ASTMH President Christopher V. Plowe, MD, MPH, FASTMH, and ASTMH member Myaing Nyunt, MD, MPH, PhD, led efforts to convene the historic conference -- held in Washington, D.C. August 2-4 -- on eliminating malaria in Myanmar. Plowe, founding director of University of Maryland School of Medicine’s Institute for Global Health (IGH), along with Nyunt, assistant professor of Medicine, and director of the IGH’s efforts in Myanmar, have been studying the disease and its impact on Myanmar for the past two decades.
Following the conference, ASTMH checked in with Plowe and Nyunt to get their reflections and insights.
1. Why is it so critical to eliminate malaria in Myanmar? What is at stake?
CVP: Resistance to the first line antimalarial drug, artemisinin, appeared first in Cambodia and is increasingly common throughout Southeast Asia. In response, the World Health Organization launched a regional effort to contain resistance. But genomic "paternity testing" showed that resistance was both spreading--for example between Cambodia and Vietnam--and emerging independently. With different resistant parasite variants popping up on either side of the supposed "firewall" running through Myanmar, the WHO recommended in May of this year that the containment strategy should be abandoned in favor of a full-on regional elimination campaign.
MMN: Although there is still more malaria in Myanmar than in the rest of Southeast Asia combined, rates are lower than they have ever been. In addition to the urgent need to respond to the growing problem of resistance, there is unprecedented political will across the spectrum to push for elimination, both within Myanmar and among the international development partners and regional governments. This is a once in a lifetime chance to eliminate malaria from Southeast Asia.
2. The effort to eliminate malaria in Myanmar is unique in that it has brought disparate political and ethnic groups together in an unprecedented way. Please describe the role science diplomacy has played in helping to bring such divided voices to one table.
MMN: I like to think of malaria as a "catalyst" for positive social change. Working on the Thai-Myanmar border, I have seen that malaria attacks ethnic militiamen, Burmese government troops, and the villagers caught between them, and they all suffer the same. So everybody can agree on malaria as a common enemy. When people are able to put aside their differences and focus on working together toward a common goal of malaria elimination, it brings out the best in themselves, and helps them to see the best in each other. It feels good, and this is reinforcing.
CVP: By getting civilian, military, opposition and ethnic groups to sit down and get to know each other, talking about something we can all agree on--eliminating malaria--the hope is that the new channels of communication, and trust, might make it easier to talk about harder topics down the road.
3. By all accounts, the recent meeting in Washington, D.C. was incredibly productive. There were several outcomes from the discussion, but what are the one or two points that stand out to each of you?
MMN: For me, the most important outcome was the simple fact that we had senior government officials from three Ministries--Health, Foreign Affairs, and Defense--sitting down with politicians from the opposition party and ethnic health organizations, reaching consensus to work together on malaria elimination regardless of political events. This was the first time that all of the groups have had a chance to express their views openly, and to be heard, together.
CVP: I agree. This relationship-building--and trust-building--exercise was the first step in a process that will continue in Myanmar, with more focus on technical and financial planning for malaria elimination.
4. What role do you see the Society having in driving this conversation forward?
CVP: ASTMH provides a neutral zone for productive scientific and global health exchanges that might not occur on home turf. At this year's annual meeting there will be a scientific symposium on malaria elimination in Myanmar that will feature scientists from the Ministry of Health, from the Myanmar military, and from a community-based organization working in border areas. As with the Washington meeting, we are bringing together groups that might not normally share the spotlight like this. It looks like ASTMH will also provide a venue for U.S.-Cuban scientific interactions at the Annual Meeting this year. I would like to see this kind of science diplomacy become one of the major ongoing activities of our Society.
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