Erry Setyawan, FAO, on Indonesian NAP: We need to work together to make it possible to manage AMR

2019-03-21

“Managing antimicrobial resistance should be done through integration and coordination of various sectors. It should not be merely led by the government, but also collaborated with private sectors, professional associations, academics and other non-governmental sectors. We all have to join hands together,” says Erry Setyawan, FAO National Technical Advisor in Indonesia, on implementing the National Action Plan on AMR in Indonesia.

Starting off his career as a veterinarian in 2000, Erry Setyawan has been working in animal health sector for more than eight years. He joined the Indonesian section of Food and Agriculture Organization of the United Nations (FAO) in 2010 and has been in charge of the Commercial Poultry Health for the USAID-funded Emerging Pandemic Threats program (EPT-2).

In a conversation with ReAct Asia Pacific, Erry Setyawan mentioned the importance of collaboration and communication in managing antimicrobial resistance (AMR) in Indonesia. Unfortunately, these two elements remain to be challenges that need to be addressed.

What motivated you to work in the animal health sector?

– I became a veterinarian because of my parents. They encouraged me to study in medical sciences. I graduated from the Faculty of Veterinary Medicine at the University of Gadjah Mada in Yogyakarta in 1999. I then developed my career in corporations, while at the same time practicing as a veterinarian. I worked for a Netherland-based company, then moved to Charoen Pokphand (CP) Group, and JAPFA.

What is your role in working on AMR in Indonesia?

– In 2010, I was offered to join FAO Indonesia for the layer chicken project in Yogyakarta. My involvement in antimicrobial resistance issues started in 2016 as it was part of EPT-2 project. Initially, when we planned for the EPT-2, no antimicrobial resistance component was included. However as the issue grew, and Indonesia was the chairman of Global Health Security Agenda (GHSA) in which antimicrobial resistance was one of the topics, FAO in Indonesia was requested to assist the Ministry of Agriculture on the AMR program.

– My main role in the EPT-2 is commercial poultry health and this is perhaps more related to antimicrobial use rather than antimicrobial resistance. In the EPT-2 project, the task force of antimicrobial resistance and antimicrobial use is a combination of two teams: poultry health and value chain. Because I am from the poultry health, my role is more focused on antimicrobial use on animals.

How does these projects aim to support on a governmental level and also on agricultural/farmer level?

– The activities of the FAO project include collaboration with the association of layer poultry farmers in conducting studies. From the farmers side, they feel the direct impact such as the increased productivity and immunity of their poultry from diseases. From the government side: helping in preventing the avian influenza outbreak that had happened since 2003. In addition, it also reduced the use of drugs (antibiotics) due to the reduced incidence of sickness among the chickens.

How do you perceive the implementation of the Indonesian NAP on AMR so far?What are the successes and the challenges?

– We envision AMR management as collaborative efforts. There should be at least coordination of the existing activities done by various parties. But in reality, we are still walking and working on our own sector. The coordination and communication elements were only carried out towards the end of the development of the National Action Plan (NAP) period. I believe it would be better if the activities done by various ministries were synchronized from the beginning.

– We all have to work together, and this is challenging for the Indonesian ministries. Ideally, the issue should be escalated to the higher level at the government, such as the President or Vice President offices, to secure commitment from the related ministries/institutions. Unfortunately, this has not happened in Indonesia. Even during the World Antibiotic Awareness Week in the past two years, although we have tried to collaborate with other organisations from the planning stage, at the end, each sector held its own activities/events. Although they have involved many sectors, but the collaboration, I felt, was “rigid” or “unnatural”.

Do you have an example when collaboration has worked well?

– One example of collaboration on antimicrobial resistance was the surveillance tricycles on ESBL e-coli (Extended Spectrum Beta-Lactamases) that were carried out by multi sectors: human and animal health, as well as the environment. The study took samples from human blood for human health, samples from chicken poultry products for animal health, and samples from the gutter and waste for the environment. The e-coli germs were isolated and their resistance were observed. This has become a joint activity among the three sectors.

What happened with the collaboration?

– This is still ongoing, and under the coordination of the Research & Development division at the Ministry of Health in Indonesia. The animal health sector is managed by the Veterinary Regional Office in Subang district, West Java province.

Do you see other actions needed that goes in line with the Indonesian NAP?

– In Indonesia, public understanding of indirect impact of antimicrobial resistance, such as poverty (as discussed in the World Bank report), should be improved. To me, it is even more difficult to relate it to an issue such as poverty if the public is not aware of the direct impact of antimicrobial resistance to human and animal health. Indirect impact is more difficult to comprehend. There should be two or three steps to describe one concept to another larger concept.

What stakeholders are engaged in the work of NAP implementation in Indonesia?

– We have many stakeholders engaged in the implementation of the Indonesian NAP, among others:

• the national government such as Ministry of Health, Ministry of Agriculture,
• the local government in selected provinces that partner with Ministry of Health or Ministry of Agriculture in implementing the activities in their respective provinces or districts,
• the academics of the universities involved in the studies funded by national government or international organizations,
• the professional associations (such as associations of pharmacists, pharmaceutical students, doctors, poultry farmers) involved in seminars, conferences, and other scientific events,
• the civil society organizations focused on antimicrobial resistance and/or patient education, such as YOP (Yayasan Orangtua Peduli, in English: The Concerned and Caring Parents Foundation) (who also is ReAct’s partner),
• the media involved in writing competition, or other media events on antimicrobial resistance held by the government and the tripartite and
• the university students (mainly from School of Medicines and School of Veterinary Medicines) involved in the public events or stadium general on antimicrobial resistance in their universities.

– Last week, the tripartite (WHO, FAO, OIE) discussed the country assessment and the new National Action Plan on AMR for 2020-2024. The planning started at the end of February.

What barriers do you find to reduce antibiotic use in farming in Indonesia?

– The implementation of biosecurity and management of poultry is the main “homework” for us. This includes modifying the theory/principles of biosecurity and management of farming into practical and applicable implementation, based on the real situation/condition in the farms. This to change long-standing habit of farmers and workers in maintaining the hygiene and sanitation, and adapting the management to become better.

The poultry sectors, especially the middle and low scales of farmers, still need to be exposed to the information and awareness on biosecurity and management.

The majority of poultry farmers are in the commercial scale (middle to low scale, and village poultry farmers). The farmers raise chickens due to the lack of options to make a living.

What can the government and community do to assure product safety and, at the same time, address AMR?

– Big companies of broiler suppliers have their own fostered poultry farmers. It should be the companies’ responsibility to assist the farmers on biosecurity. The government has the authority to create regulations to instruct the companies to assist the farmers in biosecurity management.

– The government of Indonesia has issued certification system called Veterinary Control Number (or NKV in Indonesian language) to ensure the quality and safety of food livestock origin, include chicken meat and egg. This certificate ensuring includes the residue of antimicrobial and microbial contamination in those products. The regulation was issued following the avian influenza cases several years ago. The consumers, restaurants or hotels can push the companies or suppliers to get this certification for food safety.

What would you like to accomplish in the future?

– Improved understanding and implementation of biosecurity and farm management among all poultry farmers throughout Indonesia. I want to see more intensive interaction between the government and the vets in supervising and assisting poultry farmers, particularly those from the independent and small scale farms.

What do you like to do in your spare time when you are not working?

– When I am not working I like hanging out with friends and relatives and play badminton.