People in Myanmar, from healthcare workers to the vulnerable, have rejected vaccinations for covid-19 to refute the military regime that offers them. As a huge wave of covid-19 arrives in Myanmar, the healthcare system has ground to a halt, healthcare workers are on strike, ministry officials have resigned, and laboratories have been closed. The impact on people’s health will be severe. 

The healthcare sector has been at the centre of the people’s response to the coup. Two days after the military coup, workers at 70 hospitals and clinics in 30 towns went on strike. The head of the Expanded Program on Immunization (EPI) team within the Ministry of Health and Sports, along with much of the rest of the ministry, resigned in protest. Many others remain on leave or absent. “We refuse to follow any order from the illegitimate military government that showed no respect for our sick patients,” the medical resistance organizers said in a statement.

In the face of huge protests that will have exacerbated the pandemic’s spread, the military decided to give up on prevention. It officially lifted almost all covid-19 restrictions, re-opening bars and restaurants, opening up internal travel and permitting all but the largest public events (though there remains a curfew to prevent protests, and the mask mandate has been used to punish protestors against whom the military could not find any other crime). As a result of reduced testing, the weekly total number of positive cases identified collapsed: from 2,766 up to 25 Jan 2021 to 50 as of 10 May 2021 (though this has now increased again, despite low testing rates, to 4,047 on Tuesday 13 July 2021).

The one carrot the military have left to generate support is the outstanding vaccine stock, which will be expiring soon (assuming that the vaccines have been adequately stored). Myanmar has been one of the few places in the world where anyone can receive the vaccine if they want it.

But this carrot comes with an inbuilt stick: one must submit to receiving the vaccine from the military. The military is monitoring those who come for vaccines and some recipients are photographed. People fear these images will be shared publicly to show the military’s successful campaign and implicit popularity. 

The military are trying to use the vaccine as a lever to break the unity of the resistance, by offering citizens the possibility of safety in return for compliance. Linking vaccine acceptance to political acceptance—particularly with a regime as distrusted as this one—may have negative consequences for years to come.

So far many healthcare workers are refusing to cooperate: they refuse the vaccines and continue to risk their lives by refusing to work with the military, whose actions they say are the real public health concern. Some people have already received their first dose of the vaccine, but as the effects of the first dose tail off, these healthcare workers (and vulnerable populations) are having to choose whether to enroll for their second dose or to run the risks of contracting covid-19. In a very direct way, through this lack of immunity, healthcare workers will embody the vulnerability that the military has wrought on Myanmar. 

Meanwhile routine vaccinations are also on hold, with 1 million jabs due for infants. The health system is not delivering routine vaccines. In order to get back to even the most essential service provision this regime will have to completely rebuild both the system and trust in it; so far they have shown no capacity or willingness to do so.

When the loss of human life as a result of this military coup is counted, the more than 700 people killed at the hands of the military during the protests will be easily counted. Those who die as a result of covid-19, preventable diseases, and poverty (experts estimate that the share of people living in poverty in Myanmar has doubled in the last year to over 50%) will be less easily numerated and remembered. Yet, their deaths will also be the direct impacts of the military occupation and their deaths may often be the direct result of their refusal to accept this coup.

One year ago, some were concerned that the military would step in to “take control” of the covid-19 response. Today, we are seeing exactly what “taking control” means. Far from making the tough decisions needed to defeat covid-19, the military’s response has demonstrated its willingness (again) to put its own power before all other considerations—including the health of its citizens.

Meanwhile, the Myanmar people and its health workers embody the struggle against this domination. The Tatmadaw has forced Myanmar’s nurses, doctors, and basic health staff to choose between freedom, safety, and health. Through protests, the rejection of militarised vaccinations, and the ongoing civil disobedience movement, they are choosing freedom.

This piece was written by healthcare workers in Myanmar, who wish to remain anonymous to protect their safety.