From Plastic to Pathogen: Vietnam’s One Health Battle Against AMR in Urban Waters

By Dr. Ngo Thi Thuy Huong and Team 

Editor: Anti Rismayanti, SEAOHUN Regional Program Manager 

Antimicrobial resistance (AMR) has emerged as one of the most pressing threats to global health, with repercussions that ripple through hospitals, farms, communities, and natural ecosystems. In low- and middle-income countries like Vietnam, the challenge is compounded by overuse of antibiotics in human and veterinary medicine, poor waste management, and an evolving cast of emerging contaminants—including microplastics (MiPs). These tiny fragments of plastic not only persist in the environment but, as new evidence suggests, may act as vehicles for AMR dissemination.

Backed by the SEAOHUN 2024 One Health Research and Training (OHRT) Awards Program and rooted in the One Health framework, our team at Phenikaa University, in collaboration with the National Institute of Hygiene and Epidemiology (NIHE), set out to understand and mitigate the potential link between MiPs and AMR. Our project did not merely generate scientific findings—it mobilized students, engaged communities, and piloted a model for integrated environmental surveillance and action.

Implementing a One Health Vision: From Rivers to Reports

Our project was strategically designed around three major objectives: evaluating the presence of AMR and pollutants associated with microplastics, developing intervention tools based on wastewater-based epidemiology (WBE), and raising public awareness through education and citizen science.

Over six months, we collected 72 samples from high-risk sites in Hanoi—including areas near hospital discharges, wastewater treatment plant inflows, and small rivers receiving mixed urban waste. Field sampling was complemented by questionnaire-based surveys to assess public perception and behavior related to antibiotic use and pollution. Analytical methods such as FTIR spectroscopy revealed that polyethylene terephthalate (PET) and nylon were the dominant microplastics. These were not inert pollutants: we detected multiple resistance genes (blaTEM, blaCTX-M, SHV) and multidrug-resistant (MDR) organisms like Aeromonas spp., which thrive in contaminated water bodies and are known reservoirs of resistance.

Our metagenomic analysis revealed a disturbing trend—resistance genes were not isolated events but part of a pattern involving fluoroquinolone, beta-lactam, and elfamycin groups. Simultaneously, we documented elevated levels of cadmium (Cd) and lead (Pb), elements previously implicated in co-selecting for resistant strains. These insights supported our hypothesis that environmental stressors—including heavy metals and MiPs—create conditions conducive to AMR propagation.

Student-Centered Research, Experiential Learning, and Capacity Building

A key pillar of our implementation strategy was the empowerment of young scholars. Members of the One Health Student Club at Phenikaa University (OH.PU) played a central role throughout. These students weren’t mere observers—they were researchers, communicators, and change agents. Field trips were conducted biweekly, giving students hands-on experience in using sampling equipment, collecting water and sediment samples, and conducting basic analysis under supervision.

Three graduate students integrated project data into their theses, benefiting from access to cross-sectoral mentorship and advanced laboratory techniques. We also trained over 70 undergraduate students on survey design, data interpretation, and science communication skills. They practiced these skills by organizing and moderating public workshops, developing educational materials, and participating in podcast competitions that challenged them to explain AMR in creative, relatable ways.

This dual-track approach—strengthening technical capabilities while building confidence in public engagement—was central to our success. Students learned to translate scientific findings into real-world impact, fostering a generation of leaders who understand the interconnectedness of environmental, human, and animal health.

Engaging Communities in AMR Prevention and Environmental Stewardship

Beyond academia, the project’s influence extended deep into communities. A training workshop in Tien Tan Commune, Ha Nam province brought together over 140 participants—farmers, retirees, housewives, students, and public officials—to explore the implications of AMR and pollution on their health and livelihoods. Pre- and post-workshop surveys demonstrated increased awareness of antibiotic misuse, improved understanding of microplastic risks, and a shift toward more cautious health practices, including reduced self-medication.

Participants engaged in interactive sessions led by project scientists, who presented case studies, facilitated discussions, and introduced One Health concepts in accessible language. Meanwhile, a parallel campaign targeting students used podcasts and digital media to reach younger audiences across Hanoi. This initiative attracted participation from high schoolers and undergraduates, whose entries ranged from dramatized stories to interview-style narratives about AMR, reflecting both creativity and critical thinking.

By embedding scientific literacy into public discourse, the project created a feedback loop where knowledge generation and behavior change reinforced each other. This model is now being refined for replication in other provinces.

Bridging Research and Policy Through Wastewater-Based Epidemiology

At the heart of our research intervention is a proposed wastewater-based epidemiology (WBE) model. This data-driven tool analyzes patterns in AMR gene prevalence across water systems, using geospatial mapping to visualize hotspots and inform policy. Such a tool could become instrumental in early warning systems for AMR and potentially other emerging infectious diseases.

We are currently building a GIS-integrated dashboard that incorporates sampling data, resistance gene prevalence, metal concentrations, and population density. This system can be updated in real-time as more data become available, providing local authorities with actionable intelligence for environmental management and public health planning.

We envision future iterations of this model being linked with hospital and veterinary data to create a truly integrated AMR monitoring system—something Vietnam sorely needs as it strengthens its national response strategies.

Outcomes, Impact, and Sustainability

The outcomes of our project reveal a dynamic interplay between scientific discovery, behavioral transformation, and institutional strengthening. From a scientific standpoint, our investigations confirmed that microplastics (MiPs) can serve as carriers for antibiotic resistance genes, particularly in environments subjected to intense human activity. This finding reinforces the urgency of considering environmental contributors in national AMR strategies.

On a behavioral level, the project successfully influenced public perception and practices. Participants in our workshops—ranging from local community members to university students—demonstrated increased awareness of the risks associated with antibiotic misuse and environmental contamination. Follow-up surveys indicated tangible behavioral shifts, including reduced reliance on self-medication and more responsible attitudes toward antibiotic consumption.

Institutionally, the project strengthened the foundation for sustained One Health engagement at Phenikaa University. The One Health Student Club was revitalized as an active platform for student-led research, communication, and community outreach. Faculty members also benefited, using project outputs to develop new teaching tools and integrate AMR-related case studies into their curricula. These efforts have laid the groundwork for longitudinal research and the development of more comprehensive educational modules.

Looking to the future, the project is poised for wider impact. Plans are in motion to expand our workshop format to other provinces, targeting new communities and student groups across different academic disciplines. We also aim to launch an “AMR Roadshow” that will bring interactive, science-based education to high schools throughout Hanoi. At the same time, we are preparing a series of peer-reviewed journal articles and policy briefs to ensure our findings reach the broader scientific and policy-making community.

One of our most ambitious goals is to further develop and scale our wastewater-based epidemiology (WBE) model. With support from national agencies and networks such as VOHUN, we hope to refine this tool into a practical, real-time surveillance system that can inform public health decision-making far beyond this project's original scope.

Ultimately, this project affirms that AMR cannot be tackled in isolation. It is a challenge that transcends disciplines and sectors. But through collaborative, interdisciplinary efforts and sustained community engagement, we can begin to build resilient systems that safeguard both human and environmental health for the long term.

Reflections and Lessons Learned

Perhaps the most enduring lesson is this: real change begins when science meets storytelling. Our project was most impactful when data were shared through human voices—whether it was a farmer realizing the link between pig feed and antibiotic runoff or a student confidently explaining AMR to their peers. Flexibility, local relevance, and sustained follow-up proved essential to maintaining momentum and building trust.

Timing also played a critical role. Delays caused by exam periods and budget disbursement challenges reminded us to design projects that are both rigorous and adaptable. Yet despite these hurdles, our team’s dedication and the resilience of our community partners turned obstacles into opportunities.

In reflecting on this journey, we are reminded that AMR is not just a microbial issue—it is a systems issue. And solving it requires every tool at our disposal: science, education, policy, and above all, collaboration.

Conclusion

With the support of the SEAOHUN OHRT Awards Program and funding from USAID, our project has achieved more than its scientific goals. It has built bridges between disciplines, created new educational models, and planted the seeds for sustained community change. By addressing AMR at its environmental roots and involving young people in the solution, we are not only protecting ecosystems but empowering a generation to lead the fight against one of the 21st century’s most daunting public health threats.

Vietnam’s waterways may carry microscopic threats, but through integrated One Health action, they now also carry hope—and the momentum of a movement that is just beginning.

Team Leader :Dr. Ngo Thi Thuy Huong – Phenikaa University

Team Members:

• Dr. Le Thanh Thao – Phenikaa University

• Assoc. Prof. Dr. Hoang Thi Thu Ha – National Institute of Hygiene and Epidemiology (NIHE)

• Dr. Nguyen Thuy Tram – NIHE

• Dr. Nguyen Thi Hanh Tien – Phenikaa University

• Dr. Nguyen Quoc Dinh – Phenikaa University

• Ms. Pham My Dung – Phenikaa University

• Mr. Vo Hoai Hieu – Phenikaa University