Tropical Health Matters

As part of the work for the Johns Hopkins University course on Social and Behavioral Foundations of Primary Health Care, Jenny Truong posted in the class blog about the challenges of Antibiotic Resistance as shared below. Unregulated sale of antibiotics over-the-counter (OTC): In some areas of Vietnam, nearly 91% of antibiotics are sold without a medical prescription. A prescription is required by a 2005 pharmacy law, updated in 2016 and 2024, but in practice, there is little legal enforcement. The 2024 amendment expands health insurance coverage and prohibits operating without a Pharmacy practice certificate but does not specifically address OTC sales, retaining the same fine for selling antibiotics without prescription. Expanded insurance alone won’t stop unregulated sales: 48.6% of study participants said they would still buy antibiotics without prescription even when told they were breaking the law.

We ask that the Ministry of Health and Ministry of Industry and Trade raise the fine on drug sellers from 25 USD to at least 50 USD to curb unlawful sale. There should be consequences as heavy as shutting down the business after multiple infractions. With strong penalties for operating outside of “Good Distribution Practice (GDP) requirements,” there may be a chance to slow the spread of antibiotic resistance (AR). Only when the unregulated drug supply is gone will consumers be pushed to actually use their expanded insurance to see doctors and buy antibiotics with prescription.

Three key stakeholders support regulation. The World Health Organization (WHO) recognizes the irrational use of antibiotics in Vietnam. We must involve them in planning and advocating for funding to support efforts to educate and enforce fines on unlawful sellers. The Food and Agriculture Organization (FAO) supports Vietnam’s National AMR (antimicrobial resistance) Strategy to address antibiotic resistance. We must also involve them in planning efforts and align all sectors for comprehensive education. Corporations may support antibiotic stewardship efforts, like GlaskoSmithKline (GSK). We can collaborate with them to ensure they don’t distribute antibiotics to unlicensed sellers.

Two groups are not supportive. Corporations like Hau Giang Pharmaceutical may benefit from unlawful sale and may try to prevent lost revenue. We must defend our position and prevent efforts to blockade our enforcement.Local pharmacies like Pharmacity continue to break the law and sell antibiotics to those who have no prescription. We must defend our position and notify them that there will be increased penalties for breaking the law. Local unions like Giao Tien Women’s Union and Farmers’ Union have varying stances yet can sway local opinions. We can convince them not to misuse antibiotics and to buy only with prescriptions. Then we can collaborate with them to educate their communities.  

Abigail Arthur has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care. Antibiotics are designed after years of research to determine which specific organisms they target, and at which doses they are effective. Hence, they must be used with strict adherence to prescription instructions to ensure maximum effectiveness. Unfortunately, there is a trend here in Lagos showing the gross misuse of antibiotics. Adapted from https://www.downtoearth.org.in/news/health/antibiotic-resistance-nigeria-stares-at-a-major-catastrophe-68915 The factors driving this phenomenon range from the misconceptions and practices of individuals and their contacts to factors associated with the communities and institutions within, same as well as the policies governing both. In Lagos, much of the misuse is fostered by extremely easy access to antibiotic medications aided by poorly implemented drug regulation policies. For instance, in 2005, there were 100 times more basic drug stores (patent and proprietary medicine vendors) than licensed pharmacy shops in Nigeria. ? While the operators of these basic drug stores have very little to no pharmaceutical knowledge, they are the first point of call for medications in the community.

The effect?

The next time you use the red and black tablet(ampicillin) for a skin infection, or an upper respiratory tract infection, it may not work due to the resistance built by microbes to these abused antimicrobials. ? Antimicrobial resistance (AMR) leads make treatments dear as newer generation (and pricier!) medication is then needed. Unfortunately, AMR can also lead to fatalities.

The way forward:

Antimicrobial Stewardship Programs (AMS) instituted by the Ministry of Health was implemented across only 6 health facilities in Lagos state in 2021. ? Our focus of advocacy is to encourage policy makers to consider antimicrobial resistance as an upcoming emergency following the progressive misuse of antimicrobials in the country. We call for proper control on the sale and advertisement of antimicrobials, an improvement in the patient to prescriber ratio and a strengthening of the Antimicrobial Stewardship Program already in place.