1 Risk analysis in Vietnam: Current status and ways forward Tran Thi Tuyet-Hanh, Hung Nguyen-Viet, Phuc Pham-Duc and Nguyen Thi Trang Nhung Annual meeting of the Taiwan Society for Risk Analysis 28 July 2023 1 Outline Challenges for risk analysis in Vietnam Risk analysis training and research status in Vietnam since 2010s Future collaboration opportunities 2 Challenges for risk analysis in Vietnam in recent decades Growing concern about food safety: lack of confidence and trust of consumers  “What to eat in order not to be death?” Drinking water supplies, sanitation, waste management Severe air pollution in major cities, dioxin at hot spots Impacts of Climate change and sea level rise Zoonotic diseases, emerging and re-emerging infectious diseases Rural-urban migration and EH/PH challenges... Risk communication activities have been poorly implemented; mainly done by uncontrolled, untrained mass media, social media 3 Related ministries in EH risk management Ministry of Health General Department of Preventive Medicine and its provincial departments Health Environment Management Agency and its provincial departments Ministry of Natural Resource & Environment Ministry of Agriculture and Rural Development Ministry of Trade and Industry  Challenges: limited capacity in risk assessment, risk communication, and lack of strong integration and coordination between ministries in EH risk management Challenges for risk analysis in Vietnam in recent decades (cont.) 4 2. Risk analysis training and research in Vietnam since 2010s No undergraduate or post-graduate training on Environmental Health in Vietnam MPH, BPH programs at HUPH: 3 credit elective course on “Environmental Health Risk Assessment and Management” ~10 Master thesis projects on risk assessment in 10 years at HUPH. MOH, MARD, WHO: Short training courses on risk analysis, food safety risk analysis, infectious diseases risk analysis, risk communication etc. Food Safety Law 2010, Chapter VIII, Part 2 (articles 49-51): Risk analysis for food safety. 5 6 2. Risk assessment textbooks 7 2. Risk analysis training and research in Vietnam since 2010s (cont.) Risk assessment Salmonella risk pathways developed for producers, slaughterhouse and consumers Quantitative RA (risk for consumer) Chemical risk assessment 1275 samples (farms, SH, market) collected during 1 year PigRISK: Pork safety in Vietnam (2012-2017) Farm Transportation to SH Slaughterhouse Consumers Retailer Feed in bags, remaining feeds at the cages, environment Pork Liver Kidney Consumption survey PigRISK - chemical hazards 514 pig feed, kidney, liver and pork samples were pooled into 18 samples were analyzed for antibiotic residues, β-agonists, and heavy metals, compared with current regulations. Presence of banned substances (e.g. chloramphenicol, salbutamol) Most of the samples: were negative or did not exceed the current MRL Risk misperception: what people worry about and what makes them sick are not the same: Chemical risk is low; Salmonella risk is high 9 Tuyet Hanh et al, 2016, IJPH SafePORK - Cross-sectional study: ILRI, CENPHER 2017-2022 Sample size: 671 raw pork samples Traditional pork shops: 266 shops Modern pork shops: 123 shops Food services: 77 stalls Data collection: 1-5 pork sample per shop Food safety condition Laboratory testing Salmonella presence: 671 samples TBC (Colony forming units (CFU)/g): 177 samples Methodology Results Salmonella prevalence TBC exceed standard Traditional 60.5% 97.3% Modern 50.9% 88% Food service 80.5% 94.6% Overall 58.1% 93.8% Associated factors to microbial contamination: Traditional shops: Use separate cloths Sewage or stagnant water Transportation time Modern shops: Selling many types of meat Storage temperature INTERVENTION Results at SH Grid Hand disinfection liquid Faucet Installed grid Re-organized water and electrical system Training for SH owners & workers Food safety intervention at slaughter in Vietnam Photo credit: Sinh Dang Xuan/Chi Nguyen ILRI 2020 Handbooks INTERVENTION Development of Instruction & Training materials Food safety intervention at slaughterhouse and retail (2018-2022) Approach: Participatory risk-assessment Supportive formative research with model retailers Risk communication Key content*: -Grid slaughter -Frequent washing (and disinfection) -Training -Separation clean/dirty -Branding Key content: -Easy to clean surface -Frequent washing (and disinfection) -Separation (fresh/cooked) -Training -Hygienic cutting board -Branding *only Vietnam Wastewater reuse and food safety Health and environmental issues & livestock? Crop Livestock Fishery Nguyen-Viet et al, 2014 Risk assessment: Vegetables and fish from wastewater in Hanam province High risk from eating morning glory and tilapia (diarrhea risks due to E. coli 13%, G. lamblia and C. parvum: 0 – 23%, respectively. Highly contaminated Pb level, but low risk for tilapia Local people seem to know the risk They sell contaminated vegetables and fish to other towns Truc et al. (2014) EH risk assessment and risk management of dioxin Bien Hoa and Da Nang airbases: storages for AO & other herbicides; spills occurred several times. 2/7 severe dioxin hot spots in VN 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in soil, mud, food, blood and milk samples were high (Hatfield Consultants 2006, 2009, 2011; Arnold Schecter et al. 2003…) Local residents living at dioxin hot spots are at high risk of being exposed to dioxin in the environment, especially in foods (Tuyet-Hanh et al. 2010). © Tuyet-Hanh Tran et al. 2015 High risk foods: local freshwater fish, snail, free-ranging chicken meat and eggs, free-ranging duck meat and eggs, beef. If consuming local high-risk foods: Estimated DI = 60.4 to 102.8 pg/kg bw/day (Bien Hoa) Estimated DI = 27.0 to 148.0 pg/kg bw/day (Da Nang). > TDI recommended by WHO (1-4 pg/kg bw/day) If consuming foods originate from other areas: Estimated DI = 3.2 to 6.2 pg/kg bw/day (Bien Hoa) Estimated DI = 1.2 to 4.3 pg/kg bw/day (Da Nang) TDI: Health Canada (10 pg/kg bw/day); WHO (1-4 pg/kg bw/day).  Risk communication and risk management programs Environmental remediation projects In Da Nang dioxin hot spot: 110 million USD (2012-2018) In Bien Hoà dioxin hot spot 390 million USD (2019-2028) Risk characterization © Tran T. Tuyet-Hanh et al. 2015 16 Health burden relating to exposure to ambient air pollution in Vietnam: Nguyen Thi Trang Nhung et al. 2012 2018 2019 2020 2022 One of the first reports health effects of air pollution in Vietnam Use data at Vietnam National Children’s hospital (2007-2014) Use data at Vietnam National Children’s hospital (2007-2016) Use data at multiple hospitals from Ha Noi, Phu Tho, and Quang Ninh One of the first health impact assessment of air pollution in Ha Noi First health impact assessment of air pollution in multiple provinces of Viet Nam First health impact assessment of air pollution for all Viet Nam Policy translation: food safety risk analysis Meeting with DPM Vietnam, 2 Dec 2016 2011 2012 2016 Meeting with VFA, Photo: CENPHER Meeting with DAH Photo: CENPHER The recent FSRA technical group was established on 27/4/2023 by MOH Members: researchers, managers from agencies under the MOH, the Ministry of Industry and Trade and MARD. Some organizations interested in/support risk analysis in Vietnam 3. Future collaboration opportunities Training & capacity building Joined research projects on risk assessment, communication and management. 20 21 Tran Thi Tuyet-Hanh, Nguyen Hung Minh, Le Vu-Anh, Michael Dunne, Leisa Toms, Thomas Tenkate, Nguyen Thi Minh Hue, Fiona Harden (2015), Environmental health risk assessment of dioxin in foods at the two most severe dioxin hot spots in Vietnam. International Journal of Hygiene and Environmental Health. Volume 218, Issue 5, July 2015, Pages 471–478. http://dx.doi.org/10.1016/j.ijheh.2015.03.014. Tran Thi Tuyet-Hanh, Le Vu-Anh, Michael Dunne, Leisa Toms, Thomas Tenkate, Fiona Harden (2015), Dioxin risk reduction program at the most severe dioxin hot spot in Vietnam: residual knowledge, attitude and practices five years post intervention. Global Public Health: An International Journal for Research, Policy and Practice, DOI: 10.1080/17441692.2015.1062904 Tung Bui Huy, Tran Thi Tuyet-Hanh, Richard Johnston, Hung Nguyen-Viet 2014. Assessing Health Risk due to Exposure to Arsenic in Drinking Water in Hanam Province, Vietnam. Int. J. Environ. Res. Public Health 2014, 11, 1-x manuscripts; doi:10.3390/ijerph110x0000x Anh T.K. Bui, Ha T.H. Nguyen, Minh N. Nguyen, Tuyet-Hanh T. Tran, Toan V. Vu, Chuyen H. Nguyen, Heather L. Reynolds 2016, Accumulation and potential health risks of cadmium, lead and arsenic in vegetables grown near mining sites in Northern Vietnam, Environ Monit Assess (2016) 188:525 DOI 10.1007/s10661-016-5535-5. Steven Lam, Hung Nguyen-Viet, Tran Thi Tuyet-Hanh, Huong Nguyen-Mai, and Sherilee Harper 2015, Evidence for public health risks of wastewater and excreta management practices in Southeast Asia: A scoping review. Int. J. Environ. Res. Public Health 2015, 12, 1-x manuscripts; doi:10.3390/ijerph120x0000x Some related publications 22 Tran Thi Tuyet-Hanh, Dang Xuan Sinh, Pham Duc Phuc, Tran Thi Ngan, Chu Van Tuat, Delia Grace, Fred Unger, Hung Nguyen-Viet, 2016. Exposure assessment of chemical hazards in pork meat, liver, kidney and health impact implication in Hung Yen and Nghe An provinces, Vietnam. International Journal of Public Health. 62(1), 75-82. DOI: 10.1007/s00038-016-0912-y Hung Nguyen-Viet, Tran Thi Tuyet-Hanh, Fred Unger, Sinh Dang-Xuan and Delia Grace 2017, Food safety in Vietnam: where we are at and what we can learn from international experiences. Infectious Diseases of Poverty 6:39 DOI 10.1186/s40249-017-0249-7. Hung Nguyen-Viet, Delia Grace, Phuc Pham-Duc, Sinh Dang-Xuan, Toan Luu-Quoc, Fred Unger, Sethde Vlieger, Ngoc Pham-thi, Nhiem Duong-Van, Long Nguyen-Hung, Luan Tran-Dinh, Tran Thi Tuyet-Hanh, 2018. Research and training partnership to assist policy and capacity building in improving food safety in Vietnam. Global Food Security, Vol. 19, pp 24-30. Doi: https://doi.org/10.1016/j.gfs.2018.08.009 Nguyen Hung Minh, Tri Manh Chan, Nguyen Thi Minh Hue, Tu Binh Minh, Tran Thi Tuyet-Hanh 2019. Bioaccumulation of PCDD/Fs in foodstuffs near Bien Hoa and DaNang airbases: assessment on sources and distribution. Environmental Science and Pollution Research. Volume 26, Issue 28, pp 28852–28859. Doi: https://doi.org/10.1007/s11356-019-06046-5 Kai Hsien Chi, Yu-Ting Huang, Hung Minh Nguyen, Tran Thi Tuyet-Hanh, Somporn Chantara, Tuan Hung Ngo, 2022. Characteristics and Health Impacts of PM2.5-bound PCDD/Fs in Three Asian Countries. Environment International. Doi: https://doi.org/10.1016/j.envint.2022.107441 Some related publications (cont.) This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence.