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      Antibiotic resistance in Vietnam: moving towards a One Health surveillance system

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          Abstract

          Background

          The international community strongly advocates the implementation of multi-sectoral surveillance policies for an effective approach to antibiotic resistance, in line with the One Health concept. To comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may question the ability and willingness of surveillance stakeholders to implement the collaborations required. To assess the feasibility of operationalising this strategy within the national context, we explored the role of key stakeholders in the strategy, as well as their abilities to comply with it.

          Methods

          We conducted a qualitative approach based on an iterative stakeholder mapping and analysis, in three distinct steps: (1) a description of the structure of the national surveillance strategy (literature review, key informant interviews); (2) an analysis of the key stakeholders’ positions regarding the strategy (semi-structured interviews); (3) the identification of factors influencing the operationalisation of the collaborative surveillance strategy (comparison of data collected at the first and second steps).

          Results

          The mapping of the surveillance system, as well as the characterisation of key stakeholders according to organisational and functional attributes, underlined that inter-sectoral surveillance initiatives do exist, but that the organisation of the national surveillance system remains highly silo-oriented.

          Based on stakeholder perspectives, we identified seven factors that may influence the implementation of the One Health strategy at national level: governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners.

          Conclusions

          The study suggests that the operationalisation of the collaborative surveillance strategy requires the full adhesion of stakeholders and the provision of appropriate resources. Based on these findings, we have proposed a guidance framework together with recommendations to move towards a more suitable governance and operational model for One Health surveillance of antibiotic resistance in Vietnam.

          To lever and promote successful inter-sectoral collaboration, a participatory “learning by doing” process could be applied to guide, frame and mentor stakeholders through the identification of appropriate levels of collaboration, depending on the expected positive impacts on the value of surveillance.

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          Most cited references15

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          From “one medicine” to “one health” and systemic approaches to health and well-being☆

          Faced with complex patterns of global change, the inextricable interconnection of humans, pet animals, livestock and wildlife and their social and ecological environment is evident and requires integrated approaches to human and animal health and their respective social and environmental contexts. The history of integrative thinking of human and animal health is briefly reviewed from early historical times, to the foundation of universities in Europe, up to the beginning of comparative medicine at the end of the 19th century. In the 20th century, Calvin Schwabe coined the concept of “one medicine”. It recognises that there is no difference of paradigm between human and veterinary medicine and both disciplines can contribute to the development of each other. Considering a broader approach to health and well-being of societies, the original concept of “one medicine” was extended to “one health” through practical implementations and careful validations in different settings. Given the global health thinking in recent decades, ecosystem approaches to health have emerged. Based on complex ecological thinking that goes beyond humans and animals, these approaches consider inextricable linkages between ecosystems and health, known as “ecosystem health”. Despite these integrative conceptual and methodological developments, large portions of human and animal health thinking and actions still remain in separate disciplinary silos. Evidence for added value of a coherent application of “one health” compared to separated sectorial thinking is, however, now growing. Integrative thinking is increasingly being considered in academic curricula, clinical practice, ministries of health and livestock/agriculture and international organizations. Challenges remain, focusing around key questions such as how does “one health” evolve and what are the elements of a modern theory of health? The close interdependence of humans and animals in their social and ecological context relates to the concept of “human-environmental systems”, also called “social-ecological systems”. The theory and practice of understanding and managing human activities in the context of social-ecological systems has been well-developed by members of The Resilience Alliance and was used extensively in the Millennium Ecosystem Assessment, including its work on human well-being outcomes. This in turn entails systems theory applied to human and animal health. Examples of successful systems approaches to public health show unexpected results. Analogous to “systems biology” which focuses mostly on the interplay of proteins and molecules at a sub-cellular level, a systemic approach to health in social-ecological systems (HSES) is an inter- and trans-disciplinary study of complex interactions in all health-related fields. HSES moves beyond “one health” and “eco-health”, expecting to identify emerging properties and determinants of health that may arise from a systemic view ranging across scales from molecules to the ecological and socio-cultural context, as well from the comparison with different disease endemicities and health systems structures.
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            Scientists’ collaboration strategies: implications for scientific and technical human capital

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              Surveillance for control of antimicrobial resistance

              Antimicrobial resistance poses a growing threat to public health and the provision of health care. Its surveillance should provide up-to-date and relevant information to monitor the appropriateness of therapy guidelines, antibiotic formulary, antibiotic stewardship programmes, public health interventions, infection control policies, and antimicrobial development. In Europe, although the European Antimicrobial Resistance Surveillance Network provides annual reports on monitored resistant bacteria, national surveillance efforts are still fragmented and heterogeneous, and have substantial structural problems and issues with laboratory data. Most incidence and prevalence data cannot be linked with relevant epidemiological, clinical, or outcome data. Genetic typing, to establish whether trends of antimicrobial resistance are caused by spread of resistant strains or by transfer of resistance determinants among different strains and species, is not routinely done. Furthermore, laboratory-based surveillance using only clinical samples is not likely to be useful as an early warning system for emerging pathogens and resistance mechanisms. Insufficient coordination of surveillance systems of human antimicrobial resistance with animal surveillance systems is even more concerning. Because results from food surveillance are considered commercially sensitive, they are rarely released publicly by regulators. Inaccurate or incomplete surveillance data delay a translational approach to the threat of antimicrobial resistance and inhibit the identification of relevant target microorganisms and populations for research and the revitalisation of dormant drug-discovery programmes. High-quality, comprehensive, and real-time surveillance data are essential to reduce the burden of antimicrobial resistance. Improvement of national antimicrobial resistance surveillance systems and better alignment between human and veterinary surveillance systems in Europe must become a scientific and political priority, coordinated with international stakeholders within a global approach to reduce the burden of antimicrobial resistance.
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                Author and article information

                Contributors
                marion.bordier@cirad.fr
                Aurelie.binot@cirad.fr
                quentin.pauchard@gmail.com
                namdien@gmail.com
                gzhivago@gmail.com
                nicolas.fortane@inra.fr
                flavie.goutard@gmail.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                24 September 2018
                24 September 2018
                2018
                : 18
                : 1136
                Affiliations
                [1 ]CIRAD, UMR ASTRE, Hanoi, Vietnam
                [2 ]ISNI 0000 0001 2097 0141, GRID grid.121334.6, ASTRE, Univ Montpellier, CIRAD, INRA, ; Montpellier, France
                [3 ]GRID grid.419675.8, National Institute of Veterinary Research, ; Hanoi, Vietnam
                [4 ]ISNI 0000 0001 2153 9871, GRID grid.8183.2, CIRAD, ASTRE, ; 34398 Montpellier, France
                [5 ]ISNI 0000 0000 9825 317X, GRID grid.444964.f, Vietnam National University of Agriculture, Faculty of Political and Social Sciences, ; Hanoi, Vietnam
                [6 ]ISNI 0000 0001 2169 1988, GRID grid.414548.8, INRA, UMR IRISSO, Université Paris Dauphine, Institut de Recherche interdisciplinaire en sciences sociales, ; 75116 Paris, France
                [7 ]CIRAD, UMR ASTRE, 10900 Bangkok, Thailand
                [8 ]ISNI 0000 0001 0944 049X, GRID grid.9723.f, Faculty of Veterinary Medicine, , Kasetsart University, ; 10900 Bangkok, Thailand
                Author information
                http://orcid.org/0000-0002-0182-5210
                Article
                6022
                10.1186/s12889-018-6022-4
                6154809
                30249210
                ed301fc7-70dd-41ba-9d85-cfd58f2d9b65
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 June 2018
                : 6 September 2018
                Funding
                Funded by: French Ministry of Agriculture
                Funded by: Grease platform
                Funded by: France veterinaire international
                Funded by: French Embassy in Vietnam
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Public health
                one health,surveillance,antibiotic resistance,stakeholder analysis
                Public health
                one health, surveillance, antibiotic resistance, stakeholder analysis

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