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

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  • Irene Anna Lambraki
  • Melanie Cousins
  • Tiscar Graells
  • Anaïs Léger
  • Patrik Henriksson
  • Stephan Harbarth
  • Max Troell
  • Didier Wernli
  • Peter Søgaard Jørgensen
  • Andrew P Desbois
  • Carolee A Carson
  • Elizabeth Jane Parmley
  • Shannon Elizabeth Majowicz

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.

Suggested Citation

  • Irene Anna Lambraki & Melanie Cousins & Tiscar Graells & Anaïs Léger & Patrik Henriksson & Stephan Harbarth & Max Troell & Didier Wernli & Peter Søgaard Jørgensen & Andrew P Desbois & Carolee A Carson, 2022. "Factors influencing antimicrobial resistance in the European food system and potential leverage points for intervention: A participatory, One Health study," PLOS ONE, Public Library of Science, vol. 17(2), pages 1-19, February.
    • Handle: RePEc:plo:pone00:0263914
    DOI: 10.1371/journal.pone.0263914
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    References listed on IDEAS

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    1. Peter Collignon & Prema-chandra Athukorala & Sanjaya Senanayake & Fahad Khan, 2015. "Antimicrobial Resistance: The Major Contribution of Poor Governance and Corruption to This Growing Problem," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-13, March.
    2. Towse, Adrian & Hoyle, Christopher K. & Goodall, Jonathan & Hirsch, Mark & Mestre-Ferrandiz, Jorge & Rex, John H., 2017. "Time for a change in how new antibiotics are reimbursed: Development of an insurance framework for funding new antibiotics based on a policy of risk mitigation," Health Policy, Elsevier, vol. 121(10), pages 1025-1030.
    3. Derek R. MacFadden & Sarah F. McGough & David Fisman & Mauricio Santillana & John S. Brownstein, 2018. "Antibiotic resistance increases with local temperature," Nature Climate Change, Nature, vol. 8(6), pages 510-514, June.
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