AIDS, tuberculosis, malaria and bird flu spread unchecked in Burma

Government policies in Burma that restrict public health and humanitarian aid have created an environment where AIDS, drug-resistant tuberculosis, malaria and bird flu (H5N1) are spreading unchecked, according to a report by researchers at the Johns Hopkins Bloomberg School of Public Health.

In that report authors Chris Beyrer, MD, MPH, director of the Bloomberg School’s Center for Public Health and Human Rights, Luke Mullany, PhD, Voravit Suwanvanichkij, MD, MPH and Nicole Franck, MHS, document the spread of these infectious diseases, which if left unchecked, could pose a serious health threat to other Southeast Asia nations and the world. They believe international cooperation and policies are needed to restore humanitarian assistance to the Burmese people, but caution that new restrictions imposed by the military junta are making such efforts more difficult.

The full report was presented at a briefing for State Department officials on March 24 and is available from the Johns Hopkins Center for Public Health and Human Rights at www.jhsph.edu/burma. The report is also under review for publication with the journal Public Library of Science Medicine (PLoS Medicine).

The report states that Burma reported its first cases of bird flu among poultry to the World Health Organization on March 8, 2006. However, the ruling junta censored reports of the outbreak to its own public until March 17 - by which time the outbreak killed 10,000 more birds and 41,000 needed to be culled to stem further spreading.

The report documents a longstanding and severe under funding of health and education programs in Burma. Health expenditures in Burma are among the lowest globally, including an annual budget of less than $22,000 for the prevention and treatment of HIV among a total population of 43 million people. Much of the country lacks basic laboratory facilities to carry out a CD4 blood test, the minimum standard for clinical monitoring of AIDS care. In 2005, 34 percent of tuberculosis cases in Burma were resistant to any one of the four standard first-line drug treatments, which is double the rate of drug-resistant cases in neighboring countries. Nearly half of all deaths from malaria in Asia occur in Burma. The report also reveals that 70 percent of anti-malarial pills sold in Burma contain substandard amounts of active ingredients, which increases the risk of drug-resistance.

“There is a growing humanitarian crisis in Burma. In our report, we document how the ruling government’s policies have restricted nearly all aid and allowed serious infectious diseases to spread unchecked,” said Beyrer, who is also an associate professor in the Department of Epidemiology at the Bloomberg School. “With the global spread of bird flu, there is a fear that if a human form of H5N1 were to take hold in Burma, it could potentially spread unchecked for weeks or months before anyone knew about it. Uncontrolled spread of any disease, especially an emerging disease like H5N1, poses a serious health threat to Burma’s populous neighbors, like China and India, as well as the rest of the world.”

The report also documents threats and restrictions to foreign relief workers and relief groups, including the Red Cross. Because of the deteriorating situation, the United Nations Global Fund for AIDS, Tuberculosis and Malaria was forced to withdraw its five-year, $96 million dollar grant agreement with Burma. Backpack Health Worker Team, an aid group that provides primary health care services in rural areas of Eastern Burma and Thailand, is also raising concerns about its ability to monitor and contain outbreaks of bird flu and other diseases.

“The Burmese junta is increasing restrictions on humanitarian assistance and public health while the health of Burmese people deteriorates, posing a widening threat to Burma and her neighbors,” said Beyrer.

The report “Responding to AIDS, TB, Malaria and Emerging Infectious Diseases in Burma: Dilemmas of Policy and Practice March 2006” was funded by the Center for Public Health and Human Rights and the Bill and Melinda Gates Population and Family Health Institute.