Factors influencing antimicrobial resistance in the European food system and potential leverage points for intervention: A participatory, One Health study

Abstract

Introduction Antimicrobial resistance (AMR) is a global crisis that evolves from a complex system of factors. Understanding what factors interact is key to finding solutions. Our objective was to identify the factors influencing AMR in the European food system and places to intervene. Materials and methods We conducted two workshops involving participants with diverse perspectives to identify the factors influencing AMR and leverage points (places) to target interventions. Transcripts were open coded for factors and connections, then transcribed into Vensim 8.0.4 to develop a causal loop diagram (CLD) and compute the number of feedback loops. Thematic analysis followed to describe AMR dynamics in Europe’s food system and places for intervention. The CLD and themes were confirmed via participant feedback. Results Seventeen participants representing human, animal and agricultural sectors identified 91 CLD factors and 331 connections. Seven themes (e.g., social and economic conditions) describing AMR dynamics in Europe’s food system, five ‘overarching factors’ that impact the entire CLD system (e.g., leadership) and fourteen places for intervention (e.g., consumer demand) emerged from workshop discussions. Most leverage points fell on highly networked feedback loops suggesting that intervening at these places may create unpredictable consequences. Conclusions Our study produced a CLD of factors influencing AMR in Europe’s food system that implicates sectors across the One Health spectrum. The high connectivity between the CLD factors described by participants and our finding that factors are connected with many feedback mechanisms underscores the complexity of the AMR problem and the challenge with finding long-term solutions. Identifying factors and feedbacks helped identify relevant leverage points in the system. Some actions, such as government’s setting AMU standards may be easier to implement. These actions in turn can support multi-pronged actions that can help redefine the vision, values and goals of the system to sustainably tackle AMR.

Factors impacting antimicrobial resistance in the South East Asian food system and potential places to intervene: A participatory, one health study

“…Our approach to data collection and analysis were intentionally comparable to a similar study conducted in Sweden ( Lambraki et al, 2022 ). Two 6.5 h in-person workshops were conducted on October 9 and 10, 2019 at WorldFish (Penang, Malaysia).…”

“…While AMR occurs naturally, it is behavior in human medicine and animal health/food production that cause AMR to develop and spread. This makes AMR a social ecological problem ( Jørgensen et al, 2016 ; Lambraki et al, 2022 ). Antimicrobials modernized medicine ( Laximinaryan et al, 2013 ) and have been instrumental in augmenting agricultural food production systems ( Durso and Cook, 2014 ; Grace, 2015 ), but inappropriate antimicrobial use (AMU) in humans, animals, and crops ( Finley et al, 2013 ; Shallcross and Davies, 2014 ; Van Boeckel et al, 2015 ; O’Neill, 2016 ) and the spread of AMR ( Collignon et al, 2018 ) are causes of rising AMR across human, animal, and agricultural and environmental systems.…”

Governing Antimicrobial Resistance (AMR) in a Changing Climate: A Participatory Scenario Planning Approach Applied to Sweden in 2050

“…We approached 15 participants based in Europe via email, purposively selected because they represented perspectives from different sectors across the One Health spectrum that may influence AMR under a changing climate. To select participants, our team developed a matrix of desired perspectives and populated it with individuals identified through a pool of candidates from our broader research project that had granted permission to be re-contacted ( 35 ), as well as new ones identified through: authors' professional networks; Google, LinkedIn and Twitter searches; and searches of professional organizations' websites. Participants that had been involved in our previous study had basic familiarity with some of the core research team members (IAL, EJP, MC).…”

“…To assist discussions, participants were formally introduced to materials that they were sent three days in advance of the workshops or interview. Participants received a causal loop diagram of drivers of AMR in Europe [with a Swedish focus; ( 35 )] to use as a tool for exploring potential intervention impacts on AMR if desired, as well as a mock news story ( 36 ) and accompanying video ( 37 ) describing Sweden under anticipated climate change conditions in the year 2050, including impacts on vector-borne diseases, infectious diseases, physical injuries, the food system and economics, and immigration and travel. The aim of the news story and video was not to accurately describe climate change projections, but rather to push participants into a possible climate change future and stimulate their thinking about how each selected intervention could be successful in Sweden circa 2050 and identify trends (e.g., continuing growth of environmental interest groups) and uncertainties (e.g., technological advancements) that may enable or derail success.…”

Mapping out a One Health model of antimicrobial resistance in the context of the Swedish food system: A literature scan

“…This literature scan aims to be more comprehensive and capture models that extend beyond AMR-speci c models, to identify models that represent the broader system of drivers and impacts and have potential to be adapted for the AMR context. This literature scan also aimed to gather data that could be used to parameterize a broad One Health model (which we de ned as a model that include factors from the human, animal, and the environmental sectors that interact to create and perpetuate an issue) of AMR developed during participatory modelling workshops [19]. The qualitative model created through participatory modelling included many factors that were unlikely to have quantitative data available.…”