Thailand’s National Strategic Plan on Antimicrobial Resistance 2017-2021
Midterm progress in the implementation of Thailand’s National Strategic Plan on AMR 2017-2021
Thailand’s National Strategic Plan on Antimicrobial Resistance 2017-2021 (NSP-AMR) was endorsed by the Cabinet on 17th August 2016 as the first national strategic plan for tackling the problem of AMR in an integrated and coherent manner under the One Health approach. Two main reasons were behind the rationale for developing the NSP-AMR. First, actions taken to address AMR in the past were fragmented and lacked a clear direction, resulting in the continuous rise of AMR in Thailand. Second, AMR can be spread among humans, animals, and the environment and across countries’ borders. Thus, no individual country can solve the AMR problems alone. In 2015, the Sixty-eighth World Health Assembly (WHA) adopted a resolution on the Global Action Plan on Antimicrobial Resistance (GAP-AMR) and urged Member States to have their national action plans on antimicrobial resistance in place by 2017.
The NSP-AMR comprises five goals and six strategies. The Strategies 1-5 address AMR problems in specific areas whereas the Strategy 6 aims to facilitate harmonious collaboration and implementation across all strategies in order to achieve the national goals. The goals and strategies are shown below :
1. 50% reduction in AMR morbidity
2. 20% reduction in antimicrobial consumption in humans
3. 30% reduction in antimicrobial consumption in animals
4. 20% increase in public knowledge on AMR and awareness of appropriate use of antimicrobials
5. Capacity of the national AMR management system is improved to level 4*
1. AMR surveillance under the One Health approach
2. Regulation of antimicrobial distribution
3. Infection prevention and control, and antimicrobial stewardship
4. AMR prevention and control and antimicrobial stewardship in agriculture and animals
5. Public knowledge on AMR and awareness of appropriate use of antimicrobials
6. Governance mechanisms to develop and sustain AMR-related actions
Thailand, on behalf of the chair of G77 representing by the Prime Minister General Prayut Chan-o-cha, endorsed the Political Declaration of the High-Level Meeting of the United Nations General Assembly (UNGA) on Antimicrobial Resistance during the Seventy-first session of the UNGA in 2016. As a result, the Royal Thai Government (RTG) subsequently translated this policy into action by forming the National Policy Committee on Antimicrobial Resistance (NPC-AMR). The NPC-AMR, which is chaired by the Prime Minister or the Deputy Prime Minister who was designated by the Prime Minister, serves as the national governance mechanism for supervising and monitoring the progress of the NSP-AMR in an effective and unified way. Additionally, the Prime Minister presided over the launch of the “Thailand Marks the Spot to Stop AMR” mission at the Government House, which served as the official launch to drive the NSP-AMR forward. Later on, the Deputy Prime Minister (Admiral Narong Pipatanasai), on behalf of the chair of the NPC-AMR, led the Ministry of Public Health together with other 24 organizations to sign the Declaration of Call to Action against AMR, Thailand.
The NPC-AMR, chaired by the Deputy Prime Minister Admiral Narong Pipatanasai, established five subcommittees to drive strategies of the NSP-AMR. During the past two years and 10 months (January 2017 – October 2019), the NPC-AMR and its five subcommittees held a total of 12 meetings and endorsed 58 resolutions. It was found that most of the resolutions (over 90 percent) were taken into actions with clear progress and achievement. Moreover, the RTG supported the NSP-AMR implementation through the RTG-WHO Country Cooperation Strategy Program on Antimicrobial Resistance (CCS-AMR), which is a scientific platform to provide technical support and lubricate the effective implementation process of the NSP-AMR.
Prior to the NSP-AMR, there was neither the baseline data of national goals nor the monitoring and evaluation system. Thus, the initial phase of the plan’s implementation focused on the development of the monitoring and evaluation system as well as the establishment of baseline data of the national goals. The overall results are summarized below:
The 2017 baseline data is currently being developed in parallel with the integrated AMR surveillance system.
According to the Thailand Surveillance of Antimicrobial Consumption (Thailand SAC), in 2017, human antimicrobial consumption (AMC) accounted for 74.2 Defined Daily Dose (DDD) per 1,000 inhabitants per day. Antibacterials that are listed in the WHO’s Critically Important Antimicrobials (CIAs) accounted for 58.2 percent of a total antimicrobial consumption in human. Meanwhile, animal AMC was equivalent to 560 mg/PCU-Thailand. It was found that the top 10 antimicrobials are accounted for 86.7 percent of a total antimicrobial consumption in animal.
The National Health and Welfare Survey conducted by the National Statistical Office in 2017 revealed that over 27,000 Thai people surveyed, only 3 percent had correct basic knowledge about AMR and appropriate use of antimicrobials, whereas 22 percent did not have any knowledge and most of the respondents (75 percent) did not have enough knowledge.
In 2017, Thailand undertook an assessment by the World Health Organization (WHO) using the Joint External Evaluation Tool for International Health Regulation (JEE for IHR). The results showed that the overall capacity of Thailand’s AMR management system was average (with the scores between 2 and 4 out of a full score of 5). Specifically, Thailand has good capacity in AMR detection or laboratory-based AMR surveillance (Score 4), average capacity for surveillance of infections caused by antimicrobial-resistant pathogens (Score 3) and healthcare-associated infection prevention and control (IPC) programs (Score 3) and fair capacity for antimicrobial stewardship activities (Score 2).
In 2019, nevertheless, the Global Health Security Index – a report created by a US institution – established a global ranking of health security capabilities, with AMR being one of the health security indicators. The report indicated that for the AMR indicator, Thailand scored 75 out of 100 (with the global average score being 42.4), placing Thailand in the 22nd out of 195 countries.