One Health Drivers of Antibacterial Resistance in Thailand

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Like many Overseas Development Assistance (ODA) countries, and particularly those in South and South East Asia, Health and well-being in Thailand is significantly undermined by the high prevalence of antibacterial drug resistance (ABR) in disease-causing bacteria found in humans, animals and the environment. ABR reduces the ability of doctors to treat infections with antibiotics and other antibacterial drugs, with an estimated impact on Thailand in 2010 of38,000 deaths and an economic loss of 1.2 billion US$. ABR rates continue to rise and its impact is rising in parallel.Because of the threat of ABR, the Thai National Strategic Plan on Antimicrobial Resistance (2017-2022) has been instigated. This will involve improved national surveillance for ABR bacteria to quantify the problem, initiatives to reduce the rates of infections and those to reduce the usage of antibiotics and other antibacterial drugs, which are known to select for ABR bacteria. However, even when this strategic plan starts to pay dividends, there will be much still to learn about ABR in Thailand, and in other ODA countries, as is also true for developed countries where ABR reduction strategies have been in place for some time.In this development project, we will build on partnerships we have already initiated between UK and Thai clinicians and academics. We will develop a consortium grant application to address knowledge gaps about ABR in Thailand, which we have identified through discussions between UK and Thai partners. The consortium will consider whether chemicals in the environment - present naturally or as a result of agricultural pollution (e.g. herbicide use) - can select for ABR bacteria. This would render strategies to reduce antibiotic use less effective in reducing ABR in a community where chemical pollution of the environment is common. We will also consider whether ABR bacteria circulate within local environments in rural Thailand, and will measure how this changes over time as the Thai National Strategic Plan on Antimicrobial Resistance progresses. We will perform research aimed at understanding key behaviours around antibiotic use by farmers, farm management practices, and how people make decisions around healthcare. We will use the information that we generate from the microbiology, genomic and chemical screens and the anthropological research to produce mathematical models that can be used to predict useful changes that can be made to reduce ABR in Thailand and other ODA countries. We will also help Thai policymakers evaluate the effectiveness of changes initiated through the Thai National Strategic Plan. Finally, we will develop technologies that will be used to streamline our research; technologies that may also be useful to help local communities tackle the problem of ABR.During the development project we will run a series of workshops in Thailand, which will be used to develop the details of our proposed research project and to identify the study sites we will use. These workshops will also give us the opportunity to share knowledge amongst Thai and UK ABR experts, and bring together a group of early career academics, to raise the knowledge base around ABR in Thailand. We will also discuss postgraduate education strategies, and public engagement events in Thailand. The development phase will also involve a comprehensive investigation of policymaking around ABR in Thailand, enabling us to tailor our consortium research project to the needs and knowledge gaps of these groups and individuals