I’m Heiman Wertheim, I’m a clinical
microbiologist, I'm a medical doctor trained in clinical microbiology, and I was
trained in the Netherlands and then I moved to Vietnam in 2006, to OUCRU in Hanoi and I
developed the unit there, and our main focus is drug resistant infections and a wide variety
of other diseases that we’re also studying. We started in 2006 focusing on
severe influenza infections, but we saw a lot of drug resistant infections
caused by bacteria – these people are failing antibiotics that we consider should work – and
then we re-focused the things we were doing on what is actually causing drug resistant
infections and what we can do about them. What we also saw, mainly, is that
people come into hospital for reasons unrelated to infections but because of
mechanical ventilation they get pneumonia, so the local immune system is damaged, then
they get a hospital-acquired infection which is drug resistant and these people
are failing standard therapies.
If you look at more of a community level,
the problem is that there is very little diagnostics being done, but we see people
coming into hospital with drug resistant infectious acquired in the community,
we diagnose them with resistant bugs, we think it’s really high but probably in
the community it’s a bit less of a problem, but still it’s there and we only see
in the hospital the cases that failed, so we really do not know clearly the burden
of drug resistant infections in the community. Even in the Netherlands which has one of
the lowest rates of resistance and lowest rates of antibiotic use, and also in the UK,
you see all the problems coming from outside: people travelling and coming back with
resistant bugs, and I have seen cases of that, so it’s really happening, it’s not like
something that may happen in the future it’s actually happening now, and so I don’t
think you can only focus on your own country, you really should be able to go where
it has the highest burden and try and do something there, because one way or
another it’s going to come to Europe.
That is why we’re studying drug
resistance in Asia, and I think it’s an important place to do something not just
on individual patients but also on policies, and really make a change not just for
Vietnam but a change for global health. The nice thing about Hanoi is that
it’s close to the Ministry of Health, so anything that we find
also has an impact on policy, so rather than focusing on just individual
patients or doing clinical trials, we also felt like we can actually engage with policy
makers and make a change on a larger scale.
The main change in our research in the last
5 to 10 years? We moved from hospital-based research into the communities, so we
are doing clinical trials and looking at how rapid diagnoses can help bring
down antibiotic use in a community. As you can see in the communities, if
you come in with an upper respiratory tract infection which doesn’t require an
antibiotic, by looking at a biomarker, a rapid test, rather than looking for a specific
pathogen, gives a result in 3 to 5 minutes, and we found that this was really helpful
in bringing down antibiotic use by 20%. This 20% reduction is probably an underestimate
because many primary health care centres were not always compliant because they had a stock of
antibiotics that they still needed to get rid of, which is very interesting because it shows
that we also have to take into account procurement procedures for these clinics,
and also look in those kinds of things.
We should fund this research as drug
resistance is a global health issue, it’s now called by the United Nations a global
crisis – you can’t just focus on our own country, you need to take a global approach, with
the knowledge and expertise that we have, work with the local people and strengthen
their capacity, make them feel responsible and engage them and make them take the lead,
and really do the things that they should do. In OUCRU, Hanoi, we work closely with the
National Institute of Health and Epidemiology which is the public health authority, so what
we do is focus on public health issues and how our work from the laboratory impacts on what
is happening with patients or communities.
For instance we had a measles outbreak,
even though the government says there’s a very good coverage for measles, we
saw through our prevalence data that people are not protected enough
which explained the outbreak, showing that the work we do in the lab can help
and make a change for public health, for instance..