 Thanks to the media for joining us for this session. We've passed out this four-page document. If you need additional copies, there are additional hard copies, and they're available online as well. I'm Steve Morrison. I'm the Senior Vice President here at CSIS. What we're going to be reporting on here in the course of this event is a conference that really began on Sunday evening with a dinner and then involved a full day of consultations yesterday and then a concluding meeting today of a very diverse group of Myanmar constituencies that came to Washington to gather to talk about malaria elimination as a shared goal. This is unprecedented. This has required an enormous amount of effort by three organizations. CSIS is one of three partners in putting this together. The second partner is the American Society of Tropical Medicine and Hygiene, which is a leading professional body in the United States. Fully a third of its constituent members are malaria experts. And its president this year is Dr. Chris Plow, who is with us today and who will introduce our Myanmar speakers in a moment. The second organization that is partnering with us is the University of Maryland School of Medicine. It's newly founded Institute for Global Health. Dr. Chris Plow is there and Mian Mian Nguyen here with us is also based there. And the three of us, along with Karen Gorileski, the Executive Director of ASTMH, have worked very assiduously over many months in pulling this together and combining the assets of University of Maryland ASTMH and CSIS. But the real story here is to hear from the representative sampling of the Myanmar participants who've come together here for this very unusual gathering. And we've tried to capture in the statement that we've shared with you in a page and a half the major points of consensus, the major findings that emerged from this session. And so those are there and our speakers, who Chris will introduce momentarily, we've asked four of them to come and be here. We've asked the Deputy Minister of Health to kick things off with a few remarks around the process and then we'll open for questions from the media for those speakers. So Chris, would you like to come forward and please introduce our speakers? Thank you. Good morning. So we'll have four participants from the meeting come up and as I just introduced you, sort of come up and take a seat that will help the reporters in the room know who you are so they can direct their questions. So we have actually three ministries from Myanmar who have been here at the meeting from the Ministry of Health, Ministry of Defense, and the Ministry of Foreign Affairs. But we'll ask Dr. Thinthin Tay, the Deputy Minister of Health to join the panel, please. So she'll lead off with a few remarks in just a moment. The second speaker is Dr. Thinmyo Nguyen, who is the Chairperson of the National Health Committee for the Main Opposition Party, the National League for Democracy. So please come on up. We will also have here to field questions, Ekelu Shui-U, who is the Director of the Karen Department of Health and Welfare, along the eastern side of Myanmar. And then our fourth panelist is Brigadier General Tinmal Lang from the Myanmar Director of Defense Medical Services, where he is the Director of the Defense Services Medical Research Center in Myanmar. So please welcome Dr. Thinthin Tay, if you would please lead off with your remarks. Good morning. And thank you very much. That's on behalf of the Myanmar Delegations, we have 14 in number. And then I would like to express my gratitude to the CSIS and the University of Maryland School of Medicine Institute for Global Health and ASTM-H, and then Steve, Chris, and Miai for organizing this event. That we have a one and a half day. Actually, we started, as Steve mentioned, we started discussion from the Sunday evening. And then now that we have come to a very important sort of agreement that we have consensus, we have made among ourselves. And given that Myanmar is in its very important moment of its transition towards the developed nation, and then now the health, we put it health as a very integral part of the development of the whole population, and then development of the other sectors like socioeconomic and then all-round development. So Myanmar, we have a national health system, and then again now it has come to a time like we will have come up with a very integrated comprehensive sort of a health initiative. Especially this conference is we have a streamline towards the elimination of malaria in Myanmar. And then thank you for all your kind presence with us today. And then so myself and then the other, the dignified colleagues that we are happy to join with you here. Thank you. So I think we can simply open up for questions from the room. Please go ahead. Yeah. Okay. Thank you very much as you have pointed out that very important issue. And that is the sole reason why we all are here and how to combat that malaria and then leading towards elimination. Then of course malaria is endemic in Myanmar traditionally. And over the years we have bring down the very high morbidity and mortality. I'm not going back to the many decades ago, but within these five years, for example, like in 2013 we have malaria morbidity. The case load is around 300, over 300,000 patients with some in some hundreds of the mortality. And then it has been brought down in 2014, become 200,000, 500 patients and plus a 92 mortality. So that is a malaria itself. It's on the decreasing trend, but looking at the border areas, like because Myanmar is a country sharing the very long, common, porous border with other five countries. And then the malaria resistant strain that K-13 propeller has been identified in Thailand, in Cambodia, and then it has also identified in some border areas, bordering to those countries. But our concern and also not only at the national level, the regional level concern is we have a high malaria burden. Although mortality number is getting small, but we still have high morbidity, the high number of cases. And then so we really need to contain that resistance strain, not come into Myanmar. And then so that is the malaria, anti-drug resistant malaria containment program has been initiated since the over the years. But we really need to make it sure it is the drug resistant malaria strain cannot be spread deeply into Myanmar. So that's why now we are on the ongoing process with having some research and then scientific studies that do have come up and do identify how serious the spread of the malaria resistant strain in Myanmar. The studies are still ongoing, but the almost confirmed situation in the bordering Thailand and then Cambodia, it is a, we have a collaboration among the greater Mekong subregions that the CLMV plus Thailand. So we have a regional initiative have taken already also. A bit response to your question. Sorry. I just wonder Brigadier General Tin Malang, if you would like to mention how the military is mapping drug resistance using some new tools. You showed a slide of some recent results yesterday. My name is Brigadier General Tim Malang and I'm the director of the Defense Services Medical Research Center under the Director of Medical Services. My department is responsible for the research and developments for the entire military and for the healthcare system, healthcare services as well as laboratories and all the functions related to the research. Since the malaria problem is very closely connected to the soldier's nature and we give priority to the malaria control and prevention. Looking at the malaria situation in military, in 2003 there were 40,000 cases hospitalized in all the military hospitals. In the same year we adopted the ACT, which is the Ministry of Health guidelines. And since 2006, we have a very low number of mortality. And in 2014 there were only 3,000 malaria cases. In 2003 there were 270 malaria deaths and in 2014 there were only four deaths. Apparently malaria is no longer a problem in the military situation, but we found out that since 2006-2007 there was a decreasing effectiveness of auto-medicine derivatives. And then we kept on researching the malaria parasite, which is the plasmodon falciparum. And my department is equipped with the genome sequencing instrument. And this year, using this machine we could identify the chromosome 13 propeller mutation. The same thing happened to be found in Cambodia, which is the area from northeast, west, northwest. But we still need to confirm because despite the appearance of the mutated plasmodon falciparum we don't have any problem with the therapeutic regimens and the mortality and morbidity. The meaning that we all need to go on to find out that which caused the resistance and what would be the best way to contain the spread of the auto-medicine resistance gene. Thank you. And I think Ekeleushweyu would maybe say a few words about what the KDHW is doing on auto-medicine resistance in eastern Myanmar. My name is Ekeleushweyu. I am the director of the current departments of Helen Warrior from Burma. We live in the current state, especially along the Thai Burma border. And according to the political and conflict, a lot of people become the internally displaced people. And as the internally displaced people, they are poor, they are at the mountain area in the jungle, so they face with a lot of the malaria problem. When we look the biggest problems, the health status of the IDP, internally displaced people, we see that the communicable disease is the biggest problem for us. In that communicable disease, malaria is the biggest one. As I said, because of the political and conflict, the government health services cannot reach, become like hard to reach area to our area, so that as we live in the internally displaced people area, we have to find the way to solve the malaria problem as the biggest one. If we look to the malaria, we see that the incidence, the prevalence, the prevalence of the malaria rate is the average 11%. We found that since 2003. So from that, we start to provide malaria control program from 2013. And we start with only 1,500 people. And finally, we can increase to more than 100,000 people for malaria area, control area, like that. And now in this 2014, we start to study a pilot research of the malaria elimination, that is since 2013-14 like that. So now we are as the ongoing malaria study elimination pilot area in our current state, especially along the border. Yeah. What's the timeline for eradication of malaria in Myanmar, if any? And what is going to be U.S. contribution? Is it funding or providing technical assistance? What kind of assistance U.S. is providing to us that? Thank you. Thank you for your question. Yeah, the timeline is that tentatively we have agreed upon the, actually the national malaria program together with our development partners is like now we are moving from the existing malaria control program towards the malaria elimination. And then now the, because we need to go in the face by face, like now control from the pre-elimination, we need some requisite sort of a condition and then the upgrading to the elimination. So by starting from 2014 last year, we started the formulating the elimination plan and then the plan is consolidated in 2015 and then from 2016 through 2018, we are going to start it out in the regions as a pre-elimination phase. By 2020, we are aiming to have, the pre-elimination phase regions will move into the elimination phase and again that we are going to expand our reaching to the other parts of the country. And by 2025, and then so we aim to have the malaria elimination and we have some common goal of the universal, we have the Vision 2030 National Comprehensive Development Plan in which the National Health Plan has been formulated. Again, Universal Health Coverage also targeted reaching to be reached by 2030 and also malaria elimination, not eradication, elimination also by 2030, we aim to have the, to cover the whole country. Regarding the funding. Okay, the funding is the, in this kind of a combination. Yeah, a combination, for example, we have three MDG, you know, the seven EU countries and USAID and the US contribution. It's also the part of the huge funding and the President Malaria Initiative and also we have some funding. I can provide you some exact numbers later. Yeah, and some other funding, Bill and Melinda Gates also. Yeah, we have a variety of the US support and then so from this conference because we are very ambitious and then by this is a necessity to realize our target successful by 2030 and also that we do believe we will have very systematic, efficient utilization of the existing funding and also more domestic as well as international contribution will come over the years in future. Maybe I can just amplify that one of the main points that came up in yesterday's discussion was that malaria elimination is and must continue to be very much a country-owned, country-led process and by country we agree that we meant the entire country not simply one ministry or one institution and so the role of the US is very much in supplementing the financial support from the government through PMI, through Global Fund as well as helping with technical support and training, some of which has been done in this country but the vast majority in Myanmar. Yes, Dr. Mia is from PMI as well as Bernard Nalen from PMI in the room. Go ahead. Thanks. What would you say is the single largest obstacle to achieving universal access to malaria treatments? Is it sort of resources at the national ministerial level? Is it issues of infrastructure and access to rural places? Or is it concerns about conflict in some places that makes it difficult to reach vulnerable populations? If you had to name one thing, what is the largest challenge in terms of distributing malaria treatments to everyone who needs them? You just might identifying yourself. Yeah, sorry, Michael Aigo with DevEx. Okay, thank you again. Whenever we were asked about our challenges or priority that we have, if we have to find out one, it will be a 1A, B and 1C or something like that because given the very diverse geographical sharing and then the geography itself, it's a challenge to us. Now at the same time, because previously it is a control program, it has been implemented for decades already with have come up with the very success even achieve the MDG goals, but the resistance ring has come up and then so we are now the in sort of, we considered our effort and to make it very taking action to combat and to contain. At that point of time, the existing capacity of the existing, the service provider, not only in the ministry, among all other stakeholders, it becomes a challenge. And also, of course, resources. Because the malaria elimination is much different from the control program. In terms of control, it's very well, but to eliminate, we intend to have a very ambitious sort of, you know, the zero transmission and so on and so forth. And then of course, for the next 15 years, we need a lot of resource, yeah, resource problem. And so, and again, now given the, you know, the showing the evidence of now we are working in a very sort of a multidisciplinary approach because to have a success for the malaria elimination is that we need to ensure the inclusive sort of the contribution by all stakeholders, it becomes a necessity. Yes. Matthew Pennington from AP. Can I ask how big an obstacle is ongoing conflict in the border regions to combating malaria? I mean, are you able to provide malaria medications where they're still fighting going on? At the conflict area before 2012, we can find, we can purchase the malaria medicine from Thailand side. That is especially for our area, Luka area, because the current state, especially along Thai Burma border. But after 2012, we get communication with the Ministry of Health and some of our stakeholders, our partners, we start to receive malaria medicine from the Ministry of Health supported. Our challenge for the malaria medicine is just for the transportation because of mountainy and the forest. We carry the medicine in the backpack with people. We cannot transport with car and other only people carry with the backpack. So the medicine come from the city to the border and go to the village like that. I might just add that one of the other partners in the room yesterday who's not here this morning is from the Chinese Centers for Disease Control and Prevention, the China CDC. And that's another example of what we were doing yesterday in this meeting of agreeing to work together for the common effort of eliminating malaria. China CDC works both with Myanmar Ministry of Health but also with some of the independence organizations in some of the conflict and post-conflict areas. So that's that kind of deciding that we're going to work together whatever else is happening in terms of conflict and politics that we're trying to accomplish here. No, we always try to find a way if we cannot reach any conflict area and then who can reach that area or which organizations will be accepted by the local area and then we walk through in that nature and I do believe because like Chris mentioned we already have started collaborating with the China CDC and also we walk through the international NGO who has very good communication in all those conflict areas for example like HPA and CPI in Kachin State and then in Shan State, and then in Watt Region and then so the national program is collaborating with all those organizations to make it happen to ensure they have access by the ITP people in the conflict areas. In fact, professionally I'm a surgeon but I have to lead the National Health Committee of the main opposition party, NLD who is going to contest in the coming election in 8th November. I present here just to have this so-called political commitment that whatever the problems and whatever the challenges we'll work together with the government and here we have some of the members of the parliament and also from the ethnic health organizations representatives. So in fact we are always watching and want to help about the so-called the problems in dealing with the projects like malaria elimination. So I think when I have a opportunity to talk about this I'll go more in detail but for the present I think I'm quite satisfied with the answers of the Your Excellency, Prime Minister, Brigadier General and my colleague from the ethnic organizations. Thank you. Thank you Michael Ago again. Can you talk about civil society? Are civil society organizations playing a role in sort of bridging these divides between different constituencies and different parties? Is there enough civil society capacity in the country to play a significant role in this malaria issue? Thanks. Who would like to take that? Go ahead. Yeah, of course as I earlier mentioned in my statement like the all-inclusiveness it's a government policy and also it is a necessity to make things happen and successful and the same thing in the malaria elimination and also for the other health initiatives and then outcome. And then we just finished our Myanmar Health Forum last week. We have very good the theme of the forum is the investing in health and then you know the through focusing on the People's Center for Alarm and then the whole forum is before the forum we have 300 people from the various CSOs have a three days workshop and then they have come up with some visors and then although we have the some of the CSOs consent in the various health initiative you know the we always trying to extend and expand their inclusiveness. Yeah, not only CSO and then all the organization CBO, UN, INUs, local NGOs and then even the community people should be part of our health initiative especially for the malaria elimination it is really important because we need to meet although we can ensure for the availability of the services but the acceptability and the readiness for the health and the seeking behavior of the community is also very important that we need to meet in the middle between the two ends so this is we always try to include everyone in the country they have a role to play. Would anyone like to add to that? I think regarding this CSO role now we notice that we are in the condition where we have to depend also on the some of the implementation of the CSO in our country compared to the previous years so we really appreciate about the CSO especially working in the some conflict areas like as you mentioned Rakhine state and Kachin states so sometimes as opposition party if you want to work seriously we have to start talking with the authorities and also with the CSO who are working there and it is very helpful especially for the opposition party Thank you What do you all think was the biggest hurdle that you overcame this week during your discussions? The biggest hurdle that we overcame this week during our discussion I think there are two parts one is the technical and one another is the policy and the principle what I understand is the gain what you gain during the discussions you mean that? What are the questions? Of course because I think it is the first term where we have this opportunity to discuss among the diverse groups like even from the three ministries like Ministry of Health Ministry of Defence and Ministry of Foreign Affairs and also from the three various ethnic groups member of the parliament and the main opposition party myself So here I want to show and want to develop a model or the practice called the dialogue which we have to admit that this type of the culture where we used to solve the problems by dialogue and frequent meetings where we can gain more trust and confidence and we share the experience information, knowledge and especially in a condition like a country where there are so many conflict areas so but we are going for the so called the malaria elimination program but still we have to solve with the other factors because we have to admit that the political weather umbrella is very important in our country like us so if we can bring in one table talking or discussing with so many diverse groups like I already mentioned then we can go on, we can forward with how we are going to implement in our country in the very near future So even this morning we noted that whoever went in the coming election this group so called the malaria elimination program or even if we can form a committee we will go on because there will be still this disease in our country which is very threatened because from opposition party our policy was drawn and then for the communicable diseases we mainly for the malaria, tuberculosis and HIV which really threatens our country still So I think by bringing all these diverse groups here facing each other discussing, debating and we have a very optimistic view that we can overcome all these challenges and regain our objectives Thank you Would anyone like to add to what was most difficult? For me it's not difficult I would like to echo what my brother said I used to tell my colleagues from the various organization and my colleagues within ministry is that whenever we have a problem and then bring it to the table and then sit together get a dialogue and get a consensus and then move forward that is our motto and then so it's not a very big problem as long as we can have shared our thoughts and then align our vision align our intervention leverage the resources and share the credit most importantly I'm very positive David Cohn from the University of Maryland School of Medicine Where would you like this dialogue to be in five years? Where would you like the dialogue to be in five years? Where? In a few minutes ago we have that discussion and then starting from the early morning this morning and then so what will be the next step after the conference that is most important and a practical point and so we have come up with the draft idea but it is a usual practice is to form a sharing committee as soon as we go back and then under which the real practical group is a working group and then even a working group will cover all the sort of various representative from the various constituency and then we even thinking and discussing about having an extended working group and then because the working group will need to meet very frequently and the extended working group will cover some representative from the the organizations from neighboring countries even so that is a very first step and I think it is very a practical point that we can make it happen very soon. Yep, who's got the microphone? Alright, thanks. Is there any group that was not part of this conversation that will need to be sort of part of this effort or part of future conversations if these malaria elimination goals are going to be achieved is there any constituency or group of people that you will seek out after this to try to bring them on board as well? Of course because since the conference is taking place in the US this is a very small representation for the whole country and of course even this morning that we try to include in this statement that you have in your hand is we come up with the broad participation we wanted to see the broader participation and then the whole idea is based upon the all inclusiveness. I might just add that the World Health Organization wasn't physically here and was sent to communication and were very much involved with the planning likewise the Global Fund was unable to attend at the very last minute but were very much involved on the partners side and then there were efforts made to get more than just three of the many ethnic groups represented there is a coalition of the ethnic health organizations that was represented here but obviously going forward all these groups will be very important to be included. We discussed this issue this morning and then we have our three colleagues ethnic health organizations but still we need to invite more in fact particularly speaking we have more than 100 different ethnic groups but still some of the major groups and three are here sitting, discussing so we need to have this more participate and to invite more ethnic major groups because so-called the title of so-called the military elimination we have to work in these areas but at the same time we have to go parallel with the somewhat like a ceasefire political dialogue which really push forward for our country so we strongly believe that if we can start this type of the model all inclusive and inviting all the stakeholders of our country and then we strongly believe that we can go forward at the same time we also need some of the international organizations I mean the expert opinion laboratory service, the technologies and then even including the funding is also important so but anyhow we are quite optimistic about this meeting and then I think the next time I hope the meeting will be probably in our country where we can provide more participants more organizations and since this is the stage of the so-called the reform where the election is drawing near the stakeholders the government, the parliament the military, the apnex political parties we agree about this elimination of malaria program thank you and I would just add that we as we mentioned we have had three ministries here health, defense and foreign affairs and part of the discussion was how important it is to ministries of finance, ministry of planning other very key ministries in having a national malaria plan so I think we'll take one or two more questions if there are still any more questions then we better let people catch their flights home any additional questions okay, Steve any closing