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

Abstract

BackgroundAntimicrobial resistance (AMR) is a growing global crisis with long-term and unpredictable health, social and economic impacts, with which climate change is likely to interact. Understanding how to govern AMR amidst evolving climatic changes is critical. Scenario planning offers a suitable approach. By envisioning alternative futures, stakeholders more effectively can identify consequences, anticipate problems, and better determine how to intervene. This study explored future worlds and actions that may successfully address AMR in a changing climate in a high-income country, using Sweden as the case.MethodsWe conducted online scenario-building workshops and interviews with eight experts who explored: (1) how promising interventions (taxation of antimicrobials at point of sale, and infection prevention measures) could each combat AMR in 2050 in Sweden given our changing climate; and (2) actions to take starting in 2030 to ensure success in 2050. Transcripts were thematically analyzed to produce a narrative of participant validated alternative futures.ResultsRecognizing AMR to be a global problem requiring global solutions, participants looked beyond Sweden to construct three alternative futures: (1) “Tax Burn Out” revealed taxation of antimicrobials as a low-impact intervention that creates inequities and thus would fail to address AMR without other interventions, such as infection prevention measures. (2) “Addressing the Basics” identified infection prevention measures as highly impactful at containing AMR in 2050 because they would contribute to achieving the Sustainable Development Goals (SDGs), which would be essential to tackling inequities underpinning AMR and climate change, and help to stabilize climate-induced mass migration and conflicts; and (3) ”Siloed Nations” described a movement toward nationalism and protectionism that would derail the “Addressing the Basics” scenario, threatening health and wellbeing of all. Several urgent actions were identified to combat AMR long-term regardless which future un-folds, such as global collaboration, and a holistic approach where AMR and climate change are addressed as interlinked issues.ConclusionOur participatory scenario planning approach enabled participants from different sectors to create shared future visions and identify urgent actions to take that hinge on global collaboration, addressing AMR and climate change together, and achieving the SDGs to combat AMR under a changing climate.

Using a fuzzy cognitive map to assess interventions to reduce antimicrobial resistance in a Swedish One Health system context under potential climate change conditions

“…Using a previously created FCM of AMR development and transmission in the Swedish One Health system, this study further explored the system that drives AMR and assessed interventions under climate change conditions (Cousins, 2022a). The structure of the FCM was based upon a qualitative model that was created during two participatory modelling workshops held in Sweden with experts from within the European food system (Lambraki et al, 2022a(Lambraki et al, ,2022b. A second set of workshops were used as to help inform the interventions and compare outcomes from the scenario analyses.…”

“…Identified as potential success factor during the scenario planning workshop (Lambraki et al, 2022a(Lambraki et al, ,2022b. Address the ninth SDG (Industry, innovation, and infrastructure) Scenario 12 Scenario 16…”

“…Experts in the scenario planning workshops (Lambrakiet al, 2022b) agreed that simple interventions like taxing AMs alone would not be enough to alter the system. They recommend multi-pronged interventions to address underlying causes of AMR (e.g., poverty, social inequalities, basic hygiene, and access to resources), and a shift in worldviews of the population (e.g., reducing capitalism, prioritizing public health) were essential in reducing AMR (Lambraki et al, 2022b).…”

“…This analysis estimated great economic losses if the USA were to conform because the current competitive advantages they hold (low cost of their products) would be reduced (due to increased costs of production), and thus decrease exports (Johnson, 2011). The assumption that Sweden would conform to these regulations is valid as Sweden is less likely to be impacted by these trade regulations compared to the USA due to their existing strict AMU policies (Wierup, 2001;Wierup et al, 2021), the production systems they have in place (Lambraki et al, 2022a(Lambraki et al, , 2022bWierup et al, 2021), and their weak reliance on income from exports (World Integrated Trade Solutions, 2022;Lambraki et al, 2022a).…”

How Antimicrobial Resistance Is Linked to Climate Change: An Overview of Two Intertwined Global Challenges

“…While taxation of antimicrobials reveals low impact that creates inequities, in two of the three alternatives, the infection prevention measures are considered as key strategies for containing AMR in 2050, contributing for the achievement of the Sustainable Development Goals (SDGs). In this way, it could be possible to tackle inequities underpinning AMR and CC, with the perspective of a holistic approach in which AMR and CC will be considered as interlinked issues [172].…”