Description
Introduction: The food system is a key contributor to the emergence and spread of antimicrobial resistance (AMR), with negative repercussions for human, animal and environmental health. While numerous pathways linking the food system to AMR have been identified, the relationships between these factors are complex. Recent research situates AMR as an emerging property of a complex system, but efforts to characterise this system across different countries are limited. Given the multi-sectoral nature of AMR, a One Health perspective has been advocated to understand and control the emergence and transmission of resistance. We use a participatory approach to identify key food system factors that influence AMR, as well as the interconnections and dynamic relationships between them. We undertake this analysis in five countries (Canada, Hungary, the Netherlands, the Philippines and Senegal), spanning high-, middle- and low-income contexts, as well as different governance systems and policy environments.
Methodology: In this analysis we use group model building (GMB), a participatory approach to modelling complex systems, to develop an understanding of the role of the food system in driving the emergence and spread of AMR in each of the five countries. In each country, we undertook a GMB workshop, inviting stakeholders from multiple sectors to come together, share their perspectives, and develop a shared understanding of the complex system driving AMR. During the workshops, stakeholders participated in facilitated activities aiming to: characterise the dynamic behaviour of AMR in their country context and limitations in practical and policy approaches to address it; identify key food system factors they considered important in amplifying or mitigating the risk of AMR; map the interrelationships between factors in order to identify causal pathways and feedback loops explaining system-level behaviour; and suggest priority actions to mitigate the risk of AMR in their country context. Participants were invited to take a One Health perspective to this process, identifying factors relating to human, animal and environmental health, as well as cross-sectoral factors. After the GMB workshop in each country had been completed, we compared systems maps and priority actions to identify key similarities and differences across countries.
Results and discussion: Many common factors and dynamics were identified across case study countries, including antimicrobial use in humans, crops and livestock; the disease burden in these populations; biosecurity measures; the intensification of agricultural production; and the drive to improve productivity and profitability. However, distinctions were also identified: for example, counterfeit antimicrobials were deemed a major issue in some countries, but not all. The One Health nature of AMR was represented, with stakeholders reflecting on the vicious circle through which resistant pathogens spread and amplify between humans, animals and the environment, and the range of policy and governance actions that could be taken to mitigate the risk of AMR.
Conclusions: The food system plays a key role in driving AMR across multiple country contexts, though differences in the key factors and relationships exist. A One Health perspective can inform cross-sectoral efforts to strengthen policy and governance to mitigate the risk of AMR.
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