For an upper middle-income country, Thailand has very impressive health indicators and is among the few countries in the South-East Asia region that boasts of a Universal Health Care (UHC) system, covering 98% of the population. Despite these achievements, antimicrobial resistance has been a growing problem in Thailand and places a high burden on the country’s health and the economy in Thailand. Dr Niyada Kiatying-Angsulee, Thailand’s foremost civil society activist on antimicrobial resistance, speaks to ReAct about the growing public awareness issues related to antimicrobial resistance in Thailand.
Dr. Niyada Kiatying-Angsulee, Manager for Drug System Monitor and Development Program at the Faculty of Pharmaceutical Sciences of the Bangkok-based Chulalongkorn University, speaks to ReAct about the growing public awareness issues related to antimicrobial resistance (AMR) in Thailand.
The DMDC has been mobilizing people in Thailand to observe the World Antibiotic Week for several years. Can you tell us about your activities in 2018?
– Along with Drug Systems Monitoring and Development Center (DMDC), over 27 organisations representing communities, consumer and health rights groups from around Thailand came together to carry out a series of different kinds of activities during World Antibiotic Awareness Week. Over 150 delegates from seven countries in the south and south-east Asia region participated in two days of deliberations in Bangkok. This year we focused on three objectives. First to raise awareness and education of the general public. Second was to look at the aspect of Thailand’s National Strategy Plan on AMR which calls for ideas to raise public awareness. Third was on the need to reclassify and label antibiotics adequately so that people understand their vulnerability to bacterial resistance.
How is the public and response to AMR related issues now as compared to the past in Thailand?
– The response now is very different. When we started 6 years ago, the understanding of antimicrobial resistance was very low. There was just a little support, from certain people. Since the National Health Assembly in 2015, where civil society groups brought up the issue in a big way and the Thailand National Strategy Plan that was launched in 2017 things have changed considerably. Now we have started working in rural areas also on the antimicrobial resistance issue. So this year the response was quite different. There are many people involved now and the government has to accept their role and develop a strategy to empower lay persons.
How are civil society organisations in Thailand approaching the AMR issue?
– Since the announcement of the Thailand National Strategy on AMR in 2017 we are putting more pressure on government agencies and ministries to mainstream antimicrobial resistance in their work on routine basis and not just organize special events. We demonstrate the bottoms up approach as a model for the government to bring in new policy. We are also monitoring the situation and give feedback to the government to implement AMR policy. Our other focus is to bring the issue to the attention of the general public in a bigger way. We still need time to empower more people to realize about antimicrobial resistance.
At what stage is the campaign on reducing antibiotic use in the food-animal sector?
– We were among the first groups that focused on the issue of antibiotic use in food production and also the environment. As a result of our campaign the government has adopted the One Health approach. We have emphasized the consumers right to know what is there in their food. We are also working on a strategy for small farmers to adopt better farming practices to curb antibiotic use and also to bring in a proper surveillance system to monitor what is happening.
– Finally, it is important that we have a model of organic and safe farming methods. This has become a very important issue in Thailand and many consumers and farmers have joined hands to raised awareness on this issue.
Thailand – Universal Health Care system covering 98% of the population
For an upper middle-income country, Thailand has very impressive health indicators and is among the few countries in the South-East Asia region that boasts of a Universal Health Care (UHC) system, covering 98% of the population. All this has been thanks to substantial state investments in literacy, access to safe drinking water and sanitation, improvements in nutrition and a strong primary healthcare network, in particular rural health infrastructure.
Antibiotic resistance high burden on health and economy in Thailand
Despite these achievements, antimicrobial resistance (AMR) has been a growing problem in Thailand and places a high burden on the country’s health and the economy in Thailand. The burden of antibiotic resistance in Thailand has been estimated in 2010 to result in 3.24 million days of hospitalization and 38 481 deaths per annum, and to cost 0.6% of national GDP.
AMR is also emerging as an important concern in the food-animal farming sector. The lack of effective regulations, appropriate policies, and poor implementation of standards for antibiotic use, together with low levels of biosecurity, hygiene, and sanitation, have accelerated the emergence and dissemination of antibiotic resistance.
Target: 50 percent reduction in ABR morbidity and 20 and 30 % reductions in antimicrobial use in human and animal health
In 2016, the Thai cabinet endorsed the first five-year National Strategic Plan on Antimicrobial Resistance in Thailand from 2017 to 2021.The plan sets targets for a 50% reduction in ABR morbidity; 20% and 30% reductions in antimicrobial use in human and animal health respectively, and a 20% increase in public knowledge about AMR, including awareness of appropriate use of antibiotics.
World Health Organization, SEARO.
Antimicrobial policy interventions in food animal production in South East Asia Flavie Goutard; BMJ. 2017;358:j3544
Viroj Tangcharoensathien et al. Antimicrobial resistance: from global agenda to national strategic plan, Thailand.