Rogier Van Doorn: Research at OUCRU Hanoi
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.