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

PLOS ONE RESEARCH ARTICLE Is scientific evidence enough? Using expert opinion to fill gaps in data in antimicrobial resistance research Melanie Cousins ID1*, E. Jane Parmley2, Amy L. Greer2, Elena Neiterman1, Irene A. Lambraki1, Tiscar Graells ID3,4, Anaïs Léger5, Patrik J. G. Henriksson4,6,7, Max Troell4,6, Didier Wernli5, Peter Søgaard Jørgensen3,4, Carolee A. Carson8, Shannon E. Majowicz1 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada, 2 Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada, 3 Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden, 4 Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden, 5 Global Studies Institute, University of Geneva, Geneva, Switzerland, 6 Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden, 7 WorldFish, Penang, Malaysia, 8 Foodborne Disease and Antimicrobial Resistance Surveillance Division, Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada * OPEN ACCESS Citation: Cousins M, Parmley EJ, Greer AL, Neiterman E, Lambraki IA, Graells T, et al. (2023) Is scientific evidence enough? Using expert opinion to fill gaps in data in antimicrobial resistance research. PLoS ONE 18(8): e0290464. https://doi. org/10.1371/journal.pone.0290464 Editor: Jerome Nyhalah Dinga, University of Buea, CAMEROON Received: February 23, 2023 Accepted: August 8, 2023 Published: August 24, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0290464 Copyright: © 2023 Cousins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data is held in a public repository Boreal at the following citation: Cousins M. Using expert knowledge and experience to parameterize a simulation model of 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. PLOS ONE | https://doi.org/10.1371/journal.pone.0290464 August 24, 2023 1 / 19 PLOS ONE AMR emergence and transmission in a Swedish food system context: Framework Matrices [Internet]. Borealis, V1. 2022. p. UNF:6:7MNV1 +/sxDeftXfWjznwkg== [fileUNF]. Available from: https://doi.org/10.5683/SP3/WUXL5F. Funding: This study is funded through an operating grant of the 5th Joint Programming Initiative on Antimicrobial Resistance (JPIAMR 2017). Funding was provided by an operating grant from the Canadian Institutes for Health Research (Institute of Infection and Immunity, Institute of Population and Public Health: https://cihr-irsc.gc. ca/e/193.html) (PI: SEM, grant number 155210); a Swedish Research Council grant (https://www.vr. se/english.html) (PI and project consortium coordinator: PSJ, grant number 2017-05981); and an operating grant from the Swiss National Science Foundation (https://www.snf.ch/en) (PI: DW, grant number 40AR40_180189). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: 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 SARSCoV-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 Using expert opinion to fill gaps in data in antimicrobial resistance research 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. Introduction Antimicrobial resistance (AMR) is one of (...truncated)