Never Break the Chain

Episode #581: Tin Tin Htar Myint, a medical epidemiologist based in France who has worked in vaccines for more than two decades, describes Myanmar’s immunization collapse as a problem of governance as much as medicine. Before 2021, she argues, the national program had been expanding in concrete ways, adding vaccines that could reduce childhood pneumonia and diarrhea and protect girls from HPV. Then the coup shattered the human infrastructure that makes routine immunization possible. Health workers joined the Civil Disobedience Movement, hid, fled, or were arrested, and the country’s vaccine system became a set of reported numbers that no longer match the conditions on the ground.

Tin Tin points to official coverage figures that appear to rebound after 2021, but says they cannot be reconciled with the reality of airstrikes, displacement, and villages trapped behind checkpoints. In surveys she describes from Sagaing, the most isolated areas show catastrophic “zero dose” rates for children born after the coup—no BCG, no DTP, no MMR—while villages near large cities can still manage partial coverage because access exists and parents take risks to reach it. Some organize ad hoc “vaccination trips,” moving groups of children through military checkpoints to get a shot and return home.

For her, the downstream damage is already visible. She describes signs of vaccine-preventable outbreaks appearing again through social media reports, and she that tuberculosis is resurging rapidly in places with limited detection and no reliable drug supply. The collapse does not stop at vaccines. Tin Tin argues that immunization normally arrives with basic care packages, health education, and family planning, and that when the program breaks, those services break too, driving rising pregnancies, miscarriages, and the reemergence of sexually transmitted infections.

The most painful detail she offers is also the simplest proof of what is missing. “They still carry the vaccine booklet of their children.”