Prioritization of interventions to reduce antimicrobial use in dairy cows: A multicriteria decision analysis

Antimicrobial resistance (AMR) is a major global health challenge requiring integrated One Health approaches that consider human, animal, and environmental dimensions. In the province of Québec (Canada), a 2019 regulation restricting the use of category I antimicrobials (AMs) in livestock highlights the need for context-specific, evidence-based interventions to limit the dissemination of resistant microorganisms while preserving animal health and production efficiency. In this study, we developed a participatory Multi-Criteria Decision Analysis (MCDA) model to identify and prioritize future interventions aimed at limiting the dissemination of AMR from dairy herds in Québec. The model was co-constructed with stakeholders from agricultural, veterinary, public health, and consumer sectors, encompassing 22 interventions and 18 evaluation criteria covering public health, animal welfare, environmental, economic, social, and operational dimensions. Stakeholders assigned weights to each criterion under three exploratory AMR scenarios representing different risk contexts: (1) the current AMR situation (CURRENT scenario), (2) a scenario depicting an increase in AMR infections in humans (PUBLIC THREAT scenario), and (3) a scenario depicting an increase in AMR infections in dairy cattle (ANIMAL THREAT scenario). Interventions were evaluated through a literature review and expert elicitation, and sensitivity analyses were performed to assess robustness. Across all scenarios, the highest-ranked interventions included producer education (mandatory farm training, EDU1), financial support for preventive veterinary activities (subsidies for preventive monitoring, PRE2), and disease surveillance (mandatory disease surveillance, SUR5). In contrast, restrictive regulatory interventions on AMs sales (REG4, REG5) ranked lowest due to limited feasibility and acceptability. The participatory approach fostered transparency, cross-sectoral dialogue, and consensus-building, demonstrating how MCDA can operationalize the One Health framework for AMR governance. While context-specific, this framework provides a foundation for the development of similar models in other contexts, enabling adaptation to diverse livestock sectors and regional priorities.