Never Break the Chain

Summary

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Episode Summary: Never Break the Chain

Podcast: Insight Myanmar
Date: July 31, 2026
Guest: Dr. Tintin Tamient (Medical Epidemiologist, vaccine specialist, founder of Dohertyou—Together for Myanmar)
Host: Insight Myanmar Podcast

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Main Theme & Purpose

This episode delivers an urgent and deeply informed exploration of Myanmar’s vaccination crisis post-2021 military coup. Dr. Tintin Tamient, a Burmese-born epidemiologist with 20+ years in vaccine science, details the collapse of Myanmar’s public health and vaccination programs, the ramifications of denied healthcare access, and the growing epidemic threats. The conversation also situates vaccination within Myanmar’s broader struggle for freedom, the disruption of essential services (including family planning and HIV/AIDS prevention), and proposes practical pathways for international engagement.

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Key Discussion Points & Insights

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1. Dr. Tintin’s Personal & Professional Journey

(00:00–13:42)

• Tintin shares his roots in Yangon, growing up under the Burmese Socialist Party regime, and his awakening as a student activist during Myanmar’s 1988 pro-democracy uprisings.
• He describes entering medical school amid political upheaval, his discovery of public health, and a career trajectory that led to France and vaccine development.
• Candid reflection on his political awakening post-2021 coup:

  • “2021 was, I would say, a calling for me to get into, to finish up what I did in 1988, going down to the streets shouting for democracy and asking for the freedom.” (12:55)

• He founded Dohertyou to raise awareness about Myanmar through art, literature, and culture.

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2. The Foundation of Vaccination in Myanmar

(13:42–21:05)

• EPI (Expanded Program on Immunization) started in 1978, utilizing old tools (glass syringes) and minimal health education.
• Personal memory: lining up as a child for vaccines, not understanding their value or purpose, noting a general brainwashing under military rule that discouraged inquiry.

Notable Quote:

“We get vaccinated because it was supposed to do for every people... But we didn’t know what it stands for, why we are doing... No one was explaining what the vaccines (are), why we're doing the lineup to get the vaccines.” (15:55)

• Until after 2000, knowledge and value of vaccination remained limited—public health was an unpopular field, overshadowed by clinical careers.
• Hepatitis B vaccine began to gain traction in the late 1990s due to real-world impacts of the disease.

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3. Vaccination Access: Urban vs. Rural & Ethnic Areas

(21:05–25:23)

• Marked contrast: city dwellers (e.g., Yangon) gained better access; rural and ethnic areas often left behind.
• Firsthand knowledge is limited for very remote and ethnic zones, but later informal surveys and anecdotal evidence show exceedingly low vaccine coverage.

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4. Systemic Problems: Information, Regimes, and Missed Doses

(25:23–31:44)

• Healthcare professionals, even post-2000, received inadequate training about the scheduling, purpose, and necessity of multiple vaccine doses.
• The problem of incomplete vaccination regimes is universal (not unique to Myanmar).
• On herd immunity and danger of patchy coverage:

  • “If you don’t get the full dose, but you are completely surrounded by the fully vaccinated people, you are still at low risk... But the current situation in Myanmar is desperate right now because people are not getting the vaccines and so it’s becoming a serious and alarming concern.” (30:46)

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5. Impact of the 2021 Coup on Vaccine & Public Health Infrastructure

(31:44–41:15)

• Pre-coup (2012–2020): Significant new vaccine rollouts (MMR, IPV, pneumococcal, HPV, Japanese encephalitis, rotavirus).
• January 2021: Myanmar successfully begins COVID-19 vaccinations, ahead of some richer neighbors.
• Post-coup: Mass repression of healthcare workers (notably EPI program leadership); collapse of public health delivery, especially in conflict and resistance zones.
• COVID vaccinations: Stark inequalities in access; urban centers and regime-favored areas see some progress, while most civilians/ethnic areas left exposed.

Memorable Segment:

“The military is not interested in people’s health or vaccination. What matters to them is the vaccine budget, the money.” (37:57)

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6. The Present Crisis: Collapsing Coverage and Rising Threat

(41:15–56:43)

• Pre-2021, core vaccines (MMR, DTP, polio, TB) were widespread and critical in controlling child mortality.
• Since 2021, vaccine coverage by official data (WHO/UNICEF) is likely inflated—informal surveys show 60–80% of children in resistance/isolated areas have received zero doses.
  • In some zones, only 20% of new births have had any vaccination.
• "Vaccine trips"—parents risking military checkpoints just to get their children vaccinated in cities.
• Social media signal detection unearths clusters of measles, mumps, and diphtheria outbreaks; some schools in major cities closed due to outbreaks.
• Quote:

  • “We are seeing... the very tip of the iceberg of what is happening with vaccine-preventable diseases in Myanmar.” (53:32)

• Disease surveillance has collapsed; risk of silent, smoldering epidemics rising.

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7. The Four Cuts Strategy & Military Shortsightedness

(61:48–65:54)

• The junta’s four cuts strategy (cutting food, finances, intelligence, and recruitment from opposition) starves civilians—including denial of healthcare.
• Critique: In allowing diseases to spread, the military harms not only "enemy" civilians, but also its own support base and troops.
• Quote:

  • “Are they intelligent enough to understand?... Do they really care for their own people, their military troops?... Someone bombing schools and hospitals is not human.” (64:24)

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8. International Response & Barriers

(65:58–74:43)

• WHO and other international agencies face hurdles:
  • Only governments can purchase vaccines at scale.
  • Civil-society/ethnic groups must pay private-sector prices—often three times higher—and deal with single-dose packaging, making storage/logistics harder.
• Constant displacement of populations further disrupts efforts: tracking, follow-up dosing, side effect surveillance nearly impossible.
• Tintin’s Dream:

  • “Sometimes I dream that the WHO and UNICEF with helicopters drop vaccines and essential drugs, using solar assisted cold chains... It is possible if there is flexibility and political will.” (73:50)

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9. Beyond Vaccines: Family Planning, STI Challenges, Systemic Healthcare Collapse

(76:24–83:19)

• Family planning and safe sex programs have nearly vanished, leading to surges in unwanted pregnancies, unsafe abortions, and untreated STIs (syphilis, HIV—not just “milder” infections).
• Quote:

  • “No one reads leaflets these days... No proper health education campaign. There are more pregnancies, more miscarriages, and abortion rates are alarming—two, three times higher than the pre-coup period.” (78:07)

• Surveillance and treatment for HIV and TB are vastly reduced, with international funding in decline and the ground reality increasingly dire.

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10. Local Resilience & Pathways Forward

(85:26–99:15)

• Local governing units (e.g., Arakan Army, Karenni IEC, Mandalay IEC) have begun rebuilding health systems in their territories, and have shown impressive capability when left unobstructed.
  • E.g. Rakhine territory control leads to effective vaccination campaign in 2025.
• On international engagement:

  • “International organizations should work with non-state actors... Please contact them, act visibly, act and work together.” (94:15)

• Trust, adaptability, and bottom-up organizing are key: tailoring solutions to local language/culture and learning-by-doing.
• The call: support and empower local units, ensure that humanitarian assistance is not blocked by ‘neutrality’ policies when they perpetuate harm.

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Notable Quotes & Memorable Moments

• On Herd Immunity & Incomplete Coverage:

  “If you are surrounded by a lot of vaccinated people, you can feel safe, even if you haven’t had all your doses. But that’s not the case in Myanmar right now.” (30:57)

• On the Current Humanitarian Crisis:

  “No situation is without solution. Look at Rakhine: now that they have territory control, vaccination campaigns have begun again. That’s a sign of real capability—if the people are allowed to govern themselves, they can rebuild.” (86:18)

• Closing Appeal:

  “Help us build the better future right now—vaccinations, basic health facilities... are fundamental rights and essential tools against poverty. Please give us some hands and help us build again.” (100:20)

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Timestamps & Major Segments

| Segment | Theme | Timestamps | |---|---|---| | Introduction & Tintin’s Story | Upbringing, activism, entry to public health | 00:00–13:42 | | History of Vaccines in Myanmar | EPI, early campaigns, social context | 13:42–21:05 | | Access Disparities | Urban/rural/ethnic gaps | 21:05–25:23 | | Vaccine Information Issues | Healthcare worker education, partial coverage risk | 25:23–31:44 | | Post-Coup Breakdown | Collapse, crackdown on healthcare workers, COVID response | 31:44–41:15 | | Coverage/Epidemic Survey | Outbreaks, data vs. reality, risk of silent epidemics | 41:15–56:43 | | Four Cuts Policy | Military logic, public health irrationality | 61:48–65:54 | | International Barriers | Funding, logistics, politics | 65:58–74:43 | | Broader Healthcare Collapse | Family planning, STI/HIV/TB resurgence | 76:24–86:18 | | Local Innovation, Refounding | Bottom-up organizing, calls to international orgs | 85:26–99:15 | | Final Appeal | Resilience, optimism, call to action | 99:15–101:55 |

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Flow & Tone

The conversation combines personal narrative and professional expertise, with Dr. Tintin's empathy and pragmatic urgency shining throughout. The tone balances candor and hope, blending technical insights, field anecdotes, and clear moral calls for action. Both host and guest are direct and compassionate, careful to ground technical details in everyday consequences and the lived reality of ordinary Burmese families.

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For Listeners New to the Topic

This episode meticulously outlines:

• How Myanmar’s vaccine program functioned—and then collapsed after the 2021 coup.
• The profound consequences for children/families, extending to public health, gender rights, and community cohesion.
• The misplaced priorities of international “neutrality,” and the potential for partnership with local governing bodies that have demonstrated genuine commitment and ability.
• Concrete, hopeful examples of local resilience, even amid systemic collapse.

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Calls to Action

• International organizations: Work with non-state actors, show political courage.
• Listeners: Support, share, and amplify the reality of Myanmar’s ongoing crisis and resilience.
• On-the-ground actors: Continue capacity-building and collaboration—from the grass-roots up.
• "Please give us some hands and help us build again.” (100:20, Tintin Tamient)

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A sobering, essential listen for anyone concerned with humanitarian crises, global health, or the future of Myanmar.

Transcript

[A]

Foreign. Thank you for taking time to listen to today's episode. As I'm sure you know, the current crisis in Myanmar is extremely concerning and we appreciate that you're taking the time to stay informed. There's even value in just becoming a little more aware and helping to inform others. So we would like to encourage you to please, please consider sharing this episode so that more people may learn about what is really happening in the country. Now, it's just absolutely critical to ensure that this issue remains present in public discourse everywhere. But now let's get on to the interview itself. Sam. Foreign. Welcome back. I am joined today by Tintin Tiamin and we will begin we'll be having a conversation on on yet another topic that is not being sufficiently covered but ought to be as there seem to be so many angles to the ongoing crisis, the multi crisis in Myanmar which are not being appropriately covered and are leaving a lot of people ill informed. Specifically today we are going to be looking at vaccinations in Myanmar, more precisely the lack of vaccinations and the ongoing ramifications of the inability to provide vaccinations to communities in need. So before we get into this very important topic, I want to thank you very much for joining us. I want to thank you very much for sharing your expertise. I know you are a professional in the field and I want to give you the opportunity to introduce yourself and your credentials for our audience.

[B]

Thank you so much for having me to this podcast. Very important postcards. My name is Tintin Tamient, you can call me Tintin. I'm a medical epidemiologist by career and I've been in France for more than 25 years. I was born in Rangoon and raised in Rangoon. My childhood was quiet and very playful like many other children of the time and I came from a normal middle class family and I was a good and intelligent student at that school. And first I just wanted to say that when I was at grade 10, the 1988 National Wide Uprisings happened and as other students I've been in the streets and shouting and asking for the democracy and multi party elections. And to be very honest, at the time I didn't have any clear idea of what stands for democracy and what stands for multi party elections. I just wanted to be free from the dictatorship at that time. At the time it was the Burmese Socialist Party. I wanted to do something positive and bring something very useful to the population. After the 10th grade the schools are closed in 1988 and then to Rearborn in 1989 I passed the 10th grade with flying colors. And then I was classified to go to the medical schools. And that was my childhood dream as well, because I just wanted to bring something and help my people and save many, many lives. And I think that is one of the part that I'm doing right now. I'm a medical professional, however, public health specialist and. And now much more working for vaccines for more than about two decades. And that is one of the original ideas that I just wanted to be a medic. But at the time I didn't know that the public health is something useful for the community. But let's come back to the 1988 events as well. So after the military seized the power in 1988, so everything has been changed. Some of my friends fled to the border areas and to take arms and to take part the resistance movement. Movement, Armed Resistant Movement. At the time, however, majority of the youth, students and the CD people, they returned to their, you know, our usual routine lives. I think we will get back to the military propaganda through the tv, through the radio, specifically with the popular sounds. We get again into the military propaganda. And the uprising of the 1980 has been calmed down at that time, and at that time I was about 18 years old and very eager to read a lot, very eager to learn from the outside world. However, at that time, through the BSPB period, BSPB is the bomber Socialist party, you know, we were said that and we've been brainwashed from this time. The military seized the power in 1988, in September. And everything has been changed. The uprising has been coming down and a lot of people go back to the normal routines, normal routine lives. And some of my friends go to the border areas to take arms and participate in the armed resistance. After 1990, after the 10th grade passed and I was waiting for the university opened. And it took three years in fact, because at that time we didn't know when the university will be reopened. In 1988, all the university closed. And since then no more university open and just only the, how to say, the high schools. And I start, you know, at that time I just started to learn French at the French Embassy Cultural Center. And it was in 1993, September and some months later, the university reopened. And I just started the medical school as other students of that time. And I would say the 1988 appraising of the events was really how to say we remember the time, but sometime we almost forget the mission of 1988, where we ask for the democracy, where we ask for the how to Say where we ask for the freedom and the multi party elections. And parallelly I took the studies in medical and the French since 1993 and in 1996 the schools closed against the university closed again after the 1996 student appraisal in university in the Rangoon. And at that time I started working with the French NGOs and making and doing some part time French tourist guide where I really meet the French people and work with the French people and have some serious discussions. And that I really starting to understanding that we have been brainwashed through the military propaganda all over our lives. And I was taught when I was young, when I was at the high school that the foreigners are here to exploit our resources, natural resources and our jewelries as well as, you know, even women, you know, the Burmese girls. After meeting and discussing with these, you know, let's say foreigners and the French people, I started to understand that this was not really true. I really feel the sort of very respectful discussion and the manners towards our people and they have very serious and intellectual discussion with them. And I start to understand that we've been brainwashed or we've been how to say, put in an idea and have a very. How to say perceptions to hate and to get the racism against the foreigners. And that would lead to sometime somehow with some discussion the propaganda that we have been racism against our ethnic as well. After in 1998 the school reopened. I finish up my medical school and then I continue the internship in insane hospital where I started the first year in public health in a French public health school by correspondence and 2000 during my internship period. I really came to the France because I got a scholarship from French Embassy cultural section for one year study to finish up my diploma in public health specific for the developing countries. At that time I really wanted to do something very impactful. As I said earlier, I want to do something for the community and to be a medical. Medical doctor is not only the treating a patient, but we have to be able to treat the community, treat the society, treat the whole population. Maybe that end up by being becoming a vaccinologist at the end. Right now, however, my really idea is to save and to protect and to do something very positive impact to the community. And so I'm telling long the whole story because why I'm doing the medical epidemiologist and working and passionately in the field of the vaccines. Because since the beginning I really wanted to do something impactful for the community. I have been very naive, I would say and never been engaged in any type of the political activism nor any type of the political activities and political lives till in the very few of the very first hour of the first February 1, 2021. That was for me is a political awakening. Even though I've been reading a lot and interesting to the politics, I've never been, I've never interested in getting involved in real political lives or the activism. But 2021 was, I would say it's a calling for me to get into, to finish up what I did in 1988, going down to the streets shouting for the democracy and asking for the freedom. And I decided, and I say myself that I have to finish up my mission. It's a shame that I didn't do anything over this year, over the last two decades. And this is the time to do something positive impact and to bring real freedom and for the future of my people. And so now I'm doing a number of, you know, awareness campaign in France and I've created and founded association called Dohertyou Encinf Polemar. In other words, Dohertyou together for Myanmar is an association to make aware of what is happening in Myanmar through art, literature and the culture and the handcraft. So where I am now is really making awareness of what is happening in Myanmar and particularly in the field of the medicines and in the vaccines where I'm. Well, I'm being professionally getting involved. So the last, I think one thing important to make notice that I've been working for vaccine industries for more than 20 years. My last job is really in a vaccine industry where the COVID vaccine was produced and commercialized. So what I'm expressing today is completely my own and completely independent of all the vaccine industry I've been working for over the last two decades.

[A]

It's a very interesting life story and very, very expansive life story. And I want to sort of look at some parts of that a little bit more because you say you were, you were finishing up high school, you were preparing for your matriculation in the 1988. And so after you, you graduate, you go to the medical school, you would have spent substantial time in pre 2000 in the medical sector in Myanmar, seeing these things firsthand. And I want to start off by asking about that time. All of us, no matter, you know, where we come from, we all have a sort of standard vaccination routine. You know, I was born overseas, I live in a different country. And so my vaccination history is different than the vaccination history of, of the people that, you know, I work with and train with because you know, different countries have different standards but there are still vaccination standards. What was the vaccination standard like in Myanmar in that period? Either the pre1988 period or even the 1988 up to about 2000 period.

[B]

So I can tell you in two ways. Maybe one is my personal experience. The second is more about the professional look and review on it. The vaccination program, we call it epi, the expanded program of immunization started in Myanmar in I think 1978. And I remember my, you know, I was raised in Rangoons and when we grown up we are staying in resident area for the public officials. And I remember the days where we have to line up to get the vaccines. At that time the vaccination is done by the old type of the syringe, the class syringes and then we have to sleep up and then you have to line up and you get the vaccination. I don't really remember which type of vaccine I get I received at that time. What I remember is I have some sweets after the vaccinations and I have a very swollen arm and then get fever and so on, so, so forth. And I remember as well I got hepatitis V infection after these, you know, after these vaccination campaign. So I'm not blaming on think, you know, sort of, you know, the safety of that time. It was, you know, it was about in 1983 about, it was 1983, it was in Rangoon. So that is the first remembrance of experience of the vaccines personally and with the very, I would say unfortunate consequences. And fortunately I'm still alive despite this hepatitis B infection. And from a perspective of the professional look, when I get back to this 1978, it was very old time and the healthcare system is not yet very well expanded. And I'm not talking of the, the vaccination program but all about the health care, access to the people. The other thing is the value of the vaccination. We get vaccinated because it was supposed to do for every people, every children in the quadra in the area. However, we didn't know what it stands for, why we are doing, why we're doing the lineup to get the vaccines or to get the injection. I would say at that time and no one were explaining what the vaccines, what we are doing. I think my parents were not really well informed. But at that time, really you remember this is the Burmese socialist party time, you have to do what you are requested for and you have to do exactly and execute what you have to do. And I think the vaccination program really start to get evolved in a very good way only after 2000 and but 1980 to year 2000. I think the vaccination program is something not really well informed and well known. What I remember in 1990, I think it was in 1998 we have to pass the public health section exam at the medical school. And we were talking of the BCG vaccines, the vaccine against the tuberculosis. And I learned that at that time we were always thinking the vaccine can prevent the vaccines after the medical school and I didn't know that there is a different level of the vaccine efficacy and different level of the diseases. We would not get that informed. And I think at that time people are. The medical students are more interested in the clinical medicine. So I want to be the pediatrician or gynecologist or the clinicians. And public health has been the least interest topic. And for those doing the public health are the. I would say the poorest doctor in the world. So the public has never been very much popular. And then vaccination is least popular among this. And so we had a question around the vaccinations and I really learned that the BCG vaccine is not 100% efficacious. It is more efficacious and effective against the very serious tuberculous meningitis type. But it didn't really prevent against the pulmonary tuberculosis. So there are fine line between the different types of the vaccine, types of the diseases we prevent and different types of the efficacy with the different vaccine. This is my second experience with the vaccines. I think I left the country in year 2000 to do the public health and then I went for another country to do the public health mission in the French ngo. But I'd been cattle for the vaccine for over about 10 years before I started running the vaccine industry. But in Myanmar is truly that you know the well the how to say a good vaccination campaign start year two

[A]

and. And I think as a follow up. So you say that the. The EPI started in the 1970s, which is good. But the. The other big question is you. You talk about your personal experiences. You talk about remembering feeling, you know, feverish and then standing in the line and so on. But you also said that you grew up in. In Yangon and Myanmar is of course a very disparate country when we look at the major urban centers compared to the rural areas. So how much of an insight do you have on to how effective not necessarily the vaccines themselves were, but the vaccine program itself was in getting out to communities that are in rural areas or ethnic minority areas.

[B]

Well, I cannot comment on what is happening at the ethnic and the rural areas because I do not have any knowledge on this. My understanding on this is really from the year 2000 it start to get. For example, there's a number of hepatitis V infections. And then we learned that there's a vaccine against it. I think there's a sort of the public interest started there over there through the hepatitis B infections and the cases. And that was at that time I was still in medical school and then. Not medical school. Yeah, it started in 1997, 98. It is a lot of the vague of the people infected by the hepatitis B and we know how it is transmitted. And then there's a vaccine that could prevent against it. And so the people start getting vaccinated. So I think that is the time I think in the cities. But when it's come to do the I came from the areas around begin so the central Myanmar regions no one talk about of the vaccines. And I don't really think that they got a lineup of the vaccine when they were young. But I have to check. I just wanted to too much. I don't want to comment too much. Those I don't really know the situation. And in 2000, around 2008, I think the vaccination program starts to evolve really after with the initiation of the system or the vaccination benefits around 2000 and then going 2008 to 2010. In that period, the second dose of the MMR, the cancel of the measles vaccines has been added. So I think this is really the awakening even within the public health departments within the Ministry of Health in Myanmar. I don't think it is really in the ethnic area because when you look at now with the step back right now, for example, last year I had a discussion with a healthcare personnel in the Shen State in Eastern Shen State. And we are in 2024, 2025 period. And I would say these are the area what. What region. Right. Say they were not aware of any vaccines and they never get the vaccine in their lifetime. And the same story in some current areas. And so I think the knowledge of the vaccines is really rare in most of the very remote areas. I think still right now, because the

[A]

other thing that I wanted to ask about because you talk about the Hepatitis B vaccine and when I first went to Myanmar, I remember I had to get my hepatitis V because in my country hepatitis was not an endemic issue. So I never got the hepatitis vaccine. And so what I was given was twin Rex, hepatitis A, hepatitis B together. And I remember the doctors explained to me that I have to get four doses of the vaccine and they have to be carefully calculated to be three months apart and then six months apart and then eventually I think one year apart to really guarantee that immunization. And I know that lot of parts of the world, particularly less developed parts of the world, the complication with vaccines is not only getting the vaccines to those countries and getting the communities to trust vaccination and understand the importance of vaccination, but it is also the difficulty in being able to make sure that the follow up vaccinations, there may be one or two or multiple follow up vaccinations are actually being done and they are being done in the correct time frame. So that's the other thing that I want to ask about is with this epi, do you have any knowledge on whether there were any difficulties or any complications when it came to not just handing out vaccinations, but making sure that everyone was being vaccinated according to the necessary spacing of the vaccination doses?

[B]

I think what you mentioned is a very typical problem with the vaccinations, those Hepatitis B being a very popular and well known disease with the substantial consequences. But for other childhood vaccine, I think this is rather very expanded problem not only in Myanmar, but also in the well developed countries, even in Europe, for example, I've been part of a number of the consortium where we do the vaccine hesitancy groups. And so I think at the part is the theme the knowledge on the vaccination is really becoming more well known after the years 2000, not only in Myanmar, but also in largely different countries around the world, number one is, you know, vaccination is never been, or maybe I'm exaggerating, has not been part of the medical curriculum. And the second thing is vaccination being part of a small part of the public health sort of section. And we never learned to how to value the vaccines and the benefits of the vaccine and the nuances between the vaccines and the infectious disease and the diseases they prevented for. And so I think then the number of the vaccinology classes are really missing till the late 2010, I think even in Europe. So the situation in Myanmar, I think it is more than understandable that the awareness even among the healthcare professionals is very, very, very small. It's more about academic. But when it comes to the vaccination campaign organized by the epi, since we are part of Myanmar, is one of the Least developed and the poor countries. So we are vaccinated through the racial UNICEF and so this is the unicef. So we executed what we are asked for but without any or very, very few explanation to the health care personnel and so forth to the population and community and the mothers. Though hepatitis being very, very much mediatized because of the some sequential French is the very best place to discuss all the safety issue with the hepatitis B. But in different countries they perspective this different perception. So it's really country dependent and culture dependent. But when it comes to the Myanmar I think no one is really asking for the advancement at that time. And the spacings and the value of spasing, why we are getting two dose, three dose and four dose. I don't even think it is really well explained to the healthcare professional at the time. I think things have changed. Right now you have to have the leaflets on the vaccines and what you are getting for at least there's some respect to the patient and to the those vaccine getting, receiving the vaccines. So things has been changed I think. But in early year 2000, I don't think it has been well developed such type of information.

[A]

That's very unfortunate and very dangerous situation to be in. When we're giving partial vaccinations. Is that a risk as well? Because obviously the more famous issue, the more famous example that we're faced with medically is antibiotics. Where people take a certain amount of antibiotic, they start feeling better and then they stop taking the antibiotics that were prescribed. And this leads to the emergence of antibiotic resistant bacteria which we have fewer and fewer antibiotic solutions against. But is this also the case with vaccinations? If you partially vaccinate someone and they do not complete the regime of follow up vaccinations, is it possible that we will have vaccination immune strains of those particular illnesses?

[B]

Yeah, sort of. I would say the vaccination itself is hard to say. It protects in two ways. The vaccination. If you get the vaccine full dose. For example, for the dtp, the classical type of vaccines in Myanmar, it is three plus one dose, three doses in the infant, so two, four, six months and an additional booster dose during the toddler. And that could be different in the different countries because the vaccination prevent first to the person vaccinated, the vaccinated child and then if you are surrounded by a lot of vaccinated children. So we call it vaccine coverage rate. So if the vaccine coverage rate is high, even you are not vaccinated for different reasons, you will be protected through the vaccinated children, we call it herd immunity, you know, indirect immunity. We've been heart so many times during the COVID pandemic and everybody becoming epidemiologists and so the vaccination has these values. So if you don't get the full dose, but you are completely surrounded by the fully vaccinated people, you are still, you know, at low risk of getting the infections or the disease. So I think vaccination is really the individual and your second, your environment as well. So it is always good to have the full doses. Right. And without having the full doses, are you still at risk of getting the disease? Yes. And even the full doses are still good, you know, getting the diseases at risk of getting the disease, probably, I would say, because 100% protection has never happened and 0% protection never happened. So 0 and 100% never. So the CASA is between, you know, 60, 17 or 80, 90 depending on the disease and depending on the vaccines. However, if you are surrounded by a lot of the vaccinated people, we can see safe, we can, we can feel safe. So I think that's. I just wanted to come into the current situation in Myanmar. I think, you know, it's desperate right now because people are not getting the vaccines and so it's becoming a serious and alarming concern.

[A]

Yeah, that's absolutely, that's the next thing I wanted to move on to. So now that we've had, you know, after 2000 vaccines, I do not think, and correct me if I'm wrong, but I don't think that vaccines were ever a particularly political issue. I'm not aware of the Myanmar military having some sort of deep seated hatred of vaccines or conspiracy theory towards vaccines. So one would presume that even under the pseudo democratic period of, than saying vaccines would have continued and certainly under the nld, we would anticipate that they would have expanded. But post coup, with the country embroiled in conflicts left, right and center, I think the first one that came out, the first one that people were, were raising alarm bells about was Covid because the coup happened in the height of the COVID epidemic and there were many concerns being raised that while the rest of the world was receiving, you know, moderna vaccine and the Pfizer vaccine and all these other vaccines that were coming out, that Myanmar simply didn't have access to them or even if they had access to them, they couldn't afford them. And they were certainly not making their way to areas that were perceived by the military to be in open rebellion against the regime. And so A lot of the border regions, it was predicted that new strains of COVID might evolve and might develop. So do you know what has happened with regards? We will start with COVID just because that's, I think, what most people would be familiar with here in 2026. Do you know what happened with regards to COVID vaccinations? Are there still people in Myanmar who are unvaccinated against Covid, who are suffering from COVID Is it possible that new strains of COVID would develop as a result of this? Or is Covid naturally sort of becoming mild and dying out?

[B]

Yeah, when we're talking of the vaccine, we talk a lot of the COVID Of course it has been, you know, lifelong, remarkable periods. We have been staying at home and, you know, social distancing and, you know, and under the mask we don't even remember each other. But I think in the context of the public. Let me start with you start the tainting period and then are they interested in the vaccines or the conspiracy? To be very honest, they were not really interested in vaccines or any other thing. Public health, if there was no interest at all. All. So it is a general comment on this. However, the vaccination program has had tremendous milestones since 2015 in Myanmar. So I just wanted to start it here to come up with the COVID vaccines in Myanmar. For example, in 2012, for example,

[A]

the

[B]

famous GTP combined with hepatitis B vaccine has been introduced, given the endemic study of the hepatitis B in the country. And since then there's acceleration of a number of the new vaccines introduced into the EPI program in the national immunization program. This is really under the government of the NLD. Tremendous milestone. For example, in 2015, so 2012, the combination of the DTE plus hepatitis being introduced 2015, three years later. So MMR vaccines has been introduced. Before it was only measles and then they added for the mmr. So moms, measles and rubella that is more effective and it's even covering more diseases at that time. The introduction of the IPV have been introduced before it was only for the oral polio vaccines. In 2016, not 2016, pneumococcal vaccine has been introduced. You can see 2015 and 16 and 2016, pneumococcal vaccine introduced. 2018, Japanese encephalitis vaccine introduced. And 2020 and in quarter one, I think in February, rotavirus vaccines and introduced. And then 2020, in October, the HPV vaccine, human papillomavirus has been introduced. In all mean for Example in Myanmar, in a poor country, the the first cause of infant mortality is diarrhea pneumonia. So if the pneumonia is covered by having the pneumococcal vaccine it's saving a lot of the childhood mortality. The second is the diarrhea. Most of the diarrhea are about due to the rotavirus gastroenteritis. I remember my internship days during the period. This is exactly the same period, the gastroenteritis period. Cholera and some. It's not that really cholera. It's more about GE G gastroenteritis and the dengue fever period. You don't sleep the whole night. You're running over here and there. You know, we are always understaffed and we are running over the time in the pediatric wards. And so if we are able to prevent these type of infection by the vaccination it makes tremendous burden rigid reduction in the hospital. So over the five last years IPV introduced pneumococcal introduced. Japanese encephalitis vaccine introduced. ROTOR introduced and the hepatitis and human papillomavirus which is one of the major cause of the survival cancer in women. HPV prevent the most serious type of strains that cause the cervical cancer in women. I think five major introduction has happened during 2015-20 and 2020 there's a pandemic. We all know the story and we are poor and we have very. How to say compared to the other countries, neighboring countries the health care system is not that high. That high. It's not that strong. However, with what we have Myanmar is one of the country we have I would say less damage than what we expected for. And here I just wanted to highlight one thing. In January 27, in 2020, just before, I think five days before the coup d' etat the first step of the COVID 19 vaccines happened in Myanmar in Rangoon it started to get the Burmese people. I think at the time the priority people are the healthcare professionals, also the healthcare profession. They're getting the COVID vaccines. A very proud moment to be very honest. And we were able to vaccinate earlier than the neighboring healthier. How does it neighboring richer countries like Thailand. So that was a proud moment. And before we went for the digester five days later. So these are the sort of COVID vaccine period and the COVID coming to the COVID I just want to highlight another two things. One is the. The COVID vaccine. After the coup data a lot of the healthcare personnel went for the CDM the Civil Disobedience Movement. One of the head. The heads of the EPI program went for CDM and she was arrested in June 2021 along with her husband and his boy of seven years old. Her boy of seven years old and hardock and you know, she was in prison. Yeah. And so the military people are not really interested of vaccine itself. However, the vaccine has a cost. The millions of dollars million dollars of you know, vaccine budget at that time, a lot of donors going in at the Gavi, unicef, WH or wherever he knows to get the vaccines and the shipment for the vaccines has been planned for five shipments and through the different timelines all there's been a cost and they wanted to take back that budget, that money. The interest is. So they ignore the people. We know that story. They ignore the people. They are healthy or not or getting the vaccination. It is not their interest. And if the people are, you know, dying of, you know, Covid I think we have seen this in 2021 and the COVID you know, vagues as well. So I think military itself is really not interested in the people and however, you know, the vaccine related money and the budget is more interested in. And on the other hand the healthcare professional, they are very much passionate and to save people especially with the COVID period. And they really wanted to repress these health care professionals because they weren't for the scene. So all these together I think for the very first period and even in 2021 with the vaccine available, the people getting the vaccine is really, I don't really think, I don't have the vaccination coverage rate in hands but it's not that high. And I don't really think it's really reached to the ethnic areas and the rural areas. It's just in the big cities. Disease.

[A]

Yeah. And unfortunately that is what we would anticipate and what we would expect under these circumstances. But so let's, let's look at some of the big ones. Definitely here in the west, the MMR vaccine, measles, mumps, rubella, pretty important, pretty critical. And what we've seen for example in the United States, I'm sure you would be aware, is that under this recent wave of anti vaccination sentiment, we have actually seen a resurgence of measles in the United States and it is becoming a significantly more critical threat to the child population in the United States because people are not getting vaccinated. So we're seeing even in a relatively developed country with something of a healthcare system, although it can be difficult to access, measles can very rapidly return and become a Threat and be a cause of death for children. So MMR vaccine is definitely critical. The diphtheria tetanus pertussis vaccine obviously very widespread, very critical. And whooping cough as well. I definitely got whooping cough vaccine when I was young with these vaccines. And I understand that tuberculosis treatment is very important still in Myanmar and polio vaccination is very important still in Myanmar. This is a pretty sizable list of diseases that are currently being under vaccinated in Myanmar. What does that actually mean in terms of let's say health of the country in the next 10 years? What do we expect to see as a result of this?

[B]

So let me say in three different regions you really pin out all the vaccine preventable disease. And since 2021, I think in 2021 a lot of people movement to the CGM and the healthcare professionals are repressed, arrested and talked to the debt. And so they have to, they have to hide and run away and flee to the different areas. So there has a severe impact on the healthcare structures and the healthcare services in public and in private sectors. So that is something we know the story. What's happening behind is when we look at to the WHO data. Well, we always think that WHO data is the critical, you know, standard and the grail ref. You know, the gold reference for it in 2021, the vaccination coverage rate for the third dose of DTP. So DTP third dose is given on this at the six month of each. So the third dose of DTP was about 37%. Right. So it's very low. You know it. With that vaccine coverage rate we cannot get the herd immunity or indirect immunity that reflects the situation in 2021. But when it's come to the 2022, 2023 and 2024, the vaccine coverage for DDP3 and MMR getting bigger is between I would say 70 to 80%, 60 to 80% and progressively close to the 70 to 80%. Are they getting vaccinated? 60 to 70% of the children ended two years and ended five years. I would say the vaccine eligible ages. I don't think so. So before going to the what is happening to the disease? Let's start with the vaccine coverage rates, the official data and the inofficial data. I would say because these are the, you know, the pneumonia, the gastroenteritis and really first cause of the mortality in children and the five in Myanmar at the same time, you know, whooping cough. Well, we have very few, I don't want to say few cases. It's not that highest, but it's part of the respiratory, significant, significant respiratory diseases as well. So the measles we all experience in Myanmar. So when we look at to the 2022 and 2023 data, I try to understand why they are reporting 70% through the WHO and UNICEF. The situation in Myanmar. If we look at to the whole country and to the sort of armed conflicts and the airstrikes maps, you can see the red spot everywhere, specifically in Karen Karanee, Rakhine Kitchen and obviously and the most evident, the most red area is in Sakhine, Mandalaya, Upper Zakine areas. This area, how these children could get the vaccines in a circumstances where the healthcare professional are running and the people are running as well. They are moving constantly because of the airstrikes or the armed clash on the ground. And so we try to do a sort of a very quick immunization survey in the area. So there are some studies as well done in Karani State as well. I will come up later. So in Zagayan area there are three different areas regions we do the survey. The first area is very resistance strong area, but completely surrounded by the military troops. So the access to the outer big city, you know, the, the big cities is really difficult. They have to go through the checkpoints, military checkpoints. So getting out to go to the cities is very difficult. So that is the area one, I would say the area two is a very strong resistance, you know, sort of areas, villages, but they are small sort of mid sized towns. And the third one is the group of the villages close to the big cities like Moyoa and Mandalay for example. So in this area we try to do this, the first area where completely trapped and isolated villages. The vaccination coverage rate, we call it vaccine zero rate vaccine. Zero rate means zero dose vaccine. So zero dose vaccine is about 80% when we look at to the whole population, it was done in under 5 years old and it was about 60 to 70% depending on the village. However, when it comes to those born after 2021, so after the coup it's 80% of the children, they never get a vaccine. Neither BCG, neither DTP. Of course, the MMR vaccine we talk about, talk a lot in the west, it start the first dose in nine months of age for example, according to the schedule and they never get the mmr. And so and none of them get the full dose for the according to the age. If you are one year old you have to have the BCG and you have to have 2, 3 doses of DTP 1 dose of MMO etc. For example, no one gets the full dose according to the age. So this is the isolated area. And the second area is in sort of how to say resistant zone however, and the communication transports are still possible in that area. About 60% of the children born after the 2021 did not get any dose of vaccine. It's more than serious. And then in some of the. And the zone three, I would say where the. Well, the group of the village is very close to the Mendeley and the Monwa and the Zagay, the vaccination state is about 80%. So it still maintains the previous vaccine coverage rate. Before the 80% vaccine coverage rate at least one dose. They got the one dose. And there are a number of percentage. I don't remember exactly the numbers, but the number of the vaccine got the full dose according to the age. So six months they already get three dose of dtp, BCT and for example one and a half years old get the second dose of mmr, et cetera. And when we go into a little bit of the anthropological questioning for those who accepted to answer the question is about. And there are some reporting as well in the Myanmar media and saying that a number of the. In some of the well villages they gather five to 10 children and they go to the big cities. They call it vaccination trip and they get the vaccine over there and then they come back. And that is the. Because the people want the vaccine. The parents know the value of the vaccine. The parents know what is hepatitis B by experience. One of our, you know, relatives, a lot of the relative who. Who has experienced a lot on the cirrhosis, liver cirrhosis because of hepatitis B, liver cancer and whooping cough. We all experience all these things. So we wanted the vaccine. We know the value of the vaccine. The parents know it. Their parents wanted to get their children vaccinated and they are taking the risk passing through the military checkpoints and get vaccinated to children. And they bring the children from the neighborhood as well. So they are trained tremendous effort to get their children vaccinated. However, in the very isolated area, I think the vaccine is really nowhere. They can't get any dose of vaccine. So I think this is the reality which is completely contrasting what set the racial data. The Racial data says 70% of the children got the dose of the TTP vaccine. In the reality it's completely different. So we did a sort of media signal detection. It is how to say a known method for the signal detection in epidemiological term. You look for the keywords for example miso, moms in Burmese, for example misal for weta, moms for Pattaya or Mona, something like that. And you put the keywords and search for the in the social media we use Facebook as a social media and then you detect you see all the testimony of the cases sometimes with photos and sometime with under a sort of some medical information or some of the well known doctors giving the medical information around the vaccine preventable diseases. And then you can do the snowballing method. That means that you see the case, you see the testimony or you see some medical information center and you go down through all the comments below and then you see more cases appearing by this idea. What we are seeing is there are number of cases of mosquito in Rangoon, in Mandalay, in the Nindari region in 2024 and 2025 and even there are some school closures because of the moms outbreak. And the second there are diphtheria cases the grouping clustering of the diphtheria cases in Yangon and some were not necessarily clustering reporting but however there are some cases in the big cities as well. Well so I didn't see any whooping cough appropriately saying to be very honest. But however the moms when you look at the mom's child it's impressive to see the child with swollen swan mandible. So I think these are the very tip of the iceberg of what is happening with the vaccine preventable disease in Myanmar through the signature station on the media. So I think it's reflect actually the vaccine coverage rate what we did for the survey and in different regions and the what we see in the epidemiology as well. And I mentioned we didn't do in the big cities like Mandalay and Django and however the only in the India in the in the Sakai regions. And there was another survey made in Karani area and it was in 2023 and it was now published and they had the same finding. About 79% of the children surveyed they didn't get any dose of the vaccines and none of them 0 of all the surveyed children get the full dose. So it's impressive. However, I think what they did for the Karanee people is since then they they do the sort of a pilot vaccination campaign. They started with small doses and with the basic DTP vaccines and the BCD vaccines, the most important type of vaccines. Now the Kyreni children are getting the vaccines and that has been started in 2024 and scale up in 2025. But given the general population, I think in Kyreni it is about 300,000 population with about 6,000 children per year in the birth cohort. So it is a doable population. But when it's come to the Zakarian area, it is about, I would say, 5 million people living there and with about 100,000 birth cohorts per year. Yeah, I'm afraid that this is very difficult.

[A]

It's quite a, it's quite a severe issue. And I wonder how much, how much of this is, is visible because you say you're talking about something like mumps, you, you can see the swollen mandibles, right? There is, there is visibility here, but. And I think with most of these diseases, you know, measles and diphtheria, whooping cough, you wouldn't, you wouldn't have it and not notice that you have it. But I wonder whether there is a fear of diseases that are, that are quietly being transmitted just because large numbers of people may catch the disease and confuse it for something else, not realize that they had that disease or they weren't particularly symptomatic. And the failure of the vaccine program is sort of creating an environment that down the line, five years down the line, 10 years down the line might reach a critical mass and cause a very sudden and very acute medical crisis in a given area. Is that something that is likely to occur? That the severity and the prevalence of a disease can spread in the absence of vaccination programs such that we would not necessarily notice that this is happening?

[B]

I'm afraid that could happen if not started yet. Because the question is not only the vaccination. The current situation is the healthcare access in general is very much restricted in the central Myanmar area. When we talk of all these topics, I think right now we need to see different areas differently. For example, Rakhine State, they have been untrapped and isolated for four years. And the famine, the malnutrition situations and the, the hotspot hanger has been identified since earlier 2025. So no vaccine plus malnutrition plus no healthcare assets altogether combined becoming a huge issue. At the same time, population demography is decreasing due to migration, due to different reasons and due to lack of the efficient health care. So people are, were dying, I think. And so this is in Rakhine States. And when it comes to the Zagayan and the Central regions, I would say, you know, Zakay and the Qin States. Right. And the Upper Mandalay regions, I think this is the most, I would say affected areas by airstrikes and armed clashes and the most affected areas by the military hunters. Forecast strategy and with no, it's the same thing not with you know, malnutrition status. All these things combined. I'm afraid that you know it's very difficult years to, to. To come up Kareni. Fortunately they are bordering, bordering with Thailand. So some of the vaccine could be transportable through the border areas and some of the healthcare and so I think it is less maybe. Well there are. They have a lot of, you know, huge burden and they have considerable, you know people migrated to Karanee and a lot of IDP camps over there. So for a small size region I think they have a huge, you know, a humanitarian crisis and of course the healthcare needs as well and but however, you know they are getting the vaccines if I'm only focusing on the vaccine and when it's come to the vaccine, if the vaccine come, it's never come alone. They come with health care assessed. They come with the family planning usually and they come with other you know, basic healthcare like treating the hypertension, treating the diabetes and treating other diseases as well. So I think vaccination come with a package of the medical care. So that is good. What I'm really concerned is really the central Myanmar region. I think for the Rakhine area. I saw some news three, four weeks ago in January for example, in mid of January the hurricane army is organizing some of the vaccination campaign in the northern Rak kind state. So I think it's a little bit of the light at the end of the tunnel. But the political instability is not helping the situation better. Yeah but I'm not saying that you know we have to stop and take the peace at any price. We know that root cause and the military hunter has no willingness to do good things to his population and just killing through different ways and just repressing through different ways. So I'm not telling that you know, you have to take peace and you know, shake hands and just for the benefits of the people. I'm not saying that we know the root cause. We have to remove this root cause and to rebuild. But you know, after five years, half the decades of the suffering, we have a long way to come up when it's come to the vaccination we have to do a lot because the vaccination plus the disease surveillance system that has been completely jeopardized and then the cold chain system for example that has been much impacted. So to rebuild all these things again that would Take time, energy, courage and the money. And so far I don't really see the international institutions like who, like other institutions. And they have some willingness, they show up some willingness to help. But there's a lot of international regulation hurdles. And the programmatic issue as well is still very difficult. Even people are willing to do something. You know, the hurdles are so huge as mountains for the moment.

[A]

And so I, I wanted to sort of detract on this because you, you, you brought this up as you were discussing as the four cut strategy. And you know, we, we, we know the four cut strategy, we're familiar with it. And the, and the essence of the four cut strategy, of course, is attacking the civilian population themselves, which is despicable in and of itself. However, this is, I think this is a, a critical difference. When the military plays with things like starving the civilian population, as horrific as that is and as clearly a crime against humanity as that is, it does make sense from their perspective to starve a population that they see as an enemy. But when we are talking about allowing diseases to run rampant through the denial of health care, but. And through the denial of vaccinations, this is, this is sort of like having an argument with your housemate. And so you set fire to the room next to your own room, but you're still inside the house. If they deny the vaccines, not only are they going to allow diseases to run rampant in populations that they, as the military would view as enemy, despite the fact that these are civilian populations and elderly and children and so on, but they would just be creating a situation in Myanmar where certain diseases, dangerous diseases, are now running rampant. And their own population, the military population and the families of military personnel are not going to be sufficiently vaccinated and the herd immunity is not going to keep them safe and they are going to become the victims of their own cruelty. I mean, I know I'm sort of screaming into the void when I ask this question, as I've asked it many, many, many, many times in the past, but does the military not understand that by pursuing a policy like this that they're not only acting barbarously, but they are ultimately also setting fire to their own house?

[B]

It's very interesting when you're telling this. I'm saying are they, how to say, are they sufficient enough intelligence enough to that level? Number one? Number two is, are they really interested in protecting their, how to say, their own people, their own people, their military troops? Do they have that willingness, do they have that intention? If it is, yes, it's still, it's still positive. I even, I don't really think they really care of their people, the military troops, you know, so that is the one thing and the second is I'm saying just you know, a handful of people, you know, high authority in sort of, you know, general, you know, military general people, they are hyper protected. They will protect their families but it doesn't mean that the whole military family and I don't really think they have that insight on their radar. I got vaccinated and my children got vaccinated and my housekeeper and the sort of, you know, all the people surrounding me are hyper vaccinated and they would feel safe. They have no interest in caring of the others. And I can imagine that you know, someone is killing, you know, deliberately their own people bombing the schools and hospitals. They're not human so they won't be any, they won't have any interest on it.

[A]

I mean it's absurd and it's inhumane.

[B]

But my concern is not the willingness of the military people. My concern is WHO and the international institutions for public health health. They are sitting on a great public health, global public health threat. The people are migrating through the poorest borders to Thailand, to India, to Bangladesh. Well I don't know how about China? But you know the borders are porous. The people carry the diseases and we know that clearly there are reports of the re emergence of the tuberculosis. It has been two times higher, three times higher. If I understand. Well in Mesa for example there's a number of visible and invisible camps. ITP comes and there the rate of the tuberculosis is ramping up two times and three times within two years. And this is just visible because we are detecting so imagine in areas where there is no facility to detect the cases. I think you know, the problem is really huge in the gyne area. I hearsay that you know we don't have any kits for the testing for tuberculosis but we know by clinical, you know, clinical ways, symptoms. There's a number of cases and we don't have any anti TB drugs over there. So tuberculosis is very visible. But you know there's a lot of open cases who can transmit the disease to other but they could, they are not visible as an open case. So people are you know, walking around, running around and you know, in the streets without you don't even know you could be transmitted. And so this type of thing with the, a number of, you know, international organization, they know the risk that they know, you know what could be the next but they are not able to intervene. This area let's come up with. So without going to the, you know, different disease area even only for the vaccination. I would say the major problem I would categorize in three things, three categories. Number one is for international regulation vaccination. Usually vaccination is a program. So usually it is the public market. The purchase is done by the government to government and the state to state. So for the hunter so they can purchase the vaccines from the vaccine manufacturers in nearby country for the liberated and for sort of resistant area number of the cso, a number of organizations or even the nug, the national unity government legally saying since they're not legal and they could not buy or purchase high volume from the manufacturers. So it's come up like in the Karanee experience. They have to buy from the private sectors. In Thailand the price is three times at least three times higher than the retail and you know, government to government price. And the second is the volume. Usually for the programs they come up as the 10 dose viral. But when you are purchasing in the private it is one single dose viral viral making more or less packaging the same volume for 10 viral and the one viral. So when it comes to the cold change and the transportation because you have to maintain the same cold storage facilities and the situation, you know, circumstances and it is very much difficult, programmatic difficult. You know, 10 dose of vaccines in a normal time. For a program you can carry in the same box 100 doses. It makes a huge difference in conflict affected areas and in areas where there is no electricity. So you have an ice pack. You have to carry all these programmatic issues. Vaccine and cold change. It's inseparable. You have to really maintain the cold change at the standard temperature. These are the things that all these things then non recognition of the organizations and our government in parallel. It's a huge problem number one. Number two is there's a lot of non governmental organization like international organization like Mitant and sort of Mise En San Frontier. All these organizations they are. They don't have the ability to do the vaccination program. Only my understanding only the MSF can do the vaccination program. They have the ability to do so. I don't even think ICRC could do this. I think so in Myanmar. In the context for example MSF is in Myanmar. But they cannot reach the affected people in the central areas as well. So this is another area of burdens and huddle adding on it this one. So the second is really the who can take care of of things. As you know, there's a Lot of, you know, people and the institution, they want to give the funding, their willingness to do something. But however logistically and programmatically saying there's a lot of. A lot of things to overcome. The third one is the receiving population and this is the children and the communities in the Sakai region, Karanee and the Rakhine State for example. And they are, they are in constant run. They are running here and there and I think there is some family. They bring their vaccination leaflet booklet. It showed that they wanted to get vaccinated. They are running under the life threatening conditions because of the bombing and the airstrikes. They still carry the vaccine booklets of their children. It's painful to hear that story. However, how to do the vaccination program to a community, to a population in Konstantrand dispersing here and there or the time that vaccination is all about the regular doses, having the second dose, third dose and also having a good surveying system for the adverse, eventual adverse events of the vaccination as well as to detecting the vaccine preventable disease. All these infrastructures has been seriously disrupted. How could it be so we have several layers of difficulties and we don't really see yet tangible solution right now. I would sometimes dream maybe I'm a dreamer, but I think it's still worth dreaming for this. Sometimes I really dreaming of WHO and UNICEF with the helicopter. They are dropping some of the vaccines and essential drugs in the affected area and having the solar assisted coating system that has been largely used in Africa and it can be used in the Zakaria regions and in very remote conflict affected areas. But there's need to have a flexible political willingness from the helping countries from the outer international communities. I don't think it is not an not doable but something it is feasible but all the partners need to sit together to overcome all these hurdles. But on the other hand as well the people on the ground were not yet equipped technically and I would say theoretical and the information and the knowledge. So a company along with the skill building, capacity building at the same time provision of the. The vaccines for the very first period. Then we had a lot of wastage. However we can learn and then trust building could build up in there over the time. But the interest is really the children and it is not only the children within Myanmar, it's the children all over the world. So I think I'm still dreaming to have sort of helicopters dropping some of the essential trucks and the best vaccines and through the solar system because I

[A]

think because you, you mentioned tuberculosis and the tuberculosis cases. And I just wanted to clarify because it was, I believe the who, the World Health Organization has as part of its policy and its mission that it provides a full six month course of tuberculosis treatment.

[B]

Yes.

[A]

To all people around the world for free.

[B]

Yes.

[A]

And, and yet in Myanmar, even when I was in Myanmar before the coup, there were people actively with tuberculosis who were not receiving treatment. Why was this?

[B]

Well, Not being on the ground, to be very honest, I, I don't really know what the root cause of this because you may have met someone in the big cities, not in remote areas, that active open case and usually they have free anti TB doses, the full doses. Yeah, that's a rule at least I think, and free of charge. But you know, with the, wow. With the corruption still happening in these countries even before the couple, and I think there might have some, you know, leftover cases there now the situation is, you know, getting worse and worse and very chaotic and catastrophic situation. And so. And it's tuberculosis. And I think when it comes to the other sexually transmitted disease, I think, my God.

[A]

And that's something we want to transition to because I know that you wanted to discuss this, that besides the vaccination programs which are of critical importance and you've alluded in a couple of the comments you made here to vaccines not existing in a bubble, vaccines forming part of a complete and holistic provision of essential medical services. And as part of that, that comes to family planning, it comes to safe sex, it comes to abortion rights, which very often are sort of sidelined. It's relatively easy to get people on side with vaccinations, it's generally an easy sell, the anti vaccination movements over the last 20 years notwithstanding. But when it comes to family planning, and particularly when it comes to safe sex programs and abortions, vaccinations, here we start to get a lot of pushback, socially, politically and in a lot of ways. So how would you, just to start off, how would you compare the struggle to provide vaccination as part of healthcare to the struggle of trying to provide family planning, safe sex and abortion services as part of healthcare?

[B]

I think that is the topic we have. Maybe we can talk over another one hour. I think. Let's start with what I say. The vaccination comes along with the other healthcare packages, including healthcare information. And one of the most important healthcare information, how to say health literacy is the family planning and safe sex. My understanding from the ground and here, see here and there and in the news, is that, you know, the Net the how to say the family planning services were really completely disrupted and even for the healthcare professional, for example very few doctors in the area in the guinea areas and very, very few and very understaffed let's say for the medical trained nurses and people for example in the IDP camps, for example in IDP camp I think there are about 3 million internally displaced people region. It's a huge. And some of them are staying in the relative house but there are some, you know, displaced groups and acts as a camp and they were saying so there's a lot of interactions with the new arrivals and the reality is that there is no real health education campaigns and people in charge of these camps. Their priority is more about getting into the humanitarian basic humanitarian assistance like food provision and others and even for the water sanitation it is not adequate. So I think the health education is a little bit of, you know, not as a priority because there's so many things to do and they have to do, you know, once at a time. So the leaflets for example, the number of the leaflets we are providing, they can print it out and they can you know, pin ups and do in the end how to say distribute as track. However, no one, no one reads these days, right. In our case people are you know, swiping the telephone. They're not really reading the true things and when it comes to the health education they don't do anything. So what we see is the pregnancy, sorry, there are more and more pregnancy and under these circumstances severe Maldives situations and the not really comfortable family settlement And I think that the abortion rate, miscarriage rate is very huge. But I don't have the data in mind but I see that the numbers are really impressive. Two times, three times higher than the pre coup period and the abortion and miscarriage rate in this area. So it's alarming and people are not more interested in the. And I think there are two categories. I would say number one is the lack of the health. Health literacy. They don't know how to prevent the. Prevent the. Have the safe sex. The second is they know that however they don't have the resources. The materials I think when we are distributing for example to the sort of the resistant forces condoms are part of the distribution as well. So these materials are lacking and severely lacking as well. So these two are part. And with very much reduced funding and the resources I'm afraid that it's coming back and we found that there are some, you know, sexually transmitted disease coming up. I don't get, I don't have the numbers in my mind there's no real true survey making on it or the true data on it however here and there. But through the media signaling I found it some sexually transplanted lichenorrhea and the syphilis is coming up as well. So HIV and aids truly I don't really know if there are any testing facilities there in that area. However it's coming up again as well in some areas like Kitchen and in areas in Aydangon where the facilities for the HIV detection is and it's obvious that the numbers are increasing over the last two, three years. How to handle it? The first thing is we need to have a public willingness, public awareness of the re emergence of all these preventable disease and all sexually transmitted disease. The public awareness I think people that the whole country is in chaotic situation you know, financially and you know, with the second, with all these conscription as well and the young people are fleeing and the demographic is significantly and seriously changing and with the upcoming, with you know, infectious diseases and with substantial consequences. I don't know, I don't want to be very much negative but situation is nothing positive at the moment.

[A]

I mean, I mean you said, you said syphilis and HIV here because I mean other other types of sexually transmitted diseases, herpes, chlamydia, gonorrhea, the diseases, they're bad, they're not great but these are, are significantly less likely to be life threatening. Whereas we obviously, we all remember the HIV epidemic or we've heard of the HIV epidemic and, and the people who died of AIDS and how devastating it can be and we know that it's, it's significantly mitigated now but that's because of medications, because of things like prep that, that allow people to, to be able to manage this infection and syphilis. I mean we, the people who have studied modern history would remember the large numbers of very famous people including you know, Lenin, Al and so on who had syphilis and it lives with you and it destroys you and it destroys your brain. It's a very cruel degenerative disease. So these are not diseases to be taken lightly. These are very literally life threatening diseases. Without proper treatment, is there any hope? Like do we have organizations? You mentioned medicine Sans Fortier, obviously the who, the Red Cross. Are these organizations even theoretically equipped? Let's say that the revolution ends tomorrow, the military is removed from power and Myanmar transitions to a stable democracy. Are the international medical aid and support organizations equipped to be able to handle another outbreak of, of HIV in the world? Are they equipped to handle Something like an outbreak of syphilis.

[B]

Well, in an ideal world, if the military can be removed the next day and that we would get rebuilt together again for a better future, that would be a wish. And I think even in that situation, whether the international organization can cope with this situation with a crisis in who you know, that, you know, with the significant reductions of the U.S. aIDS funds and significant budget reduction across all over the world for the humanitarian assistance and the escalating humanitarian crisis around the world, in Gaza, in Syria, in Myanmar, in Sudan, in Africa, wherever, you know, I think are they able to cope with. I'm not sure. You know, international organization can do everything, but I think there is some willingness to get up and to rebuild. Whether the community, the Burmese community, we have that willingness, you know, over the five years, the resistance is being very strong and determination is still very strong and there's a lot of still unseen, you know, resources behind. So I think we may not be the best, but we can do it again and rebuild again. If the hunter is removed the next day, if it is not, you know, the cows will be, you know, the crisis, the poly crisis, what we call will be worsening. But I don't want to be on the very cynical in this way neither because there is no situation without any solution. For example, in Rakhine States, I just say they mentioned that the vaccination campaign started in January because they have the territory control since months and if not or one or two years, so they started to give the public services with what they have, they're doing the healthcare services. And the vaccination campaign is for me is a very significant signal of their capability to handle the public service. Because the vaccination is not treating a patient in a hospital. You need to have a gather people and structured organization and with a good planning. So it reflects somehow a better service provision facilities and the organizations for this area by the territory control. I would say the same in the Karanee Kareni. They have started the Karanee iec, the interim executive committee, sort of the governing committee units for Kareni since 2023. So at the same time the vaccine survey has been happening and now they are in very much in progress and they are able to vaccinate their children, if not 100%, but significant 70, 80%, I think. So it is very huge. I think it's a huge progress. And these are part of the local governing unit and they are trying their best with all the, you know, budget, you know, budget decrease and they, they're able to do something public services and this is very positive. I would say so if it happens to the central Myanmar region. We know that there are popping up and growing bottom up governing units like Mandalay Interim Interim Executive Committee, Mendeley governing units, the kind unit and Nagoyun units, they are starting to get built. So in one or two years maybe they will be able to do more public services including preventive measures and more well structured education structures despite all the constant airstrikes. And by doing this maybe probably the international institutions could channel or create flexible mechanisms to fund more and to, to make some flexible cross border transportations of the basic necessities. That could be something we can, we can I think try for and starting to, to yeah build together, work together and try. Instead of you know, I think the removal of the hunter or even we wish for, I think it would take a bit longer than we, we expected. But during that time we cannot stay. We cannot stay. You know, we cannot stay without doing anything. We we could at least try and we can see where what we have seen right now in Rakhine State and the Karani region and so just sort

[A]

of connected to, to this because we have, you know, talking about the Arakan army, you're talking about Karen, you're talking about, you know, other places and you, you mentioned that they have territorial control and they have stable long term territorial control, which is critical, which is essential. And on top of that they have very fortunately for them access to the border so they can import things. However, this does not change two very important factors. The first is that as we know medication costs money, even, you know, even if it's being provided for free at the, at the end someone had to pay for for it. And if you're an international organization, maybe you can cover those costs. But if you're a revolutionary organization, then, then that, that money is, is a significant barrier. But the second is that many international aid organizations, whether we're talking about medicine, whether we're talking about the Red Cross, whoever we might be talking about, they have to play a, a political game. They correct. Have to look at Myanmar and say I will pretend that the military is legitimate not because it is in the best interest of Myanmar, but because if I violate the military's control of Myanmar, then 20 other countries in Asia, in Africa, in the Caribbean, in the Middle east are going to turn around and say well, you've lost your access to my country because I can no longer trust you to support my regime. And in their attempt to be neutral, the end result is that they very often I would Argue fail to provide the care that needs to be provided in order to appease the whims and the wishes of brutal regimes who don't really care about their people. But allow these organizations most of the time to do at least some good work just because it doesn't cost them anything and they're willing to let these organizations do and it buys them a little bit of goodwill and that can be taken away at any time. And so this puts them in a very difficult position. And I don't envy them their position and I don't want to judge them too harshly for the decisions that they make because I can understand the pressures that they face. But my question to you here is what do you feel is the best approach? What do you feel is the best option for international groups whether they are UN affiliated, whether they are completely independent and private, whether they're government associated, non government associated private foundations, what have you? What is the best course of action action to be able to bring about the greatest amount of medical good in Myanmar when you are an outside organization approaching this poly crisis,

[B]

the most important thing. It's really a great question and this is the way forward. We have to work over the, the years, coming years in the, in the resistant area. The international organization should work with non state actors. They have been working in different countries in Africa, in Sudan, in other areas. So they have to do that work. So it needs a little bit of more courage, more efforts and bravery and embrace the real reality why they are doing the humanitarian job. If they are not really truly thinking of the people suffering. There's a lot of and they are, they are professional, they are professional humanitarian assistant people. They know the ground, they know the suffering and they may have the keys the political winningness of the big organizations, international NGOs stop acting like a forov we call it, you know, the stock option like industry. But they have to really act for the humanitarian mission and this is the political willingness they have to do. I can understand internally they might have some difficult to make the progress to make the change. The change is difficult everywhere, even in within the, you know, humanitarian organization. So please look at to the people sufferings and the solutions are not far from there, you know, at hands. But there's there the non stake actors like Karen eic, the governing units on the ground, the Rakhine, the same things as well. So please contact them. I think they may have some information or they already have some context on ground. But act visibly act and work together, hands in hands and make it public and be brave that's really the most important thing I think political willingness and as well as a little bit of show off what you are doing and you have to do. And I think in this area, for example different ethnic revolutionary organization, CSO or maybe NUD affiliated organization recommended by nug. So depending on the Internet policies and the internal mandates of the institutions, please get in contact with these organizations. There may be. So all these organizations except from the Eros, a number of CSO or in energy affiliated organizations are new. They all developed after 2021. So they didn't have that much long term experience and have not yet the track record they wanted to have. However, why not build together for the benefits of the people and this is what we need for. And on the other hand they may have some concern about the absence of the rule of law in this area. They cannot send their stuff, you know, in a very insecure, I would say in other words area. So this is not having the people on the ground. But there are different ways of having the methods like localization or having maybe the, you know, having completely confining the whole mission to the local organization. And there are different ways I think they can, what they can work for. But please, the trust is another issue I think and we shouldn't lost, we shouldn't lose in, in translation as well because local people speak the local language. I'm not saying Burmese or English the way we're doing, you know, the job and the way we're doing the humanitarian assistance in our proper Burmese way. And, and it's not that translatable to the international humanitarian assistant languages. So I think, you know, we have to learn by doing for both sides. So when we are talking off to the sort of international organization oh this and that and this and that and all the, you know, difficulties they come up with, why not accepting the difference and embracing that difference as an opportunity, as the, as a sort of the opportunity to learn from each other and you know, make more impact on the ground. But you know, they have to really, how to say, work with these all non state holders, non stake actors. I think this is the, the most important way we have to move on.

[A]

Absolutely. And I think that that covers quite a lot of ground for, for our discussion here. It is a relatively in depth discussion and I want to thank you very much for sharing your insights and your expertise. We, we really value the opportunity to hear from subject matter experts like you on, on these critical issues.

[B]

Thank you. We are now 5 years post coup and the people are still resisting and the determination of These people and you have to acknowledge this and our country cannot go back before 2021 period. We all are determined to have a better future and we, the international community institutions must hear that. This is the one thing. So we need to have a political way to get rid of this military junta. This is the first thing. The second thing is help us in building the better future right now through the different channels. Vaccinations, basic health facilities. These are the essential tools. These are the fundamental human rights and the essential tools against the poverty. With all the economic crisis and the different circumstances, we are suffering a lot, but we are not giving up. Please give us some hands and help us build again our communities right now and trust. So I think what I really wanted to say is trusted and the bottom up governing units who are providing the public service to their own community, understanding their own community and having the influence and their own communities selected and elected from their own communities are popping up now as governing units in Karani in the Guide and the Rakhine Help us, hear us and the way forward is absolutely feasible, possible. We may have still, you know, barriers and huddle, but these are not. We can all over overcome all these barriers as well. So please hear us and we can build right now and for the better future in India. And thank you so much for having me as well. That is a rare opportunity that I can express my thoughts and my wish for the benefits of the people. Thank you.

[A]

What a great conversation that was. You know, every so often listeners share with me how deeply they've connected with the guests they heard on our podcast. Sometimes they've shared being so profoundly touched by what they've heard. They tell me they just wanted to reach out and hug the speaker when the episode ended. Hearing this kind of feedback, it's always real motivation for me and for our whole team because it shows that even in this virtual space, we've been able to foster true heart to heart connection with this global community of listeners. Indeed, many of our guests have made extraordinary personal sacrifices in their efforts to create a better future for their society and continue to do so every day despite the many challenges they face. And so if you've been touched in this way yourself from hearing a past episode, you might consider supporting the work of of one of our guests directly. Such contributions not only provide material help, they also send a powerful message of solidarity and of shared humanity. To get involved, send us a message with your intention, of course. You can always make a general donation@insight Myanmar.org donation. Saranaya da yarana.