H1N1: Myanmar’s undeclared emergency

Deaths from the H1N1 swine flu virus rise. A grossly underfunded healthcare system struggles to cope.

By Oliver Ward

As of the 6th of September 2017, the death toll from Myanmar’s H1N1 influenza (swine flu) outbreak stood at 36. The virus, which caused the global panic in 2009, arrived in Myanmar in July and quickly spread to more than 213 registered cases and 62 confirmed cases across the country.

The government maintained that the outbreak was merely seasonal and urged the public to remain calm and cautious. However, a lack of public faith in the government’s ability to handle an outbreak, coupled with the fact that Myanmar has had to rely on aid from India, the World Health Organisation (WHO) and Turkey to contain the spread of the virus and administer vaccines, has created an atmosphere of alarm.

Public panic is driving the sale of surgical masks

In an attempt to protect themselves, residents of Yangon adopted the use of facemasks to prevent infection from the virus. The virus spreads by inhalation or through physical contact with the mouth and nose. Companies distributed the facemasks to their employees and street sellers stocked up on the protective masks to sell to the anxious public, after many shops sold out of them in Yangon.

The government response centred around a public awareness campaign

Myanmar’s health authorities delivered a public awareness campaign to alleviate the population’s fears. They advised the general public to avoid crowded places, to wash their hands more often, to cover their mouths with a mask and use disposable tissues when coughing or sneezing.

Officials also cancelled the nine-day “nat” festival in Tuang Pyone village out of concerns the virus would spread among those attending.

The timing of the outbreak is particularly unfortunate, as, in late July, the government simultaneously had to combat an outbreak of the H5N1 avian flu virus in the Southeast of the country. In Dawei, officials closed local schools for five days from the 27th of July and culled more than 20 thousand chickens in an attempt to bring the outbreak under control.

Is this really a seasonal occurrence?

The virus has been circulating in Myanmar seasonally ever since the global H1N1 outbreak in 2009. However, there had not been any deaths from the virus reported in recent years. This outbreak is undoubtedly the worst in recent memory and it could get worse before it gets better.

WHO Director for Southeast Asia, Samlee Plianbangchang said, “a winter surge is a real possibility in the Southeast Asia region”. However, with the government unwilling to declare a state of emergency, the funding available to contain the outbreak remains insufficient.

Many hospitals are taking matters into their own hands

The government response was slow and their capabilities for handling such a large viral outbreak are under scrutiny. Anthony Quick, an employee for a pre-hospital care and training firm in Myanmar, shared “the current health facilities are not yet fully adequate to meet the demands of the general population”.

The Burmese health care system has suffered from years of underfunding. Healthcare funding under military rule was as little as 2% of Gross Domestic Product (GDP). In comparison to other countries, this falls woefully short. Even other impoverished nations like Laos and Cambodia still spend 4.5% and 5.6% of GDP on healthcare respectively.

Years of underfunding have left the country’s healthcare system unprepared for a viral outbreak of these proportions. Myanmar’s health service relies on volunteers, using them for burial duties, ambulance drivers and, in cases like this, implementing public awareness and education campaigns.

Many hospitals and NGOs mobilised volunteer groups to fill the information and treatment deficit left by the government’s response. The United Nations started running training workshops across the country to train volunteers and educate the public on prevention measures.

As the death toll creeps up, and the number of cases rises, the crux of the issue becomes more apparent. Myanmar’s healthcare system is creaking under the strain of H1N1. The government can turn a blind eye to the emergency unravelling before their eyes, but sooner or later the issue of an underfunded health service needs to be addressed. The question remains – how many more people need to die until it is?