Vietnam's national action plan on AMR: Who's involved and is it working?
Rogier and Heiman are clinical microbiologists and senior scientists at the Oxford University Clinical Research Unit (OUCRU) in Hanoi. They are dedicated to creating interventions that prevent drug resistant infections or improve the outcomes of patients already infected.
Vietnam is a country of over 90 million people in Southeast Asia. Antibiotic overuse and resistance are significant problems here. Antimicrobial resistance (AMR) is not a threat anymore, but a reality with clear and apparent consequences for patient management.
Antibiotic sales without prescription in private pharmacies constitute a large proportion – 80% – of total human antibiotic use in Vietnam. Vietnam has 60,000 private pharmacies, found on many street corners in urban and rural areas, which depend on antibiotic sales for about 25% of their total revenue. Antibiotics are sold for uncomplicated complaints such as a cough, runny nose or sore throat without fever.
In primary health care centres and outpatient clinics, antibiotics are prescribed for similar complaints. In hospitals, and particularly intensive care units (ICU), antibiotic stewardship programmes are often absent. As a result, antibiotic use is high (270 DDD/100 bed days) and empiric therapy with broad spectrum antibiotics is used without proper feedback from microbiology labs. Poor infection control leads to high rates of hospital-acquired infection (5% overall, 30% in ICUs).
After a situation analysis by the Global Antibiotic Resistance Partnership and conducted by a working group led by the National Hospital for Tropical Diseases (NHTD) and Oxford University Clinical Research Unit (OUCRU) with representatives from the Ministry of Health (Moh), a National Action Plan to combat AMR was designed, with support from WHO. The Action Plan was presented in 2013, 4 years before the international 2017 deadline set by WHO.
Vietnam’s National Action Plan to combat AMR
The Vietnamese National Action Plan outlines 6 objectives, which are similar to the 5 objectives in WHO’s Global Action Plan:
- to raise awareness of community and health workers on drug resistance
- to strengthen and improve national surveillance systems on the use of antibiotics and drug resistance
- to ensure adequate supply of quality medicines to meet the needs of people
- to promote proper safe use of drugs
- to promote infection control
- to promote proper safe antibiotic use in livestock, poultry, aquaculture and cultivation.
The plan describes the planned activities for each objective and a phased time and schedule for implementation. It also has specific objectives in these areas:
- policy and management
- information, education and communication
- technical expertise and training
- scientific research and international collaboration
Finally, it includes implementation of a steering committee chaired by MoH, and assigns responsibilities to 12 agencies within the Ministry of Health and to the Ministry of Agriculture and Rural Development.
Current progress on action plan implementation
In reality, the implementation of the action plan is limited. Recent activities include communication events in 2014 and 2015, including MoH guidance on antibiotic use in 2015. Current priority areas in AMR are to:
- raise awareness
- establish an AMR surveillance systems
- strengthen capacity of health system
There are several research projects ongoing involving NHTD, the National Institute of Hygiene and Epidemiology (NIHE), Hanoi Medical University, OUCRU, and French and Swedish groups. WHO, US CDC and OUCRU are working closely together with MoH to support the establishment of a national surveillance system, based on the existing Vietnam Resistance Project. In addition, OUCRU and NHTD have obtained funding from the Fleming Fund to establish a coordinating laboratory capacity for AMR. Furthermore, OUCRU with MoH and NHTD are working on establishing an appropriate governance structure for coordinating AMR activities, supported by the Newton Fund.
Lack of funding, expertise and human resources are major hurdles for implementation of the ambitious national action plan which will require commitment and investment from international development partners, collaborators and the Vietnamese government.