Op-Ed

Pursuing disease diplomacy in Myanmar

Myanmar is slowly emerging from 50 years of isolation and military rule. Even after the victory of the pro-democracy party in November elections, the country is fragile and fragmented. The military still holds much political power. The country is struggling with entrenched poverty. Decades of ethnic and regional warfare have left Myanmar with more armed groups than there are candidates in the U.S. Republican presidential primary.

What could improve this situation? Maybe malaria.

Last summer in Washington, D.C., more than a dozen of the country's officials, military leaders, opposition politicians and ethnic groups — people with a long history of mutual distrust — met to discuss how to combat this deadly parasite. Some of these groups had never sat at the same table to discuss anything. Now, engaged in what might be called "disease diplomacy," they agreed to cooperate on malaria elimination no matter what happened in the election or what became of ongoing cease fire negotiations.

Malaria is a major health and economic problem for Myanmar, where 300,000 people are afflicted every year. More than 75% of malaria deaths in Southeast Asia happen in Myanmar. Particularly worrying is that drug-resistant malaria is on the rise there; if these parasites spread to surrounding countries and then to Africa — as happened in the 1970s — it could kill millions.

The meeting was a model for how to use science and medicine not only to solve important health problems, but also to foster wider social and political change.

As public health clinicians and researchers, we have worked all over Myanmar. Some of our field sites can be reached only by a combination of motorcycle, boat and ox cart. But at the end of the journey, we always find dedicated people ready to put aside any differences to fight malaria. Mosquitoes indiscriminately infect government troops, the militias fighting them and poor villagers caught in between. It is everyone's enemy.

This is not the first time public health has taken precedence over conflict and politics. For 30 years, UNICEF has been negotiating Days of Tranquility in war zones when children can be vaccinated against measles, polio and other diseases. These cease-fires first occurred in El Salvador in 1985; more recently they've taken place in the Democratic Republic of Congo, Iraq, Sudan and Somalia. These breaks can be enormously useful: eight years ago, during a three-day break in fighting in Afghanistan, health workers vaccinated 1.4 million children, certainly saving many thousands of lives.

At the height of the Cold War in the '50s, American and Soviet scientists collaborated on developing and testing an oral polio vaccine. In the 1960s, scientists from the two countries again worked together to come up with the vaccine that eradicated smallpox. In both cases, scientists had to overcome strenuous objections from their home nations, where some asserted that such collaborations were shortsighted or even traitorous.

We have heard the same arguments regarding our own anti-malaria efforts in Myanmar. Over the years, those efforts have required working with its military junta, which has been linked to human rights violations. Working with corrupt or repressive regimes lends them credibility, critics say.

We understand these concerns better than most people realize. One of us (Dr. Nyunt) was born in Myanmar and was a student activist in 1988 during the military crackdown of a popular pro-democracy movement. She saw her friends shot down in the streets during protests; like thousands of others, she fled the country.

She put that personal history aside, however, to work closely with government and military officials on its malaria crisis. The fight against deadly diseases can't wait for political change.

We are convinced that to eliminate malaria in Myanmar, everyone must be involved. As the country's new government forms — with Aung San Suu Kyi's opposition party now in control of the legislature's upper and lower houses — the dialogue that started last summer in Washington is expanding to include additional marginalized groups. The Ministry of Health is now finishing a national malaria elimination strategy based on input from across the political spectrum.

On its own, Myanmar's coalition against malaria won't solve the country's political and social issues. But there is no question that this alliance already has been a catalyst for more dialogue, reconciliation and social change. Linking health and diplomacy can improve the prospects for both — in Myanmar, and in other troubled places as well.

Dr. Myaing Myaing Nyunt and Dr. Christopher Plowe are public health scientists at the Institute for Global Health at the University of Maryland School of Medicine.

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A version of this article appeared in print on December 14, 2015, in the News section of the Los Angeles Times with the headline "In Myanmar, disease diplomacy" — Today's paperToday's paper | Subscribe
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