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. 2023 Aug 24;18(8):e0290464.
doi: 10.1371/journal.pone.0290464. eCollection 2023.

Is scientific evidence enough? Using expert opinion to fill gaps in data in antimicrobial resistance research

Melanie Cousins  1 , E Jane Parmley  2 , Amy L Greer  2 , Elena Neiterman  1 , Irene A Lambraki  1 , Tiscar Graells  3   4 , Anaïs Léger  5 , Patrik J G Henriksson  4   6   7 , Max Troell  4   6 , Didier Wernli  5 , Peter Søgaard Jørgensen  3   4 , Carolee A Carson  8 , Shannon E Majowicz  1
Affiliations

Is scientific evidence enough? Using expert opinion to fill gaps in data in antimicrobial resistance research

Melanie Cousins et al. PLoS One. .

Abstract

Background: Antimicrobial Resistance (AMR) is a global problem with large health and economic consequences. Current gaps in quantitative data are a major limitation for creating models intended to simulate the drivers of AMR. As an intermediate step, expert knowledge and opinion could be utilized to fill gaps in knowledge for areas of the system where quantitative data does not yet exist or are hard to quantify. Therefore, the objective of this study was to identify quantifiable data about the current state of the factors that drive AMR and the strengths and directions of relationships between the factors from statements made by a group of experts from the One Health system that drives AMR development and transmission in a European context.

Methods: This study builds upon previous work that developed a causal loop diagram of AMR using input from two workshops conducted in 2019 in Sweden with experts within the European food system context. A secondary analysis of the workshop transcripts was conducted to identify semi-quantitative data to parameterize drivers in a model of AMR.

Main findings: Participants spoke about AMR by combining their personal experiences with professional expertise within their fields. The analysis of participants' statements provided semi-quantitative data that can help inform a future of AMR emergence and transmission based on a causal loop diagram of AMR in a Swedish One Health system context.

Conclusion: Using transcripts of a workshop including participants with diverse expertise across the system that drives AMR, we gained invaluable insight into the past, current, and potential future states of the major drivers of AMR, particularly where quantitative data are lacking.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: EN, TG, and DW have no declarations of interest to report. MC and IAL work for the Public Health Agency of Canada. EJP is engaged in research funded by the Canadian Institutes for Health Research, Natural Sciences and Engineering Research Council, Ontario Ministry of Agriculture, Food and Rural Affairs, the Public Health Agency of Canada, and the Canadian Safety and Security Program. She is currently President of the Board of Directors of the Centre for Coastal Health, president of the Canadian Association of Veterinary Epidemiology and Preventive Medicine, member of the Board of Directors of the McEachran Institute, member of the Advisory Council for Research Directions: One Health, and a member of the Royal Society of Canada One Health Working Group. Prior to February 2019, she was employed by the Public Health Agency of Canada. ALG is engaged in research funded by the Canadian Institutes for Health Research, Natural Sciences and Engineering Research Council, Agriculture Canada, and Canada First Research Excellence Fund. She has served as a consultant for the Ontario Secondary School Teachers Federation (OSSTF) and as an expert witness in legal proceedings related to the SARS-CoV-2 pandemic. She is currently a member of the Board of Directors for the NSERC Emerging Infectious Disease Modelling Network – OMNI network, and Advisory Board Member of the National Collaborating Centre for Infectious Diseases (NCCID). Prior to January 2014, she was employed by the Public Health Agency of Canada. PJGH is partially funded by FORMAS Inequality and the Biosphere Project (2020-00454) and partially by CGIAR Trust Fund. PJGH is a member of the Technical Committee for the BAP Vanguard Climate Action Standard and PJGH and MT act as scientific advisors to the Seafood Business for Ocean Stewardship (SeaBOS) initiative. PJGH was supported by the CGIAR Research Program on Fish Agri-Food Systems (FISH) led by WorldFish and on Climate Change, Agriculture and Food Security (CCAFS) supported by contributors to the CGIAR Trust Fund. PJGH and MT acknowledge the Kjell and Märta Beijer Foundation for supporting this work through the Beijer Institute’s Aquaculture and Sustainable Seafood programme, and the SEAWIN project funded by FORMAS (2016-00227). PJGH is partially funded by FORMAS Inequality and the Biosphere project (2020-00454). AL works for the Swiss Federal Food Safety and Veterinary Office. PSJ was also funded via an ERC starting grant: INFLUX, grant number 101039376. He holds/has held grants as principal or co-investigator, from the following agencies and foundations all related to the topics of social-ecological systems and/or AMR: Swedish Research Council FORMAS, Wallenberg Foundations, IKEA Foundation, Erling Persson Family Foundation. CAC works for Government of Canada at the Public Health Agency of Canada. In that role she has been a subject matter expert for the World Organisation for Animal Health (WOAH) and the World Health Organization (WHO). She is a member of the advisory committee for Animal Health Canada. She has previously been engaged in research funded by the Canadian Institutes for Health Research, Ontario Ministry of Agriculture, Food and Rural Affairs, and the Canadian Safety and Security Program and has been a co-topic editor for two volumes of a Frontiers in Veterinary Science, Research Topic: Antimicrobial Usage in Companion and Food Animals: Methods, Surveys and Relationships with Antimicrobial Resistance in Animals and Humans. SEM is (or has been in the last 5 years) engaged in research grants/contracts funded by the Canadian Institutes for Health Research, the Bill and Melinda Gates Foundation/UK Dept., International Development, the Natural Sciences and Engineering Research Council of Canada, Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Dairy Farmers of Canada Research Funding Program, the World Health Organization, British Columbia Centre for Disease Control, Indian and Northern Affairs Canada, and Ontario Ministry of Agriculture, Food and Rural Affairs. She currently sits on the Editorial Boards of Foodborne Pathogens and Disease, and Epidemiology and Infection, and is a member of the World Health Organization’s Foodborne Disease Burden Epidemiology Reference Group, and she has served as a paid expert on behalf of the Attorney General of Canada in legal proceedings, providing evidence on the public health risks and benefits of unpasteurized milk. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Combined concept map from the two workshops in which participants described the drivers of antimicrobial resistance in a Swedish One Health system context.
The map consists of nodes (bubbles) and relationships (arrows) referenced by the participants in which the colour of the nodes represents the level at which the drivers of antimicrobial resistance exist, the amount of shading of the nodes represents the source of the data, the colour of the arrows represents the strength of the correlation of the relationship, the weight of the arrow represents the source of the data, and the direction is represented by +/- when available. Note: this figure is zoomable in the PDF version to legible font size.
See this image and copyright information in PMC

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