Why is this a hot topic?
This is hot topic for obvious reasons at the moment, given the COVID-19 outbreak. As the disease has now appeared in nearly every country on the globe, we can observe in real time how national governments and the international community are responding, offering an opportunity to consider the options open to policymakers.
It’s also an opportune time because the Hluttaw is reviewing a bill to address the risks posed by communicable diseases. This briefing presents just some of considerations for policymakers when seeking to address the threat of a new disease.
What is a communicable disease?
A communicable disease is one ‘whose causative agents may pass or be carried from one person to another directly or indirectly’ . Examples include influenza, measles, HIV/AIDS and COVID-19. By contrast, non-communicable diseases are those which cannot be transferred from person to person, often ‘the result of a combination of genetic, physiological, environmental and behaviours factors’. They include diabetes, asthma and cancer.
Infectious or communicable diseases have been a prominent danger to populations throughout human history, and it is only since the nineteenth century that medical science has been able to control them through the development of vaccines, a greater understanding of how diseases are spread and a better understanding of the importance of hygiene. Major outbreaks have been such a major feature of human existence that they have often even had an influence on the direction of human history. For example, it is thought that bubonic plague in the fourteenth century, which was known as the ‘Black Death’ and led to as much as 60% of Europe’s population perishing, had such a profound cultural, social and economic impact, it led to the emergence of modern democracy a nd an epoch of artistic flourishing known as the Renaissance .
Diseases such as the plague frequently cross international boundaries and have done so for centuries. However, technology allowing humans to travel faster and further has meant diseases can now travel further and faster too, often with severe consequences for populations encountering diseases for the first time. In the 15th and 16th centuries, European invaders took smallpox with them to North and South America, with devastating results. Smallpox, along with the flu and measles, are thought to have led to the deaths of nearly 90% of Native American populations .
Diseases that spread rapidly through a population are known as an epidemic. When a disease covers a particularly wide geographic area – such as multiple continents, or worldwide – it is known as a pandemic. Epidemics and pandemics usually occur when a virus previously harmless to humans mutates, allowing transmission from an animal host to a human host, and then further transmission human-to-human.
Past epidemics • The ‘Black Death’, spread across much of Europe from 1331 to 1353, killing 75 to 200 million people – up to 60% of the population of Europe • The cocoliztli epidemic, thought to be a virus called salmonella enterica, wiped out 80% of the population of Mexico between 1545 and 1548 • The First Cholera pandemic killed over 100,000 people in Asia and Europe between 1816-1826 • Encephalitis lethargica, from 1915, killed 1.5million people worldwide • The global HIV/AIDS pandemic which emerged in the 1960s, has led so far to over 32million deaths • In 2009, a seasonal flu pandemic killed 203,000 globally • Ebola, prevalent between 2013 and 2016, killed 11,300, mainly in Africa
At the World Health Organization, declaring a pandemic can be useful way to alert people to the risks and to mobilise resources to stop the spread of the disease. However, such declarations have to be carefully balanced with the risk that causing panic in the population can sometimes be counterproductive for the prevention of new infections.
How should governments respond?
There are two main ways that governments around the world are responding to the threat of the new virus. The first (1) is to try to control the spread of the contagion through policies such as restriction of movement, enforced shutdowns and social isolation. The second (2) is through measures to mitigate the impacts of the disease. This may address the direct impacts on the healthcare system, as well as indirect impacts on the economy and society.
1. Controlling the spread of communicable diseases
Vaccine for new diseases typically take a long time to develop, and in the case of rapidly spreading viruses like Covid-19, this may be a minimum of 18 months away. In the meantime, governments and the international community need to implement measures to slow down the rate of infection, protect segments of the population who are most vulnerable, and ensure healthcare systems are able to care for the sick.
Many of the data-driven and scientific analyses circulating online recently have referred to the importance of ‘flattening the curve’. This means that with a pandemic as infectious as COVID-19 there is little that can be done to prevent the disease sweeping through the population, however if the rate of infection can be slowed down and the most vulnerable offered additional protection, healthcare systems stand a better chance of not being overwhelmed.
The same numbers of people may get infected, but over a longer period of time, so hospital beds and ventilators are available for those with severe cases, and the general population has time to acquite ‘herd immunity’ and develop a vaccine. Whilst this theory has been brought into question , the global consensus that has emerged is that governments must act early and decisively, and not wait for confirmed cases, for example, before implementing restrictions on movement. Amidst all the doom and gloom, examples including Taiwan seem to suggest that this containment strategy can work.
Over a long period of time, it is hoped the general population will acquire herd immunity. Whilst this strategy has been called into question, especially for low income countries like Myanmar, a global consensus has emerged that governments must act early and decisively, not waiting for confirmed cases or widespread illness before implementing containment strategies. Examples such as Taiwan and Japan suggest that early action has made a significant difference.
Measures to control the disease – sometimes known as the ‘contain and delay’ strategy – typically include containment or quarantine, restrictions on travel, closure of schools, shops and other ‘non-essential’ services, cancellation of events and public gatherings.
2. Support to reduce impact
As noted above, support measures globally to mitigate the impact of the disease have typically included both healthcare measures and economic/social support. Health care support invariably means significantly increased funding for equipment and facilities such as new hospitals, testing kits, personal protective equipment (PPE) or ventilators. Funding may be accompanied by the use of emergency powers, under existing or new legislation, to enforce testing, for example.
Economic support comes in many forms and includes fiscal measures to support both individuals (eg enhanced unemployment support) or companies (eg tax exemptions). Many countries are also taking monetary policy action such as cutting central bank interest rates.
Overarching Principles for Policymakers
Making the right decisions at the right time is extremely difficult for policymakers in the face of such an unprecedented global event. Lives are being lost, health systems overwhelmed; but we also know that severe restrictions on movement will have major implications for the economy and are likely to be socially and politically destabilising for decades to come.
There is some increasing concern that the ‘contain and delay’ strategy adopted by high income countries may not be the right approach for under-developed economies like Myanmar, for various reasons, such as:
‘Flattening the curve’ means spreading the impact on the healthcare system over a longer period of time, so it has a better chance of coping with the increase in demand. However, health spending is extremely low in Myanmar and the system was already unable to cope even before the arrival of COVID-19. Compared with the UK’s $4,178, Singapore’s $4,084 and Malaysia’s $1,053, Myanmar spent just $291 on healthcare per person in 2016 (current health expenditure per capita, PPP current international $).
Whilst in richer countries a strictly enforced lockdown will cause economic hardship, there is often some form of social safety net in place for those already struggling to survive. In Myanmar, where there is no such universal safety net, a lockdown for many people could be as deadly as the disease, as people lose access to work, cannot feed their families, and are less likely to have access to healthcare for COVID-19 or other illnesses.
Given Myanmar’s ongoing civil war and failed peace process, there are growing fears that a lockdown could allow abuses by the authorities – clearly a particular risk in non-Bama majority areas.
The death toll is proving much higher in countries with an older population – the risk of succumbing to the disease rises sharply for the over-60s. However, Myanmar has a relatively young population and due to weaknesses in the healthcare system people with underlying complications such as diabetes, hypertension or respiratory issues are less likely to reach old age.
Selecting the correct strategy is an extremely difficult task. A difficult trade-off must be made between the sickness and deaths that the disease will bring, versus the hardship, and undoubtedly extreme suffering that will result from both the economic impacts of disease, and the measures used to contain it.
In deciding on the best course of action, policymakers may wish to consider the following key principles:
If you are going to act, act fast: If containment measures are to work, they need to be implemented quickly. It may feel wrong or unpopular to impose restrictions before there are even confirmed cases. But when so few tests have been carried out, as is the case in Myanmar, a working assumption could be made that the virus is already widespread, and action taken accordingly.
Surround yourself with science: It is vital at this time that political decisions are informed by the best scientific knowledge available. Policymakers must demand the best quality data and advice to inform their decisions. Community assumptions or folkloric/religious ideas about how diseases spread or can be prevented – whilst comforting for some – must be firmly and publicly rejected unless scientific evidence backs them up.
Tell people the truth: At a time of crisis governments have an even more important duty to tell people the truth. Politicians must show their leadership not by patriarchally controlling information deemed too frightening or complicated for lowly ordinary people to understand; but by being honest and by explaining calmly the measures that are being taken, and why.
Monitoring and collaboration, not surveillance and fear: In Myanmar, where the amount of testing being done is negligible, government must rely on community-level information about sickness, hospital admissions and other data if they are to have any idea about what is happening at the local level. The community should be encouraged to support this effort, not by being told to spy on their neighbours, nor threatened with punishment if they share information on the grounds it might cause panic. At this time communities must be caring and look out for one another, not encouraged to be suspicious and blaming.
Re-direct the resources you have got: Policymakers should ask themselves whether there are any government entities with reserves of cash that could be re-directed to support the health system and mitigate economic impacts. Some state-owned enterprises have large bank accounts, for example, and The Ananda has already written about the underspent reserves of the Social Security Board (SSB) – funding that could be released to support laid-off workers.
Use the institutions you have got: We have seen time and again in Myanmar how public policymaking can be paralysed by an obsession with creating endless numbers of new committees. This crisis requires quick action, however, and time cannot be lost to creating committees, discussing who will chair what meeting, which organisation will represent what issues, etc and so on… The executive branch of government has already established the necessary committees and its departments must stand ready to get behind a coordinated effort. Relevant committees should be inclusive and open, inviting media to support dissemination of information, and civil society to help gather local-level data. Now, more than ever before, is the time for the government to abandon its tendency to be secretive.
The role of parliaments
The role of legislatures is particularly vital during a crisis, even if parliament is not sitting. This is because:
As representatives, MPs have a vital role to play in ensuring the situation in their constituencies is reflected in national policy debates. During a crisis MPs are also uniquely placed in their communities as coordinators of public services, and as community leaders.
As overseers of the executive, MPs must be especially vigilant as government takes steps to implement emergency measures or pass new laws. The executive, acting with urgency, may circumvent the usual procedures, and may have strong justification for doing so. However, MPs must keep a close watch to ensure the crisis is not used as an opportunity to permanently further curtail people’s rights, and that any new measures are time-limited and reversible once the crisis is over.
As legislators, MPs have an important role to play in using their knowledge of their community to inform new legislation. Unless MPs are considering how policies will impact on the most vulnerable or marginalised segments of the population, it is unlikely anyone else will.
Considerations for Myanmar’s Hluttaw and MPs
Even though the Hluttaw is in recess now until after Thingyan, MPs must play an important role outside parliament. Based on a briefing prepared by the ParlAmericas group, the following are ten suggestions for MPs.
MPs as community representatives
1. Represent the most vulnerable
MPs play a critical role in bringing the voices of marginalised or vulnerable voices into the heart of policymaking, and they must play this role during a crisis. MPs should take a close interest in how the impacts of this disease are unevenly felt by certain groups and raise these issues both through the Hluttaw and with government at all levels. Groups who are most vulnerable are likely to include:
- Women: for example, the majority of frontline healthcare workers are women, and women are overwhelmingly at greater risk of domestic violence during a period of social isolation
- Non-majority nationalities/ethnicities: for example, many ethnic groups are in areas of few/no health services, and due to existing prejudice and ignorance may be targeted by others looking for someone to blame
- People living in or close to poverty: for example, the very poorest may not have access to information about preventive measures like handwashing, and they may live in overcrowded slums or refugee camps, where the disease is easily spread and there is limited sanitation. Many working poor have lost their jobs due to the economic impacts of the disease and have been thrust into poverty as a result.
- Disability or lack of literacy
2. Act as community leaders
MPs have been chosen at the ballot box as a popular representative, meaning they have significant recognition in their communities as leaders. At a time of crisis, MPs must use this recognition and their leadership skills to bring together community leaders, local government agencies, public service providers, civil society organisations and other institutions to coordinate efforts. This should be done virtually (not using physical meetings) wherever possible.
3. Inform the public
In this trusted leadership role, MPs should join the responsibility for sharing accurate and timely information with their constituents about the current situation and helping them to follow any government guidance. It is important that in this role MPs are discerning about the information they share, always fact-checking sources and avoiding sharing any information that is incorrect, fake or harmful for particular groups.
Oversight of government
MPs, even while the Hluttaw is not meeting, should continue to oversee and scrutinise the government’s response on behalf of their constituents. Questions can be asked of all government agencies responding to the epidemic, and this can be done to local, state/region and Union government bodies, as well as by asking questions within the Hluttaw during future plenary sessions.
4. Ask about the public health response
Questions should include:
- How is the government procuring the necessary medications, supplies, and equipment (including for testing)?
- How is the government protecting health care workers?
- What coordination is there between health authorities at all levels of government?
- How is data being collected on community-level outbreaks of COVID-19, and is disaggregated data being produced (including by gender) on differential impacts, rates of infection, etc?
- How will government monitor and respond to the burden on the health system?
- How will government protect personal data by collecting and sharing only the minimal amount needed to inform prevention and containment measures, and not sharing personal information?
- How will government ensure that vulnerable groups have equitable access to prevention and health care resources, as well as to specialized services when required?
5. Ask about the emergency relief response
Questions should include:
- How will government increase funding to hospitals and the health sector, and ensure that testing and treatment for COVID-19 is available to all free of charge, regardless of insurance or immigration status?
- How will government protect the vulnerable poor who have lost their jobs? E.g. by providing back pay, wage replacement, or layoff protections;
- Has government allowed for payment deferrals or suspensions on loans, rents or utility bills?
- Has government supported the survival of small and medium enterprises? When protecting businesses has government presented logical criteria for accessing support?
- How will government take into account the sudden increase in care work that already disproportionately falls on women, including those previously in paid employment?
- How is government providing support for some of the most vulnerable communities in your constituency, such as:
- Informal workers;
- Those experiencing homelessness, or those at risk of it
- Internally displaced refugees
- Single-parent households
- People living with disabilities
- Marginalised ethnic groups
- Women and children at risk of domestic violence during social isolation
- Non-profit organizations providing vital services to communities
- Frontline health care workers
6. Ask about communication with the public
Questions should include:
- How is government providing timely and accurate information to the public on risks, preventive measures at the community level (such as social distancing and self-isolation for recent travellers), other relevant government measures being implemented, and the availability of public resources?
- When will the government demonstrate leadership and communicate with the public regularly and on the basis of science, and not on the basis of populist leadership? This could be done through the establishment of a Chief Public Health Officer, filled by a qualified public health professional who provides independent reporting on actions adopted and progress made.
- How will the government counter the spread of misinformation, especially misinformation that stigmatises certain groups or proposes ineffective folk remedies as protections against infection?
- How will government ensure, as much as possible, the public’s continued access to the internet, and prevent arbitrary restrictions of access to news outlets at a time when the media role is of critical importance?
7. Ask about anti-corruption measures
Questions should include:
- How will government prevent the diversion or mismanagement of public funds within the health system and other governmental agencies involved in the response?
- How is open and transparent contracting for the procurement of goods and services being managed?
- How are journalists being protected and supported?
- What whistle-blower protections are in place for those who report wrongdoing, price gouging, and other predatory practices?
MPs as lawmakers
8. Preparing to scrutinise COVID-related legislation
On 10th February 2020, a new draft law for the control of communicable diseases was posted to the Pyidaungsu Hluttaw website, to replace a 1995 law. However, with the Hluttaw now in recess and not due to sit again until after Thingyan, it is unknown whether this bill will be passed. It is also not clear whether the new law is entirely necessary, given government is already taking actions under existing laws. Nonetheless, MPs should assume this Bill may come forward and should prepare to give it a thorough reading.
As part of this preparation, Hluttaw Committee chairs could, for example, informally contact the MPs in their committee and related civil society organisations and gather intelligence about how the disease is affecting the sector relevant to their committee. For example, the Women’s Affairs Committee could consider disproportionate impacts of the outbreak on women, or the education committee could help inform the Ministry of Education’s plans to protect teachers and students. Such information can also be fed up to the national coordinating committee on COVID-19 and will greatly assist their work.
Continuity of Hluttaw activity
9. Actions to protect MPs and staff from COVID-19
The Hluttaw will need to implement a range of protections for MPs and staff, similar to those being adopted by all institutions. The box below lists a number of things the Hluttaw should consider. To manage this, a team composed of high-level members of the parliamentary administration could be made responsible for closely monitoring the COVID-19 pandemic to protect the health and safety of employees and mitigate its impact. This team could remain in regular communication with local public health agencies to ensure that it is receiving the most current information and guidance and based on this information, implement corresponding mitigation and adaptation measures.
Possible measures for the Hluttaw **Mitigation** - Restrict all non-essential domestic and international travel by parliamentarians and staff - Suspend public visits to the Hluttaw - Increase frequency of cleaning and disinfecting areas, install hand sanitizer, and take temperature of individuals entering the parliament - When the Hluttaw does return after Thingyan, suspend plenary sessions or limit sittings to sessions that address essential legislation - Allow parliamentarians to work from their constituency office or home - Conduct sittings with only the necessary personnel - Suspend in-person committee meetings, or limit to those focusing on legislation relevant to the health situation - If meeting ensure there is sufficient space (following distancing recommendations from the WHO or local health authorities) between individuals - Suspend non-essential events in Hluttaw buildings, including training sessions, workshops, conferences, public hearings, town halls, etc. - Limit physical work attendance to essential staff, rotate essential staff to limit the overall number of individuals in the building, implement remote working arrangements, permitting flexible hours, and allow staff who are considered vulnerable to COVID-19 because of age or medical conditions to stay home with pay. -Close cafeterias, dining rooms, stores, and gyms **Adaptation** - Use information and communication technologies (ICTs) to facilitate remote work with parliamentarians and staff, such as using video conferencing technologies and providing secure remote access to work files - Organize in-person sessions with only the required number of parliamentarians needed to reach quorum in each chamber, ensuring proportionate cross-party representation, in circumstances where emergency or other essential legislation needs to be passed and virtual voting is not an option. - Conduct virtual committee meetings using video conferencing technologies. - Political parties should remove overbearing intra-party hierarchical systems of authority that might prevent MPs from sharing timely information with their constituents.
10. Hluttaw communication with the public
Parliaments can play a very important role in public communications by:
- Publishing, in a timely manner, any mitigation and adaptation measures adopted by the parliament on the homepage of its website
- Disseminating information online, and through radio, television etc, not forgetting those who may not have access to the internet
- Always providing links to sources of information, and publishing references to official websites where the public can obtain up-to-date information about the situation
(This article is updated on 7 April 2020.)