Sunday, May 1, 2016

Vietnam - Asian nations see boom in working age population

Demographic changes in Asia and the Pacific region are occurring at unforeseen rates. An explosion in the working age population and a fall in birth rates - changes that are expected to take a century in Europe and North America - could occur here in just 30 years.

If countries do not start planning for the demographic change, they will miss out on opportunities to boost growth and investment in the future, said Bakhodir Burkhanov, United Nations Development Programme Deputy Country Director in Việt Nam, at the launch of the 2016 Asia-Pacific Regional Development Report yesterday.

The report, entitled “Shaping the future: How changing demographics can power human development”, found that Asia-Pacific countries now have more working-aged people and fewer dependents than at any other point in history, providing a springboard for growth.

About 68 per cent of the region’s population is at working age, and only 32 per cent are dependents.

“When countries have a greater share of people who can work, save and pay taxes, they have the potential to transform their economies and power investment in health care, education and other building blocks of future prosperity,” said Thangavel Palanivel, lead author of the report.

The report called for an immediate response and outlined actions for sustainable development.

As Việt Nam is at the end of the middle stage of transitioning to an ageing demographic, the country’s biggest challenge is to capitalise on its remaining demographic dividends and prepare for the demands of an ageing population, experts at the meeting said.

Richard Marshall, Policy Advisor for the UNDP, said Việt Nam should focus on improving productivity and creating quality work.

He suggested that the country mobilise savings, invest in productive sectors and ensure gender equity within labour market.

It is necessary for the Vietnamese Government to accelerate social protection reform, especially pensions, he said.

He advised the Government to focus not only on technology transfer, but also wider education, skills training and health care reforms.

Dr Nguyễn Quang, Programme Manager of the United Nations Human Settlements Programme in Việt Nam, said despite the fact that urbanisation was considered low in Việt Nam compared with other countries in the region, much attention should be paid to the management of cities.

Once cities are well-managed, it would be a great source for the country’s development, bringing about high production values and productivity as well as more employment, he said.

Although the country is benefiting from the “golden age” population, it will last a short period of time. Therefore, Việt Nam should prepare for an ageing population. The country should invest more in healthcare and education, and create jobs for young people, he said.

Quang also emphasised the need to take advantage of senior citizens’ knowledge for research activities and consultancy related to policy making programmes. Senior citizens should be encouraged to associate their activities with recreation and the community, he said.


Vietnam - Health sector highlights disease, ageing population

VietNamNet Bridge – Viet Nam still faces long-term threats including A/H7N9 bird flu and new infectious diseases such as Ebola, Zika, Middle East Respiratory Syndrome (MERS) and other problems such as high blood pressure, diabetes, cancer and unsafe food.

Associate Professor Nguyen Cong Khan, director of the Department of Science, Technology and Training under the Ministry of Health (MoH), made these remarks at the national scientific conference on public health, which was held yesterday (April 25) in Ha Noi.

In a presentation, Khan said that high blood pressure increased from 1.9 per cent of the total population in 1976 to 27.2 per cent of the total population in 2008.

More than 78,400 enterprises violated food safety and hygiene regulations last year, and measles and dengue fever are at high risk for outbreaks.

In addition, only half of pregnant ethnic minority women received regular pregnancy examinations, he said.

Le Vu Anh, president of the Vietnam Public Health Association, said another problem is that the country’s ageing population is quickly increasing, and geriatric care is not up to par.

Ten per cent of the elderly had to live in temporary houses, especially in central and southern provinces, while only five per cent of them had pensions.

A total of 95 per cent of the elderly suffered from chronic diseases, and many suffered from more than two diseases.

Professor Nguyen Viet Tien, Deputy Minister of Health, said that going forward, public health researchers should focus on health insurance and hospital administration, non-infectious and infectious diseases, food hygiene and safety, and geriatric health.

Treatment should go hand-in-hand with prevention, Tien said, adding that an overarching health information system should be set up.

Universal health insurance and health equality should be promoted to ensure that everyone can access health care services, he said.  

Le Vu Anh suggested that the elderly be encouraged to join community activities to improve their health.
Through these activities, the elderly could learn from each other, help each other and contribute to the community’s development, he said.

The elderly would feel that they were respected and would be in better physical and psychological condition, he added.

During the national conference, experts from the MoH and non-governmental organisations, lecturers, researchers and postgraduates in the public health sector shared public health results and discussed ways to apply scientific research to real situations.

Vietnam - Health Ministry warns malaria outbreaks could be more complicated in Vietnam this year

The Ministry of Health has warned that insecticide-resistant mosquitoes have appeared in the country and are liable to spread.

The ministry predicted that combating malaria will likely be more complicated this year, with the number of cases increasing both in areas where the disease used to be common and in places where cases had not previously occurred.

Director of the National Institute of Malariology, Parasitology and Entomology (NIMPE), Tran Thanh Duong, said on Tuesday that malaria had been greatly reduced since 1991. In some cities and provinces there have been no cases reported in recent years.

Disease prevention work produced encouraging results last year. The number of people contracting the malarial parasite decreased sharply against previous years.

The number of malaria patients nation-wide last year was reduced by 31 per cent against previous years, with only three deaths reported.

In 2015, city and provincial authorities mobilised financial and human resources to implement disease discovery, diagnosis and treatment for patients.

Local authorities took the initiative in preventing mosquitoes from breeding, killing their larvae and disseminating methods for people to protect themselves from malaria.

The director said that disease prevention work faced difficulties in remote and poor areas, where people still slept in fields in the mountains over-night without mosquito nets.

There was the additional threat of malaria spreading via those who travel and trade at border areas with Laos and Cambodia. Also, there were increasing numbers of Vietnamese labourers going to Africa and countries where malaria and medicine-resistance parasites are endemic.

The State budget for malaria prevention programmes is limited and sources of international aid for the problem have decreased.

The Preventive Health Department reported that the health sector strives to reduce the ratio of people contracting malaria to under 15 people per 100,000 in the 2016-2020 period.

The department continues to maintain and develop grassroots prevention health workers and expand effective working models in high-risk areas.


Saturday, April 30, 2016

Vietnam - Cervical cancer cases cut in half in last 30 years: experts

The number of cervical cancer cases in Việt Nam has fallen by half in the last 30 years thanks to a nationwide network of health facilities providing gynaecology screening, according to Professor Nguyễn Chấn Hùng, chairman of Việt Nam Cancer Association.

Hùng told Việt Nam News that gynaecological examinations and tests for the presence of precancerous or cancerous cell on the cervix were available at most health facilities in the country.

In addition, people’s awareness of the need for regular examinations and tests also improved,  he said. 

“Patients can get more timely treatment to prevent the development of cancer, which has resulted in a drop in cervical cancer,” he added.

Vaccinations, which are given to women under a certain age, have also reduced the incidences of cancer, he added.

According to International Agency for Research on Cancer’s Globocan 2012, a report on incidences, mortality and prevalence of cancers in 184 countries, showed that Việt Nam had a lower prevalence of cervical cancer than many other countries, including Cambodia, Myanmar and others in the region.

“People should not be too anxious about this cancer because with early diagnosis and treatment, the rate of recovery is 80-90 per cent,” he said.

However, it should not be disregarded, Hùng said. Whenever women have excessive vaginal bleeding, they should visit a doctor.

According to a report from Globocan 2012, Việt Nam reported 5,146 new cervical cancer cases in 2012.

Speaking at a conference about cervical and ovarian cancers held on Saturday in HCM City, Dr Vũ Văn Vũ, head of medical oncology ward No 1 at HCM City Oncology Hospital, said: “Cervical cancer still is a challenge for the country, and HCM City.”

The cancer still is one of the leading causes of death among women¸ with more than 2,400 dying each year.

In cases of late detection, the five-year survival rate is only 16 per cent.

Increasing survival rate

Late last year, the drug bevacizumab, which the Ministry of Health approved to be used in the country, began to be used with chemotherapy. It has helped increase the survival rate for patients in the last stage of cancer.

In 2014, the US Food and Drug Administration approved bevacizumab solution for intravenous infusion in combination with chemotherapy.

At a conference held by the Việt Nam Cancer Association in co-operation with HCM City Oncology Hospital and HCM City representative office of Hoffmann-La Roche, Dr Mary McCormack, consultant Oncologist at London’s University College Hospital, said that doctors should note side effects and have careful patient selection before treatment.

Adverse complications such as wound healing, hypertension and thrombosis can also be avoided by appropriate planning for treatment, she said.

In Việt Nam, the drug and chemotherapry combination is used for treatment for patients in the last stage of cancer, including ovarian cancer.

Ovarian cancer

The Globocan 2012 showed that Việt Nam had 1,229 new cases with ovarian cancers in 2012.

The prevalence of ovarian cancer was the lowest in the region.

However, most cases of cancer are detected in the last stage because ovarian cancer often has similar symptoms to digestive diseases.

Hùng said that the cancer could occur at any age, including children.

He said women should have periodic health check-ups, including abdominal ultrasounds which are one of the ways to detect tumours in ovaries.

Even if tumours are noncancerous, they should be watched by doctors frequently, he said.

“Tumours can reoccur, and become worse,” he added.


Vietnam - Vietnam's vaccine scandal calls for action

After a month of exhaustive coverage of the vaccine scandal in China, the facts of the story have crystallized as have theories about how nearly $90 million worth of expired or improperly stored doses could have reached consumers. But little attention has been paid to Vietnam where a similar scandal is unfolding, albeit on a smaller scale.

In China, blame has been placed on the country's fragmented vaccine supply chain. In particular, criticism has been leveled at the lack of regulation of cold chain distribution, leading to vaccines routinely being stored below or above the optimal temperature range of 2-8 C. Some commentators add that the Chinese Communist Party leadership deserves criticism for choosing to invest in an increasingly draconian security and censorship infrastructure but neglecting regulatory agencies such as the woefully understaffed China Food and Drug Administration.

In Vietnam, parents have been putting off vaccinations for infants following the deaths of 20 babies over the last four years linked by the media to the 5-in-1 Quinvaaxem vaccine, manufactured in South Korea and distributed in Vietnam by Berna Biotech Korea as part of Vietnam's National Immunization Program.


Hong Kong’s Zuellig Pharma provides cold-chain storage in Vietnam
but a thermometreprovided to a HCMC pharmacy shows the temperature inside reaching a steamy 30C.

Like other vaccines distributed through the program, Quinvaaxem is free to patients, but parents across the country have either decided to let their children go without it, potentially exposing them to diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b, or pay $24 per dose for Pentaxim, an alternative manufactured by France's Sanofi Pasteur.

As in China, a lack of cold chain facilities has been cited as a key reason for spoilage of the Quinvaaxem vaccine. The World Health Organization has tested Quinvaaxem and proclaimed it safe, implying that whatever dangers arise from its use occur between its South Korean production site and the administration of the vaccine.

Moreover, as noted by Vincent Goulard, managing director of IPS Vietnam, a pharmaceutical consultancy, cold chain storage is almost nonexistent except for facilities run by international companies such as DKSH Vietnam and Zuellig Pharma. However, these foreign companies do not handle government vaccines, which are controlled by the Ministry of Health and public hospitals. It is not unusual, in domestic supply chain practice, to see drugs sitting on the pavement, negating the benefits of cold storage in public hospitals and clinics.

As in China, Vietnam's vaccine troubles are taking place against a background of systemic healthcare problems. The country's healthcare system is characterized by overburdened hospitals, a lack of public trust in domestically made drugs and a fragmented pharmaceutical supply chain that shields irresponsible suppliers from supervision.

Some see this neglect of the healthcare system by the Vietnamese Communist Party as a political choice, similar to the one that has held back the development of China's healthcare system; in both countries, economic growth and the protection of party interests have taken precedence over healthcare system development. In this context, the problems will get worse before they get better.

Similar situation

It is easy enough to draw a public health analogy between China and Vietnam. Both have focused policymaking on economic development at the expense of social services and have allowed political cronyism and corruption to dominate the government apparatus, leading to eerily similar results in the healthcare industry.

Both countries' leaders are facing politically damaging vaccine scandals and a further erosion of public trust in domestic drug manufacturers and suppliers. The public cannot be faulted for questioning the safety of vaccines in countries that have 21st century economic ambitions but have neglected to upgrade their mid-20th century healthcare infrastructure.

For foreign pharmaceutical companies, Vietnam's ability to prioritize the strengthening of its healthcare delivery system and its drug and vaccine supply chains will be critical to their long-term success. Vietnam is one of the last places where pharmaceutical market growth is projected to remain in double-digits over the medium term, a prospect that will be solidified once the Trans-Pacific Partnership, the wide-ranging trade agreement between Vietnam, the U.S. and 10 other countries, has been ratified.

With a young population and with operating rights for foreign pharmaceutical companies still newly granted, Vietnam's pharmaceutical market is only beginning to take off. Virtually all its problems mirror those of China 15 years ago, when foreign companies enjoyed preferential treatment in the tendering process, the population was still relatively young and the middle class was quickly expanding.

Foreign pharmaceutical companies went wrong in China by chasing profits rather than pursuing global-standard sales practices. Companies and Chinese hospitals focused on increasing profits from drug sales while the government turned a blind eye to the failing healthcare system. Against this backdrop, all the problems of the healthcare system were projected onto foreign companies, making them easy political targets.

A series of hardline government inquiries into pharmaceutical companies began in the summer of 2013 when several executives of U.K. group GlaxoSmithKline were arrested on charges of bribing doctors to prescribe certain drugs. The move was widely praised by the Chinese public, but condemned by the foreign business community and foreign press. Several GSK executives were convicted in 2014.

By 2015, growth projections for foreign pharmaceutical companies operating in China had been significantly revised amid swelling fines doled out by local regulators and the risk of anti-corruption penalties in jurisdictions such as the U.S. and the U.K.

Whether the future of foreign companies in Vietnam will mirror the fate of those in China may depend not on the two markets' similarities, but on one key difference: Unlike China, Vietnam is heavily dependent on imported raw materials to manufacture drugs and vaccines.

This dependence makes it more accountable to foreign healthcare organizations than China is. Consequently, the international community may be able to put pressure on Vietnam to prioritize its cold chain vaccine practices and to invest in its broken healthcare system. If foreign companies feel unable to do this, the job should be given to diplomats who have access to Vietnam's decision-makers.

The need for healthcare diplomacy must be taken seriously. The international community must use a combination of pressure and aid to assist Vietnam in speeding up the development of cold chain capacity and healthcare system reform. Otherwise, foreign pharmaceutical companies, lumped in with other corrupting influences that have made healthcare inaccessible to most, will acquire an insurmountable reputation as corruptors in the minds of Vietnam's citizens.

In the wake of TPP, there is a real risk that concessions won by foreign pharmaceutical companies -- the elimination of import taxes and a more level playing field in bidding against domestic drug manufacturers for public tenders -- will become politically toxic.

That might make the concessions ineffective in practice, even if they remain in force on paper. Companies from the U.S., U.K. and Japan are providing good, safe products, but rising foreign pharmaceutical profits in the face of ever-worsening drug and vaccine access for Vietnamese citizens would leave a sour taste in the mouths of many.

Such an outcome could potentially derail the sales operations of pharmaceutical companies in Vietnam more quickly than was recently witnessed in China. On the other hand, the government's susceptibility to foreign lobbying creates the potential to save foreign companies from the fate that befell them in China.

Which of these outcomes occurs depends on the willingness of Vietnam's international allies to push for immediate reforms in the healthcare system and the pharmaceutical supply chain.

Damjan DeNoble


Vietnam - US helps Vietnam train field epidemiologists

A graduation ceremony for two classes of the Field Epidemiology Training Program (FETP) was held within the framework of the fourth annual National Field Epidemiology Training Program Scientific Conference in Da Nang last week.

FETP in Vietnam is a two-year program led by the Ministry of Health's General Department of Preventive Medicine aimed at building trained epidemiologists who can rapidly respond to epidemics and other public health events, the U.S. Embassy in Hanoi said in a press release.

The program, supported by the U.S. Centers for Disease Control and Prevention (U.S. CDC), World Health Organization (WHO), Training Programs in Epidemiology and Public Health Interventions Network, and South Asia Field Epidemiology and Technology Network.

There are currently 22 field epidemiologists who have completed the program since FETP was established in Vietnam in 2009.

FETP fellows have contributed to public health in Vietnam through their involvement in outbreak responses such as cholera, avian and pandemic influenza, and hand foot and mouth disease.

During the program, fellows conduct independent research studies which are then used to inform timely and effective disease outbreak responses.

Research topics include zoonotic diseases transmitted from animals to humans, food-borne diseases, vaccine preventable diseases and immunization, HIV/AIDS and other communicable diseases.

“FETP fellows are at the frontline of any strong public health system,” said Dr. Anthony Mounts, country director of the U.S. CDC in Vietnam. “When an outbreak occurs, such as in the recent Zika virus cases in Vietnam, they are the ‘disease detectives’ that go into the field and investigate the outbreak.”

“Through the program, they receive hands-on training and mentoring in the use of scientific approaches to identify causes and trends of public health issues,” Dr. Mounts said.

An induction of the seventh class of FETP fellows and the launch of an alumni network to strengthen information sharing and training of FETP alumni also took place alongside the graduation ceremony.

Organized by the Vietnamese Ministry of Health's General Department of Preventive Medicine, the three-day scientific conference starting on April 22 gathered over 100 public health leaders in Vietnam, including international participants from the U.S. CDC, WHO, and FETP fellows from Australia, the Philippines, and Indonesia.

It also showcased over 35 public health research projects from national, regional, and provincial public health institutes in Vietnam.


Tuesday, April 26, 2016

Vietnam - Vietnam veterans want action for Agent Orange exposure

Two bills aimed at helping victims, families

DES MOINES, Iowa —Some local Vietnam War veterans want lawmakers to help people exposed to Agent Orange, a carcinogenic herbicide used during the war.

The herbicide is now linked to 14 diseases, including prostate cancer and Parkinson's disease. The diseases can be passed on to veteran's children through their DNA.

Veterans and their family members shared their stories at a symposium Saturday in Des Moines.

Jill Monson of Clear Lake said she needs a cane to walk. She's only 44 years old, but doctors told her that her bones have a different age.

"About a 100 (years old). I lost about 60 to 70 years of bone in two years," Monson said.

Severe osteoporosis, cancer, seizures and a heart attack are among the complications she has faced. Monson said it's all linked to her father's exposure to Agent Orange during the war.

"I always thought I was a very unhealthy person and really never knew why," Monson said. "It seems the more I'm reading, the more connections I'm finding with my problems and I'm seeing my daughter's problems as connections."

There are two bills in Congress, HR1769 and S901, aimed at helping affected veterans and their families. The Senate bill is known as the Toxic Exposure Research Act.

"We have some issues that need to be dealt with, not just the research and finding cures, but the funding so we can compensate those that have been seriously affected," said Dan Gannon, commissioner of the Iowa Commission of Veterans Affairs.

About 300 people signed a petition for Sen. Joni Ernst to sign S901. Organizers said Sen. Chuck Grassley and all the other congressmen have already signed.

Monson said the issue is a fight for her family's future.

"As a mom, like I do each and every day I fight for justice for (my daughter) and I will continue as a mom, just like I'm here with my dad,” she said.


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