Influenza is real. There are many things which help ease its symptoms; a week off work, piles of takeaway food and lots of sympathetic mollycoddling from your partner. These are some of the most effective treatments.
But antibiotics don’t work, for influenza or any other type of cold, which are caused by viruses; antibiotics only work against bacteria. And colds and flu are ailments which strike most people at least once a year, which in Vietnam means good business for the pharmacist.
I’m sure most foreigners living in Vietnam are familiar with the often-told tale, that of going to a pharmacy with a blocked nose and being sold a colourful combination of mystery medication, almost always including a course of antibiotics.
It’s happened to me more than once. Most recently, after researching at home what I’d been sold, I found out that not only was that particular medicine an antibiotic not effective for my cold symptoms, but was actually intended to treat a certain sexually transmitted infection.
Antibiotics serve no purpose other than in the treatment of bacterial infections. This simple premise is the single biggest misunderstanding in Vietnamese medical habits, and is one reason why in a 2001 study, Vietnam had the highest prevalence of penicillin-resistant pneumococcus (a bacteria causing pneumonia) out of the 11 countries in the Asian Network for Surveillance of Resistant Pathogens.
As old antibiotics lose their effectiveness, authorities turn to newer, more expensive antibiotics; keeping these affordable becomes a big challenge. The issue quickly becomes a national one, because even someone who has never taken antibiotics before may one day catch a more developed bacterial infection which is resistant to standard treatment.
At the top of the medical food chain, there is wide awareness of the problem. Deputy Health Minister Nguyen Thi Xuyen last year blamed increasing antimicrobial resistance on the widespread sale of antibiotics without a doctor’s prescription.
Similarly, Nguyen Van Kinh, director of the National Tropical Diseases Hospital, said: “It is no exaggeration to say that drugs, especially antibiotics, are bought and sold… as easily as vegetables.”
“Vietnamese use antibiotics like eating rice,” he added. “They go to the pharmacy to pick up antibiotics anytime they feel sick.”
Moving down to more localised awareness, most pharmacies know what they are doing is wrong. A 2010 Ministry of Health survey found that out of 3,000 pharmacists in the north of Vietnam, 88% sold antibiotics without a prescription.
A pharmacist in Hanoi told Thanh Nien News that “almost no drugstore asks buyers for prescriptions”, suggesting the main reason was that they would never be able to compete with other stores which don’t insist on prescriptions.
Luong Ngoc Khue, head of the Ministry of Health’s examination and treatment department, added that the penalties for pharmacists flouting regulations were too mild to be a real deterrent. Current penalties range from VND200,000 to VND500,000 for selling medicines not supported by prescriptions.
Unfortunately, awareness among the general population is a combination of very low, and aware but uncaring. In November last year, the World Health Organisation (WHO) conducted the first World Antibiotic Awareness Week. Of the several dozen Vietnamese people I’ve asked about it, none knew it had happened at all, despite a 63-province national relay and a huge social media campaign.
An investigation by Tuoi Tre found pharmacists in Ho Chi Minh City who would even sell antibiotics for a customer’s friend or relative.
“You simply tell me about the symptoms and I will sell medicine to you. No need to have a prescription,” one reporter was told, after asking for medicine to treat a child who had stayed at home.
I spoke to a foreign doctor working at a private hospital in Hanoi, who lamented the state of selling pharmaceuticals in Vietnam.
“Prescriptions are shopping lists, no patient data is recorded and pills are often dispensed in unmarked blister packaging,” he said. “A pharmacy is a business first, so the only records they keep are to check how much money is being made. But until the culture of seeing a doctor as a last resort changes, I can’t see any big improvements coming soon.”
Some actions have been taken to try and reduce the abuse of antibiotics in Vietnam. In 2013, the Ministry of Health set up a committee for drug-resistance prevention, and in 2015 established a special unit to study the specific problem of antimicrobial resistance.
In 2014 an aide-memoire jointly agreed by several Vietnamese ministries, formed the basis of a national action plan to help raise awareness among health workers and the general public, improve the monitoring of antibiotic use and resistance, and nurturing safe and rational drug use and infection control.
One Minister of Health, Dr. Nguyen Thi Kim Tien, said her ministry would more vigorously enforce the regulations which oversee drug sales by pharmacies, and raise people’s awareness of using prescribed drugs.
The solution needs to start from the ground up. Certainly, there needs to be stronger sanctions against rogue pharmacists, but there also needs to be grass-roots education across all parts of society to ensure the wider public are aware of why this is an issue which can no longer be ignored.