SM-VN-2015-02

Project Description

Next to high dynamics of populations and of health systems, rapidly spreading diseases, the dual burden of infectious and chronic diseases as well as the health of ecosystems impacting on human health – increasing resistance to antibiotics emerged as a major global health problem. Global health problems need national and local solutions.

Antimicrobial resistance (AMR) is a major public health challenge of the 21st century. It results in a large burden of human illness and death as well as higher health care costs. In addition, the use of antimicrobials in livestock and aquaculture for growth promotion, disease prevention and treatment also lead to the AMRs. This dual problem of AMR in the human and animal sector threatens particularly developing countries where antimicrobial are not strongly regulated.

In developing countries, information on the use of drugs in animal agriculture and human medicine is hardly available. In Vietnam, antimicrobial use in both human and agriculture (livestock and aquaculture) is not properly managed. Indeed, with its large population, high burden of infectious disease, intensified livestock and aquaculture systems (also for export), and the access to drugs is virtually unrestricted. Therefore, Vietnam presents an excellent case study regarding the difficulties that emerging economies face in controlling antimicrobial resistance.

A major link of human and animal sector derived antimicrobial resistances are waste waters, sludge and waste. These are thought to be hotspots of new resistance emergence. An integrated approach bringing human and animal health sectors to work together in the framework of a One Health approach is needed for research and intervention of antimicrobial resistance. Swiss TPH has provided underlying theory and largely validated the use of a One Health framework for human and animal diseases control, particularly for zoonotic diseases in Africa and Asia, but also for antimicrobial resistance in Switzerland. Swiss TPH has assisted the Hanoi School of Public Health in research and training on One Health and ecosystem health, who then has applied it for environmental sanitation, food safety and health. Human and livestock waste management was addressed in the past with projects on ‘Productive sanitation and health’ and ‘User-driven sanitation’ of a tripartite partnership
EAWAG/Sandec – HSPH and Swiss TPH. The Hanoi School of Public Health with its research centre of excellence, the ‘Center for Public Health and Ecosystem Research’, has broad experience in human and livestock water and waste management. We want to extend this rich expertise to an innovative research program on AMR in Vietnam.

A new proposal for a research program within a Swiss-Vietnamese partnership will tackle the understanding of the drivers of resistance emergence, persistence, and spread in human/animal carriers and infections. The data will be used to predict resistance emergence (including hot spots for emergence to direct where interventions will be most effective) and how intervention strategies may impact spread.

We have formulated the following two objectives of this seed money project:
– To develop a competitive grant proposal on antimicrobial resistance in Vietnam by association of relevant actors from research, governmental agencies and authorities
– To renew and strengthen research collaboration between Swiss TPH and HSPH by extending the One Health approach to mitigating the rapid development and spread of antimicrobial resistance in Vietnam.


Dr. Esther Schelling
Dr. Hung Nguyen-Viet