ReAct Asia Pacific

The ReAct Asia-Pacific (RAP) node works on multiple projects and initiatives related to AMR, from piloting an ‘Antibiotic Smart Communities’ program in the southern Indian state of Kerala to working among college students to starting clubs that create awareness on antibiotic use. RAP reaches out to a wide range of stakeholders, especially policymakers and state governments - to engage with them on the implementation of the National Action Plan on AMR. A key focus is also to identify and bring together different civil society groups working on community engagement in AMR-sensitive and AMR-specific issues. 

The Asia-Pacific region, where most of the world’s population lives, has been the centre of global economic growth for the last several decades. On the health front, however, the region continues to be affected by a very high burden of both non-communicable and communicable diseases, making it a hot spot for increased antibiotic use and emergence of antimicrobial resistance (AMR).

For ReAct, the Asia Pacific has been a major focus of activities right from its inception. Starting in 2006, with just a few contacts in a couple of countries, the ReAct network in the region today has spread widely involving a wide variety of individuals and institutions tackling the problem of antimicrobial resistance.

From 2016 to 2023 the headquarters of ReAct Asia-Pacific was hosted by the Christian Medical College, Vellore in Tamil Nadu, India. Since January 2024 RAP is hosted by the Global Health Institute, Trivandrum, Kerala.

India has one of the highest burdens of antimicrobial resistance in the world and the policies and interventions implemented here would have ramifications for tackling the problem globally too.

Currently, ReAct Asia Pacific’s work is primarily focused in India and Indonesia. However, the node also has collaborators from Bangladesh, Vietnam, Thailand and Malaysia.

Antibiotic Smart Communities

The Antibiotic Smart Communities project of ReAct Asia Pacific came from a realization that the implementation efforts around the Global Action Plan on Antimicrobial Resistance (AMR) and National Action Plans on AMR were mostly top-down in character.

Many policies and interventions were planned at high-level meetings – with very little involvement of the target stakeholder groups and communities in the design of the initiatives. As a result local ownership of AMR interventions was poor.

The Antibiotic Smart Communities project was based on the premise that National Action Plans on AMR will have more impact if there is robust community engagement.

Measuring ‘antibiotic smartness’

In order to measure the impact of community engagement the project designed a holistic indicator framework to measure the ‘antibiotic smartness’ or the level of preparedness of local communities to address the issue of drug-resistant bacteria.

Following consultations with both local communities and health experts, a 15 indicator framework was  prepared and tested in several parts of India as well as in Indonesia. Monitoring these 15 AMR-specific and AMR-sensitive indicators from the human, animal, environment, and trans-sectoral domains, can help policymakers and local stakeholders understand the impact of various antibiotic resistance policies, and identify opportunities for action.

Based on the experience with the Antibiotic Smart Communities project RAP has also produced a policy brief on community engagement in health, with a  special focus on AMR. Content for the brief was collected through interviews with individual researchers and groups working on this theme in South and South-East Asia. The brief provides do’s and don’ts of community engagement in health, as also a review of literature on different models of community engagement.

Learn more on Antibiotic Smart Communities

ASPIC clubs

ASPIC (Antibiotic Stewardship & Prevention of Infection in Communities) Clubs was started in 2018 in the southern states of India by  ReAct Asia Pacific to engage students on the issue of Antimicrobial Resistance (AMR), using a One-Health approach.

The ASPIC clubs initiative believes that  students anchored in their universities and research institutions are uniquely positioned to push for normative change on health and AMR. The original objective of the network was to engage  non-medical students on the issue. Consequently, the clubs were set up among science and arts students in tertiary level institutions. For example, life science and environment students from diverse academic backgrounds join in club activities.

The clubs have been seeded in tertiary level educational institutions and also engaged school students on AMR in the form of the ASPIC Jr program. Currently, the clubs operate on sixteen campuses in South India.

Competitions for raising awareness

Apart from seminars and training sessions ASPIC clubs use competitions as a way to engage students. These include photography and video contests as well as research proposals and scientific poster competitions on topics such as One Health, food safety, appropriate medicine use antibiotic resistance.

The ASPIC clubs have helped spread awareness on AMR and infection prevention measures among student communities.

Learn more on ASPIC Clubs

State Action Plans

RAP has engaged with state governments around India to formulate State Action Plans that can supplement the WHO-mandated National Action Plan on Antimicrobial Resistance.

In a country like India, which has a federal structure and where health is a subject that comes under the purview of state governments, it is pertinent to develop state level action plans taking into account the local needs and resources.

The learning from these exercises are of relevance in several other low and middle-income countries that follow a federal governance system.

In 2022, RAP organized the ’Colloquium on state action plans for AMR in India’ in New Delhi, along with the Indian WHO country office and World Animal Protection, India. This meeting served to share ideas and experiences with representatives from 16 Indian states, experts from the Indian government, civil society, and others.

Learn more about the State Action Plan, Kerala.

React Asia-Pacific in Indonesia

Participants at an event to raise awareness about smart use of antibiotics in Jakarta, Indonesia.

ReAct Asia Pacific began its activities in Indonesia in 2012, when it provided funding to The Concerned and Caring Parents Foundation (Yayasan Orang Tua Peduli/YOP) to conduct an awareness-raising campaign on antibiotic resistance targeting parents and the general public in Indonesia. These activities included public campaigns, media briefings to local journalists, seminars/webinars for parents and university students, and the development of communication materials.

From 2015, ReAct Asia-Pacific strengthened the node’s and the network’s communication efforts via staff located in Indonesia. The RAP representative has  active collaboration on AMR with regional offices of  WOAH, UNEP, WHO and the FAO in Indonesia.

Recently, RAP initiated the Antibiotic Smart Community pilot project in two locations in Indonesia, where local researchers assist in data collection, analysis, and reporting of the pilot project.

Antibiotic use in food-animal farming

Since 2017 ReAct Asia-Pacific has also produced a series of booklets that give a situation analysis of antibiotic use in food-animal production in India, Indonesia, Thailand and Malaysia. The booklets have been circulated widely and are used by policy makers, researchers and media as reference material in the region.

In December 2018, nearly 40 civil society representatives convened from around the world for a three- day conference, “Globalizing Food Campaigns: Sharing Strategies to Address Antimicrobial Resistance” in Bangkok, Thailand. The meeting was jointly organised by RAP and the Strategic Policy Program of ReAct, based at the Johns Hopkins Bloomberg School of Public Health, USA.

Bangkok Declaration on Antimicrobial Resistance

Based on the discussions held, civil society groups issued the Bangkok Declaration on Antimicrobial Resistance, food systems and farming, to guide global action to address AMR through agriculture and food systems globally.

RAP also produced a case study on the United Nations Food and Agricultural Organization’s 3-zone biosecurity project in Indonesia aimed at reducing infections and reducing antibiotic use in poultry farming. A report on the trend towards using antibiotic substitutes in food-animal and livestock industry in Asia has also been prepared.