WHOベトナムのCommunicable Disease Group Coordinator加藤昌哉氏から生徒の質問に対する回答が届きました。
１）マラリアに効くワクチンが１つしかないと言っていたけれど、それに対してWHOではどのような対策を取っているのか。
Please see:Malaria vaccine development
WHO activities
Tracking the global malaria vaccine portfolio
The WHO Initiative for Vaccine Research (IVR) tracks all clinical and advanced preclinical malaria vaccine projects activity in spreadsheets; updates are posted on the IVR web pages. These spreadsheets are known as the WHO Rainbow Tables and are compiled with help from funders, sponsors and investigators around the world.
Providing a forum for malaria vaccine stakeholders
WHO IVR acts as the Secretariat to the Malaria Vaccine Funders Group, which was established to facilitate exchange of information and opinions among internationally active funding bodies for malaria vaccine development. The group enables a better coordination of ongoing and planned vaccine research activities, and identifies areas of research that can be supported in a complementary manner. In addition, IVR’s Malaria Vaccine Advisory Committee (MALVAC) is a scientific group of experts that meets regularly to address a specific theme.
２）マヌさんのプレゼンのヘルスセンターが密集しているところとそうでないところのスライドと、人口が多いところにヘルスセンターが少なくて、少ないところに多いというスライドはわかった。しかし、三枚目のスライドの意味がわからなかった。
The slides can be accessed:Ha Giang test map
About the last map, I think the students refer to the map where we actually combine density of facilities with density of population. The map then shows that in some areas of Ha Giang there is a strong concentration of facilities, but not of people. Hence, the facilities are not optimally being used.
３）ベトナムでは抗生物質を容易に手に入れることができるが、政府は規制したりはできないのか。また、村の人たちの抗生物質の扱い方や薬剤耐性菌についての認知度はどれぐらいあるのか。
For the first question, some information can be found in the following report:Antibiotic use and resistance in emerging economies
Drug regulation and supply
Half of all drugs consumed in Viet Nam are made locally and more than 50% of these are antibiotics. Most domestic producers are joint-stock companies, in which the State holds a 46.5% share. This partnership can complicate drug regulation.
The Pharmaceutical Law (2005) made antibiotics prescription-only drugs. Despite this, antibiotics continue to be dispensed without a doctor’s prescription. In 2007, the circular on Good Pharmacy Practice (GPP) was issued to improve the standard of pharmacy. GPP requires pharmacies to have proper facilities, monitor drug quality, record drug consumption and comply with the prescription-only regulations. However, GPP-certified pharmacies continue to dispense antibiotics to patient’s who do not possess a doctor’s prescription. Currently, there are no sanctions and as of March 2013 no pharmacy has been penalized for dispensing without prescription.
Several MoH departments issue these drug policies and are responsible for regulating private and public healthcare facilities. In 2006, 230 full-time health inspectors were employed to regulate over 39,000 pharmacy outlets. Given this discrepancy of greater than 150 outlets per inspector, it is understandable that despite legislation regulation of the national drug supply chain is weak.
Drug regulation and supply is also problematic at the local level. The MoH instructs all hospitals to appoint a Drug and Therapeutics Committee (DTC). The DTC is responsible for implementing MoH guidelines, establishing lists of commonly used drugs in their hospitals and advising on rational antibiotic therapy. Certain “reserved” antibiotics, should only be dispensed after consultation with the DTC. A recent MoH instruction requires hospitals to implement local guidelines for rational and safe drug use, monitor antibiotic prescribing, strengthen hospital pharmacies and train staff to improve knowledge of drug use. However, these requirements are often not met by hospitals.
For the second question, I believe JICA supported a KAP survey => they may have more information.
Last year, WHO supported AMR awareness week:WHO supports nationwide campaign to combat antimicrobial resistance