia: Law and Policy Contexts, edited by Victor V. Ramraj and published by Oxford University Press.