Myanmar’s Malaria Timebomb: A Global Threat?

Conflict and instability are fuelling a rapid rise in malaria cases in Myanmar. Community-based health providers are working against the odds to hold back the tide. However, this resurgence could have global implications for public health.

“While data is fragmented, the trend is clear. Malaria is coming back. Fast.”

Between 2012 and 2020, Myanmar (Burma) made extraordinary gains against malaria. The number of confirmed cases fell by almost 88%, and the reported number of deaths fell by 98%. In 2020, only ten deaths in Myanmar were officially attributed to malaria. This resulted from a coordinated multi-stakeholder prevention, control, and elimination strategy supported by sustained local and international investment.

These gains were significant as Myanmar is a hotspot of multidrug-resistant malaria. Surveillance, control, and elimination of these dangerous malaria strains help to protect populations worldwide as climate change enables malaria-carrying mosquitoes to expand their range. The Centers for Disease Control (CDC) and state health departments in the United States have documented locally acquired malaria cases in Florida, Texas, and Maryland.

However, since February 2021, conflict and instability have engulfed much of the country and continue to intensify. Medical supply chains are collapsing. Ethnic and community-based health organizations operating in malaria-endemic areas have mostly suspended cooperation with the central government. More than 2.5 million people have been displaced, with many fleeing to forested areas where malaria is more prevalent. Community health workers are struggling to reach communities and re-supply clinics.

While data is fragmented, the trend is clear. Malaria is coming back. Fast.

“Conflict has shattered medical supply chains, making malaria drugs and insecticide-treated bed nets more challenging to procure.”

The World Health Organization (WHO) reported a sevenfold increase in malaria cases in Myanmar between 2019 and 2022. Other data point to a tenfold increase in cases in eastern Myanmar between 2020 and 2023. Data from Community Partners International (CPI)’s partners in southeastern Myanmar reveal a doubling of cases from 2022 to 2023.

However, case numbers don’t tell the whole story because reaching communities and conducting malaria rapid diagnostic tests (RDTs) has become increasingly difficult. An additional way to measure malaria resurgence is the rate of positive RDTs. According to CPI data, test positivity rates increased from 3% in 2020 to more than 13% in 2023. Startlingly, In Thaundauggyi Township in northern Karen (Kayin) State, test positivity rates rose from 20% to 65% between 2021 and 2022.

Meanwhile, the conflict has shattered medical supply chains, making it more challenging to procure malaria drugs and insecticide-treated bed nets. This has several impacts.

Bed nets are an effective way to prevent malaria. Fewer bed nets equals more malaria.

If malaria is left untreated, treatment begins late, or the full course of the appropriate drugs is unavailable, the risk of severe malaria, death, and drug resistance increases. Furthermore, as cost and supply chain issues restrict the supply of genuine malaria drugs, counterfeit versions become more widespread. These also increase the risk of severe malaria, death, and drug resistance.

“Many malaria services have been suspended, and there has been a lot of displacement and migration into forested areas where mosquitoes are more common.”

In this worrying context, Community Partners International (CPI) is helping the Yoma Social and Development Association (YSDA) sustain malaria services to conflict-affected communities in Karen State, southeastern Myanmar.

“We used to serve 52 villages in Kawkareik, Kyainseikgyi, and Hpa-An townships,” confirms YSDA Project Officer Nan Win Win Htay. “But this year, due to the conflict, we can only reach 41 villages in Hpa-An Township.”

“Case numbers rose in 2022 and 2023,” she continues. “Many malaria services have been suspended, and there has been a lot of displacement and migration into forested areas where mosquitoes are more common. Insecticide-treated bed nets offer one of the most effective ways to protect against malaria, but we haven’t gotten any since 2020.”

Saw Oliver is a YSDA Field Facilitator coordinating a village-based malaria volunteer network. “The volunteers provide malaria education, testing, and treatment,” he explains. “If they find severe cases, they transfer them to the nearest health care facility. I help to provide them with supplies and monitor their activities.”

“I supervise ten villages in very remote areas,” Saw Oliver continues. “Most can only be reached on foot. Sometimes, villagers have to flee because of fighting. In one case, our volunteer had to flee with villagers, leaving his test kits and medicines behind. When he returned to the village, they were all destroyed. He immediately contacted me, and I arranged for the urgent delivery of new supplies.”

“The biggest challenge we face is travel restrictions due to conflict,” Saw Oliver reveals. “It affects our ability to deliver supplies to volunteers. Sometimes, we can’t even reach them by phone because of cell network issues or because they have been displaced.”

“The international community needs to mobilize rapidly to prevent Myanmar’s malaria resurgence from becoming a global threat.”

Moo Ka Wah is a village malaria volunteer in Hpa-An Township, Karen State. “People know me and reach out if they have symptoms,” she explains. “I also go around the village to identify potential malaria cases. In the rainy season, village leaders organize gatherings, and I give malaria education and conduct rapid diagnostic tests.”

“At first, it was challenging to gain people’s trust,” Moo Ka Wah reveals. “They didn’t think it was relevant and were too busy to participate. But now they participate actively, and their malaria knowledge is improving. They are aware of the symptoms and make sure they sleep under bed nets at night. When they go to the forest to harvest bamboo shoots, they try to prevent mosquito bites.”

With Myanmar’s conflict showing no sign of easing, the outlook for malaria remains bleak. While community-based organizations like the YSDA are providing a lifeline of essential malaria services, they urgently need more support. Immediate priorities include adequate supplies of malaria drugs and bed nets. The international community needs to mobilize rapidly to prevent Myanmar’s malaria resurgence from becoming a global threat.