Antibiotic resistance in Vietnam: moving towards a One Health surveillance system

Abstract

Background: The international community strongly advocates the implementation of multi-sectoral surveillance policies for an effective approach to antibiotic resistance, in line with the One Health concept. To comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may question the ability and willingness of surveillance stakeholders to implement the collaborations required. To assess the feasibility of operationalising this strategy within the national context, we explored the role of key stakeholders in the strategy, as well as their abilities to comply with it.

Methods: We conducted a qualitative approach based on an iterative stakeholder mapping and analysis, in three distinct steps: (1) a description of the structure of the national surveillance strategy (literature review, key informant interviews); (2) an analysis of the key stakeholders' positions regarding the strategy (semi-structured interviews); (3) the identification of factors influencing the operationalisation of the collaborative surveillance strategy (comparison of data collected at the first and second steps).

Results: The mapping of the surveillance system, as well as the characterisation of key stakeholders according to organisational and functional attributes, underlined that inter-sectoral surveillance initiatives do exist, but that the organisation of the national surveillance system remains highly silo-oriented. Based on stakeholder perspectives, we identified seven factors that may influence the implementation of the One Health strategy at national level: governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners.

Conclusions: The study suggests that the operationalisation of the collaborative surveillance strategy requires the full adhesion of stakeholders and the provision of appropriate resources. Based on these findings, we have proposed a guidance framework together with recommendations to move towards a more suitable governance and operational model for One Health surveillance of antibiotic resistance in Vietnam. To lever and promote successful inter-sectoral collaboration, a participatory "learning by doing" process could be applied to guide, frame and mentor stakeholders through the identification of appropriate levels of collaboration, depending on the expected positive impacts on the value of surveillance.

Keywords: Antibiotic resistance; One health; Stakeholder analysis; Surveillance.

Fig. 1

Organisational and functional mapping of the main stakeholders of the ABR surveillance strategy in Vietnam. Surveillance in food-producing animals = Department of Animal Health: management of the surveillance of ABR and ABU in food-producing animals; National center for veterinary hygiene 1: leading laboratory and central unit for ABR, sampling, laboratory testing; Regional animal health office: sampling, laboratory testing; National institute of veterinary research: technical and scientific advice; Provincial veterinary services: collecting data on antibiotic sales and monitoring usage at farm level; Animal pharmaceutical companies, feed mills and drug sellers: reporting sale data; Customs: reporting data on antibiotic importation. Surveillance in humans = Medical services department: management of the surveillance of ABR and ABU in hospitals, central unit for ABR and ABU in hospitals; Hospitals: laboratory testing and reporting data about ABR and ABU; Preventive medicine department: management of the surveillance of ABR and ABU in community; National Institute of hygiene and epidemiology: laboratory testings and central unit (national reference laboratory) for ABR in community. Surveillance in food of animal origin = National institute of nutrition: management and central unit for ABR surveillance, sampling, laboratory testing

Fig. 2

A guidance framework to support the operationalisation of One Health surveillance of ABR in Vietnam