Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Antibiotics are widely used in Vietnam, leading to widespread antimicrobial resistance. Monitoring antibiotic use helps inform the government to change treatment guidelines and implement antibiotic stewardship programmes. This may also prevent the transmission of resistant bacteria outside the country.

My name is Rogier Van Doorn, I am a clinical microbiologist from the Netherlands. I have been working in Vietnam for 10 years and I am currently the director at the OUCRU unit in Hanoi.

The research that we focus on in Hanoi has two main topics: we work on human and avian influenza and we work on antimicrobial resistance to bacteria in both human diseases in hospitals, in communities and in agriculture and the environment, so a holistic approach to AMR.

We established a household cohort 10 years ago in Hà Nam which is 60km south of Hanoi, this is about 1,000 people. We’ve been following them for 10 years so we know very well how often these people get flu, we know what kind of flu they get, which viruses are involved, and we know how their immune system responds to it. From what we learnt in Hà Nam, we think we can predict what potential viruses may cause influenza next season and then we try to make those viruses in the lab, and use those viruses for vaccination. That’s what we’re going to trial in the next few years, and if that works that will revolutionise the way we vaccinate people against flu.

We’ve been awarded a grant from the Flemming Fund from the UK government to establish a national surveillance network for AMR using a network of 16 hospitals. Alongside that we’re setting up a building, literally, a reference laboratory for AMR. We will be able to gather much more and much better data on AMR in Vietnam than we currently have. That’s important because Vietnam has been listed as one of the countries where AMR is the most pressing: it’s 3rd in the list after China and India and the resistance mechanisms that we see are the resistance mechanisms against our most broad drugs, last resort drugs. Those numbers are higher than in most other countries I’ve worked in and have seen.

How I see translational medicine is the use of data from research into something that can be used. We are using the Hà Nam cohort to learn about influenza, and a lot of the things we’ve learnt we are using to make vaccines in an entirely new way and then trial them in that cohort. On the avian influenza side we’ve helped the ministry of agriculture to set up a tool to follow the evolution of avian influenza viruses in a way that can be done in Vietnam. The existing methods were very sophisticated and could only be done in high income countries using ferrets. We’ve set up a system to do it with chickens which we can use in Vietnam, and that’s now being used to directly monitor the evolution of avian influenza virus. This is important because we think they may at some point cause a pandemic in humans, so it’s also a very practical thing that we’ve contributed to developing.

Our research is important in Vietnam on AMR because AMR is perceived as a massive threat to human health because of the huge amount of antibiotic overuse that we see here. In high income countries in Europe we’re used to only being prescribed antibiotics by a physician, and usually only when we’re really ill. Here antibiotics are used without restriction, they are available everywhere. There are 60,000 pharmacies in Vietnam and you can buy antibiotics over the counter there, broad-spectrum antibiotics. They’re cheap and everybody does it.

If you would ask a cross section of mothers with children under 5 whether their child has used antibiotics in the past month, more than 50% will say yes. That gives you a bit of an idea of the scale of the problem. Because of this large amount of use of antibiotics you see a lot of resistance and the resistance we see here is getting out of control: patients are dying from it, children are dying from it. Working on that, trying to get better data and use this data to inform government to change policy, change treatment guidelines, change the use of antibiotics through antibiotic stewardship programmes is important for Vietnam, but also important globally because it may prevent further transmission of those resistant bugs outside of Vietnam.

Rogier Van Doorn

Professor Rogier Van Doorn leads our OUCRU Ha Noi unit with research focus on antimicrobial resistance and influenza and other respiratory infections. The study over 10 years of a cohort in the Ha Nam province helps predict which flu viruses may cause influenza next season; this may revolutionise the way we vaccinate people against flu.

More podcasts related to Global Health

Mike English: Health services that deliver for newborns

Basic hospital care may be key to saving newborn lives. Professor Mike English outlines a multidisciplinary project engaging policy-makers and practitioners in Kenya. This project demonstrated poor coverage of Nairobi’s 4.25 million population if a sick newborn baby needs quality hospital care. Using novel research approaches the team also identified how severe shortages of nurses contribute to poor quality of care for patients and negatively affect nurses themselves.

Tran Hien: Infectious diseases in the tropics

Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.

Ronald Geskus: Sophisticated biostatistics for complex clinical research

The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.

Heiman Wertheim: Clinical research in low and middle-income countries

Drug resistant infections are a global crisis and we cannot focus on our own country only. Clinical trials in low and middle income countries where the burden is highest, as well as work with local communities and engagement with policy makers help influence public health policies.

Guy Thwaites: Tuberculosis meningitis

Tuberculosis meningitis affects a fractions of TB patients but causes high levels of mortality and morbidity. A recent trial at OUCRU showed that aspirin can greatly improve outcomes. Such trial is typical of the work done in our Vietnam units, where all the research is focussed on improving the outcome for patients directly.

Motiur Rahman: OUCRU laboratory management

OUCRU laboratories provide support to the unit’s extensive clinical research programme, from level 2 laboratory to SAPO 4 laboratory for high-risk pathogens responsible for zoonotic infections. Early diagnosis and detection of antimicrobial resistance helps prescribe the right medicine in time, contributing to better patient management.

Raph Hamers: Developing collaborative clinical trials in Indonesia

Indonesia is a very populous country with a huge burden of infectious diseases such as TB, malaria, HIV and CNS infections. Running clinical trials requires high levels of expertise, currently developed and strengthened by institutions such as IOCRL (Universities of Indonesia and Oxford Clinical Research laboratory). Better collaborations will also help great ideas make a bigger impact.

Jeremy Day: Central nervous system and HIV infections in Vietnam

Brain infections such as meningitis and encephalitis are highly debilitating diseases, and an accurate diagnostic is essential to give patients the best treatment available. For cryptococcal meningitis, clinical trials focus on prevention, for an early diagnosis, and novel ways to use existing treatments or repurpose old drugs.

Abhilasha Karkey: Connecting research with communities in Nepal

Antimicrobial resistance is a huge burden in Nepal, particularly in hospitals where many nosocomial infections are caused by resistant pathogens. With limited resources, little infection controls and proper guidelines in place, finding out the main risk factors helps reduce infection rates within a hospital and better target vaccination campaigns.

Juan Carrique-Mas: Antimicrobial resistance in poultry production

Many households in Vietnam raise animals for food production, particularly chickens, using large amounts of antimicrobials with no veterinary support, and those antimicrobials find their way into the food chain. The ViParc project conducts intervention trials similar to human clinical trials, to help farmers reduce the level of antimicrobials used when raising chickens.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.