Economic growth in the GMS is highly vulnerable to outbreaks of emerging diseases, such as severe acute respiratory syndrome, avian influenza, and Middle East respiratory syndrome. Other communicable diseases, including drug-resistant malaria, dengue, and antimicrobial-resistant infections, also have a significant economic impact. Multiple factors play a role in spreading communicable diseases, including an increasingly mobile population, increasing trade, and intensified interaction between people and animals. Particularly at risk are the poor, ethnic groups, and those living in border and remote areas or living along economic corridors. Infections can therefore easily pass beyond borders, and a regional approach is (i) necessary, so at-risk countries can participate and work together to improve their health systems; and (ii) beneficial, since it can result in synergies arising from coordination and lessons learned from regional peers.

In recent years, the ministries of health (MOHs) in GMS countries have made progress in regional information sharing, inter-sectoral dialogue, and cross-border cooperation for communicable disease control (CDC). Cross-border collaboration between neighboring provinces across international borders (which includes joint outbreak investigation, information exchange, and patient referrals) is gaining momentum but needs to be integrated into routine CDC activities.

Health service networks within Cambodia, the Lao PDR, Myanmar, and Viet Nam (CLMV) have expanded rapidly, but marginalized, mobile, and poor people still have limited access to health services. Mobile populations, ethnic minorities, and other vulnerable groups (MEVs) and populations living in remote border areas are more likely to spread infectious diseases and tend to use health services less than the general population. Cross-border migrant workers returning home with HIV or tuberculosis infection have limited access to treatment. Disease control programs for HIV/AIDS, tuberculosis, and malaria are in place but often do not reach these vulnerable groups in border areas due to staff and funding constraints. Consequently, in some countries, up to one-third of tuberculosis cases are not identified, and one-third of diagnosed tuberculosis and HIV/AIDS cases are not properly treated.

The MOHs have implemented surveillance systems for notifiable diseases and syndromic reporting to improve reporting of events and identification of cases from the community level. However, the disease surveillance system needs further digitalization and extension to all health centers, and syndromic reporting needs to be rolled out nationally. Further, MOHs must strengthen data management and analysis. Linkages and integration between disease surveillance, district health management information, and zoonotic disease surveillance needs to be improved. MOHs have to improve their capacities for risk analysis, community preparedness, and disease outbreak response. Outbreak district response teams are often poorly equipped and financed, and need capacity building on outbreak investigation and management.

Governments’ and development partners’ investments have improved laboratory services in provincial hospitals. In contrast, district hospital laboratories are unable to comply with internationally acceptable biosafety standards or to guarantee the accuracy of their laboratory tests. Underlying problems include substandard training of laboratory staff, and insufficient equipment and supplies. Formal processes for internal and external quality assurance are lacking. Laboratory auditing for compliance with quality and safety guidelines does not exist.