Covid-19 and V-RESIST in Vietnam

Welcome to Contain This, brought to you by the Indo-Pacific Centre for Health Security, an initiative of the Australian Department of Foreign Affairs and Trade. This episode is hosted by Francette Dusan, Senior Advisor at the Centre.

In today’s episode, we speak to Dr Thu Anh Nguyen. Dr Thu Anh Nguyen is an infectious diseases and public health researcher. Her research focuses on detection and treatment of tuberculosis, HIV, hepatitis B and C, and more recently, Covid-19. You may recall we spoke to Thu Anh a year ago, about her work on V-Resist, a project addressing antimicrobial resistance in Vietnam. If you haven’t already, I suggest you pause now, and scroll back to August 2020 to listen to the previous podcast. You can find more information on V-Resist here:

https://indopacifichealthsecurity.dfat.gov.au/combating-emergence-and-spread-antimicrobial-resistant-infectious-diseases-vietnam-v-resist 

Today we catch up on Thu Anh’s work supporting the Covid-19 response in Vietnam, and how the response has intersected with other work on infectious diseases including tuberculosis. We chat about research partnerships, how these can work to generate evidence to inform country priorities and some of the lesson’s Thu Anh has learnt about leadership and communication. 

You can join the conversation via our social media channels. You can connect with us on Twitter via @CentreHealthSec and @AusAmbRHS.

Enjoy the episode.

Transcript

Contain This – COVID-19 and V-RESIST project transcript
with Thu Anh Nguyen, Project Manager, V-RESIST

In this, I think the biggest lesson learned is we need to plan for uncertainty, which is very difficult. But if you do not do that, then the cost is human life. The second lesson learned is COVID-19 is not a health problem. It’s a health problem, but is not the only problem- it’s the problem of the whole society, so all sectors need to come together, to work, to discuss, to develop a response plan that balance the need, and the benefit, as a whole, not only health response, I think it's very important.

Welcome to Contain This, brought to you by the Indo-Pacific Centre for Health Security, an initiative of the Australian Department of Foreign Affairs and Trade. I’m your host for this episode, Francette Dusan, Senior Advisor at the Centre.

In today’s episode, I have the pleasure of speaking to Thu Anh Nguyen. Dr Thu Anh Nguyen is an infectious diseases and public health researcher. Her research focuses on detection and treatment of tuberculosis, HIV, hepatitis B and C, and more recently, Covid-19. You may recall we spoke to Thu Anh a year ago, about her work on V-Resist, a project addressing antimicrobial resistance in Vietnam. If you haven’t already, I suggest you pause now, and scroll back to August 2020 to listen to the previous podcast. You can find more information on V-Resist via the link in our show notes. 

Today we catch up on Thu Anh’s work supporting the Covid-19 response in Vietnam, and how the response has intersected with other work on infectious diseases including tuberculosis. We chat about research partnerships, how these can work to generate evidence to inform country priorities and some of the lesson’s Thu Anh has learnt about leadership and communication. 

You can join the conversation via our social media channels. The links are in the show notes. Enjoy the episode. 

FRANCETTE:

Hi Thu Anh. Contain This previously spoke to you in August 2020. And you've been very busy since then, with already a number of publications published this year in 2021.

I'd like to ask first up how your work on the V-Resist project has changed since the outbreak of Covid-19 in Vietnam.

THU ANH:

Hi, Francette. Our work in the AMR project, the V-Resist project, has changed significantly. When the fourth COVID outbreak arrived in Vietnam recently, you know that the impact of the outbreak is severe. Several provinces in Vietnam has to be under lockdown. People cannot get out of the house. Therefore, all of the, almost all of the activities in the villages project has to be halted.

We have to delay all the activities. We have to move on. So our team decided to conduct several interventions related to COVID because with consultation with several stakeholders in the country and with DFAT and the Australian Embassy in Vietnam as well.

04:43

FRANCETTE: 
I think your work was, as I understand quite instrumental in providing some evidence for the types of interventions that were working and you were able to show what some of the needs were. Could you talk a little bit on what your initial findings were?

THU ANH:

Actually, we conducted serological surveys in the community where the outbreak of COVID occurred to provide evidence on the level of serological prevalence in the community. Also, to access whether the, the outbreak had spread further. And in the past three outbreaks, we were able to conduct a survey in seven places and found that the serology prevalence in the community was very low, at around 1%. I have to say that it is the only community-based serological survey in Vietnam so far and the result was used by different international organizations and was marked on the world map on serology prevalence in different provinces. And that provides a firm evidence for the government of Vietnam on how effective the COVID response was in the first three outbreaks. However, with the fourth outbreak, we haven't been able to conduct the survey because the need for rescue and for COVID treatment was so high.

06:53

And a second activity we were able to do is we work closely with the epi program, the vaccination program in Vietnam, to conduct a rapid assessment on the health system preparedness to scale up of the vaccine of COVID in Vietnam, and the report was provided to the Ministry of Health as well as international organizations in Vietnam. 

They have come together to establish stakeholder working group in vaccine. The report provides a key recommendation for Vietnam, including the need for development of local vaccine, the need to prepare for health, healthcare workforce, as well as infrastructure to step up the vaccine in the whole countries and the need to listen to the community need and acceptance of vaccine. You may know that by now, the vaccine acceptance in Vietnam is very high. Very, very high. And that what is lacking is the lack of COVID vaccine compared to the need.

08:16

So the report provides advice on how to implement the vaccination plus scale. And after completing the report, we also work with some provinces and provide a detailed suggestion or recommendation on how you form a team of health workers in the field to conduct a mobile vaccine campaign for the people in the community. We also conduct at a very early stage, the middle of last year, a study to look at the stigma related to COVID-19 and how it impacts on the public health response. Because we know that people who fear of COVID will hide their condition and will not share the information on contact; people who contact with them or even people who they contact with, and the stigma related to the isolation program.

09:26

Stigma related to people who have to stay in the isolation center, also matter on how public health may need to respond to that. As well as the need to keep the privacy information of COVID patient because previously, information on your name, where you go, even the address, age and how you got the COVID was exposed to the public. Many COVID patient were under depressed that impact.

10:00

So we provide a strong advice to the public health system in Vietnam that stigma related to COVID need to be taken into account when designing any public health intervention.

10:17

We also conduct a study on the evaluation on impact of COVID on the TB diagnosis and treatment in Vietnam, including the MDR TB patient as well and have the National Tropical Disease Hospital to evaluate or to, to conduct an analysis of the COVID patient’s information to also provide insight information on how to how to provide a better clinical management for the COVID patient.

10:59

FRANCETTE: 
That's a huge amount of work that you've, you've managed to achieve. And it sounds like it's certainly been very helpful to inform the government's policies in a number of different and significant areas.

You touch there on the impact of COVID and multi drug resistance or MDR Tuberculosis. Could you tell a little bit more about that, we understand that globally, the increase or the impact of COVID-19 on healthcare facilities has actually meant a large decrease in the number of TB cases which have been diagnosed and treated. Has there been the same trend in Vietnam?

11:50

THU ANH: 
Well, in the first three outbreaks, which means from last year and early this year, we found that COVID has not had a big impact on the TB program in Vietnam, there was light reduction of TB notification during the lockdown in April 2020 in August 2020,

12:18

but not later, and then the few months after the TB notification increased significantly. So, on average for the whole year, there was no impact. However, in the fourth outbreak, there was a severe lockdown in several provinces, particularly in Ho Chi Minh City, where the majority, about 40% of TB patients are in Ho Chi Minh City, we have seen around 70% reduction in TB notification, including MDR TB in the whole country. And we have seen, we haven't been able to collect all the data for analysis, but we continuously receive receiving the report on TB patient who cannot access to receive the tablet, the medication, as well as MDR TB patients who died during the COVID outbreak.

13:26

FRANCETTE: 
Yes, this fourth wave of COVID-19 infection in Vietnam has certainly had a huge impact. And Vietnam really was initially regarded as doing very well with COVID-19 and its initial response was very strong and appeared to have a lot of community support. But the next wave has proved to be more difficult. Could you discuss a little bit more how the government's per has adapted its response and how the healthcare workers are managing or doing their best in their current situation?

14:07

THU ANH: 
Yeah, I think that at the early stage of the fourth outbreak, COVID outbreak, the government's still implement the same approach as they did in the previous one. Because it is understandable because the previous strategy was proved to be success, however, Delta spread rapidly. And in a very short time, everybody's shocked with the increase in number COVID patient and the healthcare system was not well prepared to respond to that. So within a very, I think two weeks or so, four weeks, the government has to shift the health system from focusing on the

15:01

ICU patient. Even if we invest a lot of effort in rescuing ICU patients, still the mortality rate is very high. So, the government switched and invested all the resources they could to improve the treatment of COVID patient at the mild and moderate COVID patient to provide early treatment to import new medication to prevent the COVID patient to become severe. And that's why they save a lot of lives. And the mortality rate has been declined, as we seen, but in the peak of the outbreak was a very high mortality rate in Vietnam. And recently, the government are having a discussion on the reopening plan and the government accept to change from zero COVID strategy to adapt safely with the COVID-19 strategy. The strategy is under review and receiving comments from various organization. I hope that the plan will be approved in the coming days, perhaps next week, hopefully. And lucky us that we were able to inform in the process of the development of such plan to provide advice for the government. 

FRANCETTE

I think this has been a worldwide awareness of the need, even with strategies in place and strategies that have worked previously, to continue to monitor the situation and adjust your strategies and response as you need to, as the situation involves, evolves, I should say.

THU ANH:

Absolutely

17:07

FRANCETTE: 
In terms of COVID vaccination in Vietnam, I know there's been a strong push for this. How is the rate of vaccination at the moment? And does that mean that you and your partners have been able to transition back towards focusing primarily on antimicrobial resistance and tuberculosis?

17:30

THU ANH: 
Vaccination has been conducted rapidly in Vietnam. Very, very fast. On some days, we have seen over a million doses administered across the country and even in Ho Chi Minh City by the end of yesterday, around 95% of population, adult population got the first dose and 60 something percent got two doses, that's very high. However, there was an issue with the vaccination program the vaccine has with on the paper, elderly is prioritized, but when you get to implementation, this is very difficult for elderly to access vaccine. So, our team is working very hard on advocacy to the provincial level on the implementation of the vaccine priority strategy. And because we have seen some of the provinces ease the lockdown and we are having a discussion with the Provincial Department of Health on return to implement the AMR intervention because you know, during the COVID outbreak, many people in the community, , store drugs including antibiotics, and some people even got infection and worry that they couldn't come to hospital so they self-treat with the antibiotics. So, we are working with the Ministry of Health and having a draft of the guideline on how to use antibiotic at the district and community level. It is a National Guideline so it will be implemented across the whole country is not only the project provinces, we are in the process to finalize the guideline with the, taken into account the advice from doctors and various health experts in the country. We are also having a discussion with project provinces to collect baseline information on how antibiotic has been used at a district hospital where the AMR start, because when the patient go to the provincial level, higher level hospital, they already have an AMR situation. And we are struggling with importing, testing samples and all sorts of things to plan for the data collection but we hope that we can conduct the survey the baseline survey this month and start the pilot of the guideline next month in at least two provinces.

20:38

FRANCETTE: So that guideline is part of your intervention studies. I understand you have two parts to the studies, a community-based study and the health care facility study. So that intervention guideline is that for both of the studies?

20:58

THU ANH: The guideline is for the second study for the health system study. And I think that the movement of that study is very promising, because there was a very good engagement from Ministry of Health, as well as the University of Pharmacy in Hanoi, to research the process. And in regards to the study, the community-based intervention, we haven't been able to conduct intervention because there was still low vaccination rate in the project provinces, we need to work for at least 70%, or at least 50% of the population who got two dose vaccine, to start the intervention. However, we already have a plan, we already print the communication materials, we have involvement of all partners. So, I think that it will take less time for us to start such intervention.

22:03

FRANCETTE: You've mentioned your partners a number of times here, and I think that really points that the value, as you say, and the importance of having close relationships in any of this work that you do. And that it really is based on a number of partners working together. Could you talk a little bit more about this aspect and how you build up those relationships?

22:25

THU ANH: We have three groups of partners. The first one is the government authority, as such as Ministry of Health,Health Strategy and Policy Institute, the National Institute of Hygiene and Epidemiology, who leads this intervention, who share the same view with us and who work closely together with us to develop the strategy. So, when the project end, all the development work, will be engaged and included in the national plan. The second group of stakeholders of the partners is people who work in the province, including the People Committee who make decision and who, who make decisions on the health strategy and allocation of budget for the province, the Department of Health, who's in charge of the health aspect in the province. And we also work closely with provincial hospital, district hospital who prescribe antibiotic as well as the network of pharmacies in the province who sell the antibiotic to the people. In the third group we work with are the academic partners such as University of Pharmacy, or University of Medicine, who provide technical advice on how to develop the guideline how to use evidence, how to train people on the ground on the appropriate use of antibiotics.

24:12

FRANCETTE: 
We've seen that the Health Resources previously assigned to tuberculosis have been impacted and, in many cases, allocated to COVID-19 response. And that's understandable, given while tuberculosis remains a much greater killer than COVID-19. But the threat of COVID-19 has been very much more urgent. Have you seen the healthcare sector striking a balance between the two, or do you expect that this balance might be able to be met within the next year or so?

24:53

THU ANH: 
Yeah, I have to say that the problem is not only with tuberculosis, but also many other diseases. All the resources are now put into for the COVID-19. I hope that next year they will see a better balance or share funding for different programs. However, I have to say that we could look at this thing in a different point of view.

25:23

I think that all the investment or COVID-19 could be used for tuberculosis, such as the testing capacity, or capacity of health workers to respond to respiratory diseases, all the resources put into strengthening the health system could be used for tuberculosis, and COVID-tuberculosis share some many common characteristics. So, perhaps the TB program could integrate the COVID response into the program and to make it like respiratory response program or health system in Vietnam to attract more investment from the government.

26:08

FRANCETTE: 
Those are excellent points and a good way to look for, as you say, making the most use of the lessons that have been learned throughout the COVID-19 response. And I guess keeping the health system strengthening that has happened in response to COVID-19 and making the most of that going forward. What do you think are some of the biggest lessons learned during this time, about infectious diseases, but also about public health leadership?

26:47

THU ANH: 
I think that there are many lessons learned. In this, I think the biggest lesson learned is we need to plan for uncertainty, which is very difficult. But if you do not do that, then the cost is human life.

The second lesson learned is COVID-19 is not a health problem. It’s a health problem, but is not the only problem- its the problem of the whole society, so all sectors need to come together, to work to discuss, to develop a response plan that balance the need, and the benefit as a whole, not only health response, I think it's very important. The third lesson learn, I think, specifically for Vietnam, is the use of information, the use of data, scientific data, to inform decision on how to respond to COVID. And I think the fourth lesson is very important.  I think no one safe until everyone safe, so any decision made has to be based on increase the safety nets for everyone in the community. 

FRANCETTE:

Do you think there's been a greater recognition I guess, of the very strong public health leadership within Vietnam and the capability of the professionals, medical professionals in Vietnam such as yourself?

THU ANH:

I think that from my point of view, public health specialists are very important during this time, although we do not come to the front to directly rescue COVID patient, we are working on the background, but you know that if we could develop the right strategy, we save so many lives, and we save the healthcare workforce to not have to put too many resources to supply and people.  I think that in Vietnam, the public health sector has been considered as a very important stakeholders in making decision on COVID-19 response.

31:28

I hope that position a public health sector could be seen at a higher level could be seen as more important than now. There is a bigger need for public health specialists, at least like me, or many colleagues of mine, to, to go upfront, to work harder, to collect more evidence, to provide a better policy advocacy brief to the government, to try for the change based on the evidence for the government. We should not sit down and wait until people recognize us that we have to make people see us as important stakeholders in the whole National Response Team.

32:46

FRANCETTE: That that's some really great insight there. 

THU ANH:  I could give you some examples of the whole process that I have learned how to translate evidence, scientific evidence into very lay language for people in the community. At the beginning, I worked very hard to develop a dashboard of COVID-19 for the country. Actually, until now, many organizations are using data from our dashboard to make a plan and to make a data analysis for their own report. But then the dashboard is for scientific people, for people who know the numbers but not for the community. So the second step is I from the dashboard I develop a report to provide analysis on the outbreak, the cluster of the infection, provide warning of where the outbreak could occur and how to respond.  Our first report was like 10 or 20, page length, no one read it as a result.

After that, I learned the lesson. And I work with the journalists, I work with journalists from at least five biggest journals in Vietnam and ask them to help to translate the information into the lay language. And we work to get the day and night and we deliver hundreds of news on newspaper that change many policy and response in Vietnam. And at this stage, I go to a higher level, I work with a group of people who are used to work on policy advocacy, and I learned from them how to write one or two page of policy brief that could, in the language that the senior government officer understands and see the priority - view priority in the big picture of the COVID outbreak in Vietnam. And several report of ours reached the Prime Minister of Vietnam, that also provide change, initiate change in the response policy.

36:30

FRANCETTE: That's a fantastic story and a great stepwise approach that you've taken, I don't think you've been getting a lot of sleep over the last year or two, as you've been taking all of this forward Thu Anh.

THU ANH:

Yeah, you know, we cannot just sit there and wait.

FRANCETTE:

No, you have to be proactive. And I certainly think you've been showing that a very strong initiative. And I really look forward to you being able to resume the work on antimicrobial resistance and having as much impact on that side of things as well. So wishing Vietnam’s cases to continue to decrease, the vaccination rates and to continue to increaseand, and allow you to resume your work on antimicrobial resistance, and also on addressing the ongoing tuberculosis and drug resistance issues with tuberculosis.

37:39

Thanks so much for your time.

37:42

THU ANH: Thank you, Francette. And I would like to take this opportunity to thank you and DFAT and the Australian government, as a whole, to for supporting Vietnam, for so many years. And at least in our organization, we received so many funding for tuberculosis work, great work, as well as for COVID response. And millions of vaccine doses are sent to Vietnam in the right time. Really, it’s a only a good friend that do that. So, thank you very much.

FRANCETTE:

That was Dr Thu Anh Nguyen, speaking on Contain This. My name is Francette Dusan, and I’m thrilled you could join us for this important conversation. Make sure you subscribe, in order to be notified when our next episode airs. Catch you next time.