UMR ASTRE, Université de Montpellier, CIRAD, INRAE, Montpellier, France; Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.
Faculty of Agriculture, National University of Laos, Vientiane, Lao PDR.
Acta Trop. 2021 Aug;220:105943. doi: 10.1016/j.actatropica.2021.105943. Epub 2021 May 7.
In response to the global call to mitigate risks associated with antimicrobial resistance (AMR), new regulations on the access and use of veterinary antibiotics are currently being developed by the Lao government. This study aims to explore how the implementation of these new regulations might effectively reduce and adapt the sale, distribution and use of veterinary antibiotics in Lao PDR. To this end, we used the theory of change, framing the AMR issue within the context of the stakeholders involved in the veterinary antibiotics supply chain. Qualitative and quantitative methods were used to collect data, based on questionnaires (n=36 antibiotic suppliers, n=96 chicken farmers, n=96 pig farmers), and participatory tools such as a workshop (n=10 participants), semi-structured interviews (n=20), and focus group discussions (n=7 participants). The stakeholders' understanding of the AMR issue and potential challenges related to the implementation of new regulations regarding access and use of antibiotics, were also investigated. We mapped the veterinary antibiotic supply chain in Lao PDR, and analysed the roles and interactions of its stakeholders. Twenty-three stakeholders representing the private and the public sectors were identified. Many informal and formal links connected these stakeholder within this supply chain. The lack of veterinarian-farmer interaction and the evolving nature of the veterinary antibiotics supply chain accentuated the challenges of achieving behaviour change through regulations. Most of the antibiotics found on farms were categorized by the World Health Organisation's as critically important antibiotics used in human medicine. We argue that AMR risk mitigation strategy requires dialogue and engagement between private and public sectors stakeholders, involved in the importation, distribution, sale and use of veterinary antibiotics. This study further highlighted that AMR is a complex adaptive challenge requiring multi-sectoral approach. We believed that a sustainable approach to reduce and adapt veterinary antibiotics use should be prepared in collaboration with stakeholders from private and public sectors identified in this study, in addition to the new regulations. This collaboration should start with the co-construction of a common understanding of AMR issue and of the objectives of new regulations.
为响应全球减轻与抗微生物药物耐药性（AMR）相关风险的呼吁，老挝政府目前正在制定有关获得和使用兽用抗生素的新规定。本研究旨在探讨这些新规定的实施如何有效减少和调整老挝人民民主共和国兽用抗生素的销售、分发和使用。为此，我们使用变革理论，将 AMR 问题置于参与兽医抗生素供应链的利益相关者的背景下。我们使用定性和定量方法收集数据，基于问卷（n=36 名抗生素供应商，n=96 名养鸡户，n=96 名养猪户）和参与式工具，如研讨会（n=10 名参与者）、半结构化访谈（n=20 名）和焦点小组讨论（n=7 名参与者）。我们还调查了利益相关者对 AMR 问题的理解以及与抗生素获取和使用新规定实施相关的潜在挑战。我们绘制了老挝人民民主共和国的兽医抗生素供应链，并分析了其利益相关者的角色和相互作用。确定了 23 名代表私营和公共部门的利益相关者。这些利益相关者在供应链中有许多非正式和正式的联系。兽医与农民之间缺乏互动以及兽医抗生素供应链的不断发展，加剧了通过法规实现行为改变的挑战。在农场发现的大多数抗生素被世界卫生组织归类为在人类医学中使用的至关重要的抗生素。我们认为，抗微生物药物耐药性风险缓解战略需要参与抗生素进口、分销、销售和使用的私营和公共部门利益相关者之间进行对话和合作。本研究进一步强调，抗微生物药物耐药性是一个复杂的适应性挑战，需要采取多部门方法。我们认为，除了新规定外，还应与本研究确定的私营和公共部门的利益相关者合作，制定可持续的减少和调整兽用抗生素使用的方法。这种合作应该从共同构建对抗微生物药物耐药性问题和新规定目标的共同理解开始。
