Center for Disease Dynamics, Economics & Policy

The global problem of antimicrobial resistance is particularly pressing in developing countries, where the infectious disease burden is high and cost constrains the replacement of older antibiotics with newer, more expensive ones. Gastrointestinal, respiratory, sexually transmitted, and nosocomial infections are leading causes of disease and death in the developing world, and management of all these conditions has been critically compromised by the appearance and rapid spread of resistance.

There is little doubt that  the more exposure bacteria have to any antibiotic—the greater the “drug pressure”—the more likely it is that resistant strains will arise and spread. Antibiotic drug pressure is the single most important factor promoting development of drug resistance in bacteria. However, reasons for drug pressure are multi-factorial. Although drug resistance is primarily a medical problem, the causes of resistance—at least the pace of escalation—are ecological, epidemiological, socio-cultural and economic. Patients, physicians, veterinarians, clinics and hospitals, and retailers—from large pharmacies to local drug sellers—have little motivation (economic or otherwise) to weigh the negative impact of their use of antibiotics on others, especially those in the future.  Standard responses, such as increasing surveillance and launching public information campaigns on the hazards of resistance—while being a necessary part of an overall policy response—may have limited impact on their own.  In order to work, policy solutions must alter incentives for patients, physicians, and others in the health care system to act in society’s best interests. Evaluating policy solutions involves understanding infectious diseases in populations. Research on evaluating focused, context-specific policy solutions that are likely to have a significant impact on resistance is a first step.  Translating these policy solutions to policy action is the second.

Antibiotic resistance currently does not top any list of national problems. Strategies to control antibiotic resistance should not drain resources from more pressing concerns.  Done correctly, controlling antibiotic resistance should be either cost neutral or in fact, be one of the few health interventions that actually saves money.

Here we present the situation analysis of antibiotic use and resistance in Vietnam. We used international papers, local papers and reports, and expert interviews to complete this analysis. This report gives insight into interventions that can be targeted to control inappropriate antibiotic use and resistance in Vietnam, while taking care not to diminish access to these, at times lifesaving, drugs.