Understanding the implementation of antimicrobial resistance policies in Vietnam: A multilayer analysis of the veterinary drug value chain

Reducing antibiotic use in livestock production has been a target for national action plans worldwide. The Vietnamese livestock plan issued in 2017 has, among other objectives, strengthened the regulatory framework for antibiotic use. While a progressive ban on prophylactic antibiotics in feed and the introduction of mandatory prescriptions have been introduced, the level of implementation of these measures remains unknown. This study explores the level of understanding, acceptance, and application of these regulations among veterinary drug value chain stakeholders. An iterative stakeholder mapping and analysis of the veterinary drug value chain was conducted in North and South Vietnam. We organized one focus group discussion in Hanoi with 12 participants and conducted 39 semi-structured interviews with governmental authorities, national research centers, foreign partners, and private stakeholders along the value chain. The discourses were analyzed to (1) map the veterinary drug value chain and interactions among stakeholders, (2) analyze stakeholder's technical and social capital regarding regulations, and (3) identify factors influencing their implementation. From the map of the veterinary drug value chain, we identified 30 categories of stakeholders. Based on the map, the capital, and the analysis of the discourse, we identified 10 factors that could influence their implementation. These factors included stakeholder perception of the new regulations, their level of knowledge, the availability of technical guidance, conflict of economic interest between stakeholders, scale-related management discrepancies, the technical and financial barriers to the implementation of the regulations at the local level, the presence of an informal distribution channel, international influence, consumer demand for food safety, and the willingness to reduce the burden of antibiotic resistance. It was clearly identified that new regulations are a necessary step to reducing antibiotic usage in Vietnam, but that the lack of local stakeholder involvement combined with technical constraints were barriers to their implementation. The study underlined the need for greater involvement of local stakeholders in the development of regulations as well as the need to mainstream innovations developed by small producers.