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

Abstract Introduction: Antimicrobial resistance (AMR) is a growing One Health crisis that can be impacted by other challenges of sustainable development, such as climate change, but few interventions have been assessed with a systems-wide lens. The objectives of this study were to use a previously defined fuzzy cognitive map (FCM) of the Swedish One Health system to: 1) identify areas in the system to target interventions; and 2) test the potential ability and viability of interventions to reduce AMR under a changing climate. Methods: The FCM, based on participatory modelling workshops and literature scan, was used to assess the sustainability of eight interventions under potential climate change conditions. Network metrics were calculated to describe the system structure and identify highly impactful nodes. Results: The network metrics identified high-leverage nodes including alternative productions systems and good farming practices. None of the scenarios evaluated were able to adequately reduce AMR within the system. Conclusions: Overall, fuzzy cognitive mapping provides an innovative way to analyse the AMR system, identify high-leverage interventions, and examine potential impact of interventions using a broader systems lens.