The COVID-19 pandemic’s emergency vaccine distribution is shining renewed light on global wealth inequalities. Many countries classified as belonging to the Global South are reliant on COVAX and limited international donations for their supply of COVID-19 vaccines. As a result, many of these countries have vaccine timeline plans that span over the next year or two – a drastic difference from the United States where the general population of adults and adolescents already have access to vaccines.

But for many countries in the Global South, accessing vaccines is only the first step of a slew of hurdles; vaccinating the population poses greater challenges to governments and international aid workers. For Myanmar, specifically, a myriad of conflicts highlights the vaccination challenges that lie ahead for countries with ongoing civil war and ethnic conflict, authoritarianism, and political unrest.

Myanmar had only just begun distributing its first batch of vaccinations on January 27, 2021, prioritizing healthcare workers, when the military staged a coup and took (back) control of the country on February 1, 2021. What followed was a widespread Civil Disobedience Movement, spearheaded by many frontline healthcare workers who went on strike against the military regime and even boycotted their second vaccine doses. The military coup and civil unrest have effectively crippled the country’s already weak healthcare infrastructure. Clinics and offices have closed, and vaccine boycotts have become part of the public’s protest against military dictatorship.  Healthcare workers have boycotted their second vaccine doses out of fear of being forced to return to work as well as in protest of working under a military government. Other citizens refuse to be vaccinated under the current government, arguing that catching COVID-19 would be better than living under military rule.

Vaccine rollouts rely on strong healthcare infrastructures and high levels of trust between government and citizens. In Myanmar, prior decades of oppressive military rule from 1962-2011 limited the development of state services and infrastructures and led to deep distrust between military and population.

But the recent military coup is not the only internal conflict threatening Myanmar’s efforts at distributing vaccines. The government military and numerous ethnic armed groups have been engaged in ongoing civil wars since the country’s independence in 1948. Combined with the more recent genocide against the Rohingya, these ethnonational conflicts have resulted in hundreds of thousands of undocumented and displaced people. It is estimated that over 450,000 people are displaced due to conflict and violence in the country, but this estimate is likely low due to limited access to non-government-controlled areas, difficulties estimating populations who do not enter IDP (internally displaced person) camps, and limited state influence and surveillance within much of the rural highland villages.

Not only do these conflicts complicate efforts to locate and identify people in need of a vaccine, but aid workers – even in the best of times – encounter several obstacles in their efforts to reach mobile and displaced populations in conflict zones. Active combat, landmines, and checkpoints erected by all parties involved make it difficult for humanitarian workers and resources to effectively distribute services in these areas. These efforts have been even further hampered by travel restrictions and limitations to operations brought on by COVID-19 in the country.

Across the world, it is clear that a solution to the pandemic requires vaccinating much of the world’s population. But this will be no small feat. Global wealth inequalities controlling the distribution of vaccines is not the only concern. Accessing populations and distributing vaccines will be a larger concern. Among its Southeast Asian neighbors, Myanmar has suffered from several COVID-19 outbreaks. Vaccinating the population will be vital to controlling the virus. Yet, these efforts face an uphill battle in a country grappling with political unrest, distrust, active conflict, authoritarian governance, and high rates of internal displacement.

Myanmar is not the only country grappling with conflict. Across the Global South, colonialism and subsequent authoritarian governments have resulted in civil wars, protests, forced migrations, and a lack of trust between government and population. As we look towards a post-COVID-19 world, ensuring every country has access to the vaccines is not the only – or even main – dilemma. Distributing and documenting vaccines poses an even greater challenge.