Contact details: Hung Nguyen-Viet (firstname.lastname@example.org). International Livestock Research Institute, Hanoi - Vietnam.
Vietnam is a large country in South East Asia with over 96 million people and was previously one of the world’s poorest nations. It is now a middle-income country with strong aspirations of becoming an industrialised country by 2020. Agriculture contributes 15% of the Gross Domestic Product (GDP) and the livestock sector, predominantly pigs, contributes 30% of agricultural GDP1. In 2018, the fisheries sector produced 7.74 million tons (3.59 million tons from capture and 4.15 million tons from aquaculture) and the export value of seafood increased by 8.3% to 9 billion United States dollars. Vietnam is facing the challenge of antimicrobial resistance (AMR) because of the overuse of antimicrobials in humans and animals. In response, the government and partners have developed several programs. This brief outlines the current situation of antimicrobial resistance in Vietnam from the perspective of human health, livestock and aquaculture.
Evaluation and planning
In 2010, the Global Antibiotic Resistance Partnership compiled the first comprehensive report on AMR. The report analysed the development of AMR in Vietnam and outlined the way forward for AMR surveillance2. However, the report focused mainly on the human health sector with little discussion on livestock and aquaculture. In 2013, Vietnam developed a 2013–20 national action plan to combat AMR. The action plan addresses raising community awareness, improving the surveillance system, safeguarding access to antimicrobials, encouraging the safe use of antimicrobials in human health and livestock production, and supporting infection control measures3. In 2017, the Ministry of Agriculture and Rural Development launched a 2017–20 national action plan to reduce the risk of AMR through the control of antimicrobial use (AMU) in livestock production and aquaculture4.
In the human health sector, a surveillance network was established in 2013 under the Vietnam Resistance Project funded by the Swedish International Development Cooperation Agency. In 2016, the Ministry of Health established the national surveillance system on antimicrobial resistance which comprises 16 central and provincial hospitals that are enrolled in the United Kingdom National External Quality Assessment Scheme5. In 2017, ten hospitals developed antimicrobial resistance databases.
In the livestock sector, surveillance of antimicrobial resistance in animals is still at a nascent stage. Surveillance in animals and food of animal origin is carried out by the Department of Animal Health under the Ministry of Agriculture and Rural Development. The ministry collates and reviews all the information generated on antimicrobial resistance and antimicrobial use to better understand the epidemiology of antimicrobial resistance and develop policies on antimicrobial use. The department also registers drugs imported for veterinary use, manages data on imports and manufacture of antimicrobials, and leads antimicrobial resistance surveillance. Active antimicrobial resistance surveillance was conducted in healthy pig and poultry populations in five provinces between September 2017 and March 2018; the target pathogens were E. coli and non-typhoidal Salmonella.
In the aquaculture sector, surveillance for antimicrobial resistance in catfish was piloted in 2013–14 in 75 catfish ponds in six big catfish farms. The focus was on antimicrobial resistance in enteric bacteria (E. coli and Salmonellaspp.) and aquatic bacteria (Aeromonas spp. and Vibrio spp.) isolated from pond water, supply water, pond sediment and catfish. More work has been done on Pangasius and shrimp production in the Mekong.
The laboratory network for surveillance is developed in the human health and livestock sectors. In the human health sector, laboratories are mainly in hospitals and hygiene, epidemiology and Pasteur institutes whereas, in the animal health sector, there are seven regional animal health offices and two veterinary and animal hygiene centres. Because of the need for multi-sectoral collaboration in antimicrobial resistance surveillance, the One Health approach has been identified to bring together the human and animal health sectors6. Environmental surveillance is almost absent.
In the human health and livestock sectors, most of the interventions by national and international partners are aligned with the national action plans to combat antimicrobial resistance. Interventions in the agriculture sector include surveillance, implementation of Good Agricultural Practices and strengthening of inter-sectoral collaboration through a One Health approach.
The Government of Vietnam, United Nations agencies and international organisations regularly organise antimicrobial resistance awareness events. The Fleming Fund, the Centers for Disease Control and Prevention (CDC), and the Food and Agriculture Organization of the United Nations (FAO) are amongst key international players supporting antimicrobial resistance surveillance. In addition to research institutions such as the Oxford University Clinical Research Unit, the French Agricultural Research Centre for International Development (CIRAD) and the International Livestock Research Institute (ILRI) and national partners working on animal health. Research interventions are aimed at better understanding people’s behaviour around antimicrobial resistance and antimicrobial use and identifying solutions including alternatives to antimicrobial use.
The drivers of antimicrobial resistance in Vietnam include overuse of antimicrobials and purchase and use of antimicrobials after self-diagnosis (in both humans and animals). In hospitals, antimicrobial resistance arises from overcrowding and inadequate infection control, use of broad-spectrum antibiotics instead of narrow-spectrum drugs and prescribing of expensively branded antibiotics over less expensive first-line generic products2. In agriculture, the use of antimicrobials for livestock growth promotion and disease prevention is common. Therefore, the interventions should involve practical measures that need to be incentive-based to tackle these challenges.
Anchoring and scaling
The national action plans set out the framework for interventions to tackle antimicrobial resistance. Therefore, scaling out of interventions should be done within this framework. The Department of Drug Management in the Ministry of Health and the Department of Animal Health in the Ministry of Agriculture and Rural Development are the key ministerial coordinating bodies for antimicrobial resistance interventions. In addition, the national steering committee on the prevention of antimicrobial resistance, with leadership from the two ministries, is responsible for setting priorities and assigning reference laboratories for antimicrobial resistance surveillance.
While the national action plan and regulations are in place at the central level, these policies need to be channelled to the local district and commune levels through strengthening the capacity of animal health workers and improving public awareness on antimicrobial resistance and rational use of antimicrobials. Practical solutions include improving biosecurity, revising the curricula of veterinary courses and targeting research to inform policymaking. In addition to funding from international sources, activities aimed at tackling antimicrobial resistance should be included in annual government budgets to ensure sustainability of data collection and analysis and interventions7. Additionally, for anchoring it is necessary to construct impact pathways and theories of change and then use this as a tool for testing program assumptions and adapting the program.
For the past decade, Vietnam has promoted a multi-sectoral One Health approach to tackling antimicrobial resistance8. Factors that may influence the implementation of a One Health strategy at national level include governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners6.
- The World Bank. 2017. Available here.
- Global antibiotic resistance partnership (GARP) Vietnam National Working Group. Situation analysis: Antibiotic use and resistance in Vietnam. 2010. Available here.
- Ministry of Health of Vietnam. National action plan on combatting drug resistance 2013-2020. 2013. Available here.
- Ministry of Agriculture and Rural Development of Vietnam. National action plan for antimicrobial use management and antimicrobial resistance prevention in animal husbandry and aquaculture in the period 2017-2020. Available here.
- Fleming Fund. First Fleming Fund Country Grant to Vietnam. Available here.
- Bordier et al. 2018. Antibiotic resistance in Vietnam: moving towards a One Health surveillance system One Health for AMR surveillance in Vietnam. BMC Public Health (2018) 18:1136. Available here.
- Ministry of Agriculture and Rural Development. 2018. One Health knowledge sharing workshop: Addressing antimicrobial resistance through cross-sectoral capacity building. Hanoi, Vietnam, 18–19 June 2018.
- Vietnam One Health Partnership for Zoonoses. Annual One Health Forum 2018. Summary of proceedings.
- Mitchell, M.E.V., Alders, R., Unger, F., Hung Nguyen-Viet, Trang Thi Huyen Le and Toribio, J.-A. 2020. The challenges of investigating antimicrobial resistance in Vietnam – what benefits does a One Health approach offer the animal and human health sectors?