Antimicrobial resistance in South East Asia: time to ask the right questions

Abstract

Antimicrobial resistance (AMR) has emerged as a major public health concern, around which the international leadership has come together to form strategic partnerships and action plans. The main driving force behind the emergence of AMR is selection pressure created due to consumption of antibiotics. Consumption of antibiotics in human as well as animal sectors are driven by a complex interplay of determinants, many of which are typical to the local settings. Several sensitive and essential realities are tied with antibiotic consumption – food security, livelihoods, poverty alleviation, healthcare access and national economies, to name a few. That makes one-size-fits-all policies, framed with the developed country context in mind, inappropriate for developing countries. Many countries in the South East Asian Region have some policy structures in place to deal with AMR, but most of them lack detailed implementation plans or monitoring structures. In this current debates piece, the authors argue that the principles driving the AMR agenda in the South East Asian countries need to be dealt with using locally relevant policy structures. Strategies, which have successfully reduced the burden of AMR in the developed countries, should be evaluated in the developing country contexts instead of ad hoc implementation. The Global Action Plan on AMR encourages member states to develop locally relevant National Action Plans on AMR. This policy position should be leveraged to develop and deploy locally relevant strategies, which are based on a situation analysis of the local systems, and are likely to meet the needs of the individual member states.

The AMR problem: demanding economies, biological margins, and co-producing alternative strategies

“…In hatcheries, we detailed how, despite the efforts of technicians and others, economic and biological margins result in a continuing reliance on antimicrobials. Where investment is made to reduce this need, the issue becomes the extent to which disease-free seed can be translated to what Kakkar et al (2018) refer to as an 'invisible cohorts' of pericapitalist small-holders and farmers.…”

“…In the context of a global health challenge, social science is thus rendered as a form of 'first world' expertise. The deracinated result is a colonial "onesize-fits-all approach, framed with developed country contexts in mind" (Kakkar et al 2018). In essence, as antibiotic use becomes the driver or determinant of resistance and the target of intervention, other possible resistance risks, as well as the social and economic conditions of antimicrobial use (including food security, poverty alleviation, healthcare access and so on) tend to be ignored (Kakkar et al 2018).…”

“…For example, ponds are to some extent outside conventional schemes of formal regulation and accountability. They constitute part of what Kakkar et al (2018) refer to as the "invisible cohorts" of backyard and smallholder farms producing 70% of the world's food. The style of pond, the management processes adopted, the treatments used, the ways in which aquaculture is combined with other livelihood activitiesall make for a highly variable landscape of production, while the system of sales and collection renders individual farms as largely invisible to processors and retailers.…”

Antibiotic Resistance, Biofilm Formation, and Intracellular Survival As Possible Determinants of Persistent or Recurrent Infections by Staphylococcus aureus in a Vietnamese Tertiary Hospital: Focus on Bacterial Response to Moxifloxacin

“…Bacterial resistance is notoriously high in Asia, related to wide and largely inappropriate use of antibiotics, 1 as recently shown in Vietnam. 2 Resistance, which creates difficulties for health care professionals for selecting appropriate treatments, is therefore thought to be the main contributor to the persistent and/or recurrent character of many infections.…”

The challenges of investigating antimicrobial resistance in Vietnam - what benefits does a One Health approach offer the animal and human health sectors?

“…The international community has placed emphasis on the curtailment of inappropriate use of antibiotics within the human health sector and elevated antibiotic resistance to its current status as a global priority [47]. Despite the growing concern between the link of antibiotic resistance and antibiotic use within the animal food production sector, this discourse only began recently with the continuation of human health as the central context of AMR containment strategies [17,48]. As AMR increasingly becomes defined as a security threat to human health, this may result in human health being the dominant concern in efforts to curb the spread of resistance pathogens [33].…”