Antimicrobial Resistance and the Private Sector in Southeast Asia

Liverani, Marco; Hashiguchi, Lauren Oliveira; Khan, Mishal; Coker, Richard

doi:10.1007/978-3-030-27874-8_5

Cited by 5 publications

(2 citation statements)

References 55 publications

(44 reference statements)

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“…The Southeast Asia region, consisting of 11 countries (Singapore, Malaysia, Thailand, Vietnam, Cambodia, Lao PDR, Myanmar, Philippines, Indonesia, Brunei Darussalam, and Timor-Leste) is well-known for its pristine beaches and tropical forests. Nevertheless, many cities in the region are densely populated areas that facilitate the spread of multidrugresistant pathogens [1,2], such as methicillin-resistant Staphylococcus aureus (MRSA). MRSA is currently listed as one of the top pathogens in the region, and it is responsible for more than 100,000 deaths, contributing to the global antimicrobial resistance burden [3].…”

Section: Introductionmentioning

confidence: 99%

Diversity and Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) Genotypes in Southeast Asia

et al. 2022

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Methicillin-resistant Staphylococcus aureus (MRSA) is a successful pathogen that has achieved global dissemination, with high prevalence rates in Southeast Asia. A huge diversity of clones has been reported in this region, with MRSA ST239 being the most successful lineage. Nonetheless, description of MRSA genotypes circulating in the Southeast Asia region has, until now, remained poorly compiled. In this review, we aim to provide a better understanding of the molecular epidemiology and distribution of MRSA clones in 11 Southeast Asian countries: Singapore, Malaysia, Thailand, Vietnam, Cambodia, Lao People’s Democratic Republic (PDR), Myanmar, Philippines, Indonesia, Brunei Darussalam, and Timor-Leste. Notably, while archaic multidrug-resistant hospital-associated (HA) MRSAs, such as the ST239-III and ST241-III, were prominent in the region during earlier observations, these were then largely replaced by the more antibiotic-susceptible community-acquired (CA) MRSAs, such as ST22-IV and PVL-positive ST30-IV, in recent years after the turn of the century. Nonetheless, reports of livestock-associated (LA) MRSAs remain few in the region.

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Section: Introductionmentioning

confidence: 99%

Diversity and Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) Genotypes in Southeast Asia

et al. 2022

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“…The private health sector in Thailand co-exists alongside government-run health facilities, and includes a variety of providers ranging from large private hospitals, clinics, community pharmacies, to informal drug-sellers (Liverani et al, 2020). Our focus in this paper is community pharmacies, which account for an estimated 26.7% of antimicrobial distribution in Thailand, and approximately 27.04% of total drug expenditure (Chanwatik et al, 2018;Donsamak, 2020).…”

Section: Introductionmentioning

confidence: 99%

Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand

Poompruek

Perris

Whanpuch

et al. 2022

Global Public Health

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Thailand's antimicrobial stewardship strategy has focussed on promoting 'rational drug use' in the public sector, to reduce the threat of drug resistance and control healthcare expenditure. The strategy's next ambition is to attend to the private sector, where antibiotics are widely available over the counter without prescription. Using ethnographic and survey data, this paper follows antibiotics through community pharmacies, to explore drug distribution and access, and identify potential challenges for stewardship. We extend the analytical frame beyond 'irrational' dispenser-customer transactions, to explore the logics of practice of a multiplicity of actors in the context of a highly competitive pharmaceutical market. Highlighting the role of the pharmaceutical industry in mystifying medicines, we show how antibiotics are collapsed into a category of 'strong medicines' and requested by customers using 'prescriptions by proxy'. We further examine how Thailand's drug regulation and classificatory systems, historically orientated around access to medicines, enable the proliferation of antibiotics in the context of contemporary efforts to control distribution. Recognising the negotiations involved in dispensing antibiotics in a pluralistic health system, we attempt to reconfigure allocations of responsibility, advocating for stewardship approaches that take into account local ecologies of care, as well as implications for access, equity, and accountability.

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Antimicrobial Resistance and Social Inequalities in Health: Considerations of Justice

Reid

2020

Ethics and Drug Resistance: Collective Responsibility for Global Public Health

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Within-country social inequalities in health have widened while global health inequalities have (with some exceptions) narrowed since the Second World War. On commonly accepted prioritarian and sufficientist views of justice and health, these two trends together would be acceptable: the wealthiest of the wealthy are pulling ahead, but the worst off are catching up and more are achieving sufficiency. Such commitments to priority or sufficiency are compatible with a common “development” narrative about economic and social changes that accompany changes (“transitions”) in population health. I set out a very simple version of health egalitarianism (without commitment to any particular current theory of justice) and focus on two common objections to egalitarianism. Priority and sufficiency both address the levelling down and formalism objections, but these objections are distinct: giving content to equality (I argue here) places in question the claimed normative superiority of priority and sufficiency. Using examples of the role of antimicrobials in both these trends – and the future role of AMR – I clarify (first) the multiple forms and dimensions of justice at play in health, and (second) the different mechanisms at work in generating the two current patterns (seen in life course narratives and narratives of political economy). The “accelerated transition” that narrowed global health inequalities is fed by anti-microbials (among other technology transfers). It did not accelerate but replaced the causal processes by which current HICs achieved the transition (growing and shared economic prosperity and widening political franchise). The impact of AMR on widening social inequalities in health in HICs will be complex: inequality has been fed in part by tertiary care enabled by antimicrobials; AMR might erode the solidarity underlying universal health systems as the well-off seek to maintain current expectations of curative and rehabilitative surgery and chemotherapy while AMR mounts. In light of both speculations about the impact of AMR on social and global health inequalities, I close with practical and with theoretical reflection. I briefly indicate the practical importance of understanding AMR from the perspective of health justice for policy response. Then, from a broader perspective, I argue that the content by which I meet the formalism objection demonstrates that the two trends (broadening within-country inequality and narrowing global inequality) are selective and biased samples of a centuries-long pattern of widening social inequalities in health. We are not in the midst of a process of “catching up”. In light of the long-term pattern described here, is the pursuit of sufficiency or priority morally superior to the pursuit of equality as a response to concrete suffering – or do they rationalize a process more objectively described as the best-off continuing to take the largest share of one of the most important benefits of economic development?

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Antimicrobial Resistance and the Private Sector in Southeast Asia

Cited by 5 publications

References 55 publications

Diversity and Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) Genotypes in Southeast Asia

Diversity and Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) Genotypes in Southeast Asia

Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand

Antimicrobial Resistance and Social Inequalities in Health: Considerations of Justice

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