Antibiotics Bill Brieger | 28 Mar 2025
Vietnam: Efforts to Stop Free-Flowing Antibiotics and Resistance
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.
Image, 20 November 2023: Joint press release from World AMR Awareness Week in Hanoi, presenting Vietnam National AMR Strategy 2023-2030 with vision to 2045.
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.
Bird Flu &Epidemic &One Health &Zoonoses Bill Brieger | 22 Mar 2025
Bird Flu in Cambodia is a Global Concern
As part of the work for the Johns Hopkins University course on Social and Behavioral Foundations of Primary Health Care, Daniel Gomez Ramos posted in the class blog about the challenges of Bird Flu as shared below.
The Avian Influenza (H5N1) is increasingly becoming a significant concern in the kingdom of Cambodia with developing news revealing that a recent novel variant has the potential to increase the risk of a new pandemic in which human transmission could occur if no measures are taken to identify individual via screening/testing.
Given the limited quantity and quality of testing instrumentation, viable standard protocols, low personnel for both operating equipment and investigating areas of high incidence in humans and wildlife, and training programs, it is imperative that a standardized approach is created and implemented. A mandate for integrating real time-Polymerase Chain Reaction (RT-PCR) for individuals (i.e. workers who are in contact with livestock such as cattle and poultry) aged 12-65 years of age would be appropriate while focusing on the southern and central regions of Cambodia.
The following organizations and associations would have to be engaged for the policy to have any possibility of being successfully supported:
The World Health Organization (WHO): The Western Pacific regional office would be contacted to have their expertise involved into the policy making by way of utilizing their capability of conducting investigations to prevent community transmission by testing in targeted areas with high incidence rates for H5N1. Additionally, they would draw in their Cambodian partners who work within the ministry of environment, ministry of agriculture, forestry, and fisheries.
Food and Agriculture Organization (FAO): They would be involved by gathering support from the United Nations (UN) to increase resources for testing kits, and recruiting more personnel members to operate the various testing sites that are strategically located. The data collected will further advance their research efforts as well.
Pasteur Network (PN): As an experienced partner in the policy proposal, they will assist in fundraising for all objective points, and they would permit the usage of their name and network to display in blog posts as a support of a cohesive front for H5N1 testing as an approach to reduce exposure and risk.
One World One Health (OWOH): Given their extensive expertise in wildlife intervention throughout the eastern and southern regions of Cambodia, they would be an excellent partner to address wildlife testing for Avian flu as a form of tracking in areas with nearby communities.
World Bank Group (WBG): The branch of Human Development Network would be included in the process. They would provide guidance and direction of in-depth educational programs for both local workers and newly hired individuals. They have a track record of directing Avian Influenza testing sites in multiple types of setting across the globe.
Cambodian Farmer Federation Association of Agricultural Producers (CFAP): It would be paramount to engage in dialogue with this association as they have publicly shown to be uncommitted to any policy of mandatory testing, specifically for small-scale farmers who would experience the brunt of any potential interventions to prevent spread (e.g. culling of poultry). We would monitor their view and when a sufficient amount of support from the aforesaid organizations have been acquired, we can attempt to collaborate with them by presenting a report which is convincing for mandating H5N1 testing.
The goal would also ensure the well-being of the farmers and communities, while simultaneously providing alternative solutions that would not negatively impact the livelihood of the farmers. For Cambodia to successfully address the Avian Influenza situation and reduce the risk of a pandemic for the long-term trajectory, the following must be actualized:
- The Kingdom of Cambodia willingness to allocate a certain amount of funding to initiate and maintain a robust and dynamic testing program.
- The WHO and WBG to invest into programmatic development and maintenance via both in-person and remotely.
- The FAO and PN for the inclusion of their broad and supportive network that will address the logistics of the entire process.
- CFAP must be persuaded of the vitality of the testing program and ensured that protection will be provided for the farmers.