Influenza surveillance in conflict-affected areas of Myanmar

Myanmar’s public health surveillance system for influenza and other respiratory pathogens has been significantly disrupted due to the ongoing humanitarian emergency. Safeguarding public health has required innovative solutions. WHO Country Office in Myanmar, in collaboration with health partners and with support from the Pandemic Influenza Preparedness Framework (PIP) Partnership Contribution (PC), has implemented an Early Warning Alert and Response System (EWARS) as a supplementary surveillance system in conflict-affected areas such as Kachin and Rakhine states. This system plays a vital role in strengthening pandemic preparedness within such a complex setting.

Adapting surveillance to a challenging landscape

Political instability has led to restricted access to health facilities, population displacement – including health-care workers – and a decline in disease reporting. Implemented through EWARS, sentinel surveillance for influenza-like Illness (ILI) and severe acute respiratory infections (SARI) is recognised as a crucial mechanism for enhancing the timely detection of influenza and other respiratory pathogens.  

Respiratory syndromes are among the key health indicators monitored through the indicator-based and event-based components of this supplementary surveillance system. On average, in 2023 and 2024, more than 40 clusters of influenza-like illness were reported across the country through the system. However, no alerts of severe acute respiratory infection outbreaks were detected.

Given the potential for seasonal influenza and other respiratory pathogens to evolve into large outbreaks, and the requirement to report non-seasonal influenza under the International Health Regulations (IHR 2005), the early identification of such events is crucial to inform outbreak response efforts.

Despite restricted operational access and communication challenges, this surveillance approach has proven to be an adaptive and resilient solution in Myanmar’s evolving health crisis. In 2024, it provided real-time alerts and facilitated the mobilisation of response teams to mitigate the impact of outbreaks and epidemics of influenza and other respiratory pathogens. This practice demonstrated how early warning systems can function effectively, showcasing resilience in the face of adversity.

The success of this initiative has been made possible through the contribution of the PIP PC, along with other financial and technical resources. It has strengthened Myanmar’s ILI and SARI surveillance capacity as part of the Global Influenza Surveillance and Response System (GISRS), with the National Influenza Centre (NIC) leading efforts for virus sharing, genomic sequencing, and influenza data management.

EWARS in Myanmar: a model for global health security

This initiative offers valuable lessons for global health security and pandemic preparedness. The success of EWARS for infectious disease surveillance in Myanmar, particularly for influenza and other respiratory pathogens, demonstrates that even in conflict settings, a well-coordinated, multi-source surveillance system can provide a critical safety net for disease detection and response. The approach aligns with WHO’s initiatives such as the PIP Framework, Global Influenza Strategy 2019–2030, the Preparedness and Resilience for Emerging Threats (PRET) initiative, and the Mosaic Respiratory Surveillance Framework  for the surveillance of respiratory viruses of epidemic and pandemic potential.

As the WHO Country Office in Myanmar and partners continue to refine and expand EWARS, this model serves as a proof of concept for global health actors seeking to implement adaptive surveillance strategies in other crisis-affected regions. By bridging surveillance gaps and ensuring early alerts for epidemic and pandemic threats, including influenza and other respiratory pathogens, the initiative contributes to protecting both national and regional health security as envisioned in the South-East Asia Regional Strategic Roadmap for Health Security and Health System Resilience for Emergencies 2023–2027.