The interdisciplinary CARE project is led within the PEPR PREZODE program. Her coordinator, Katherine Worsley-Tonks, is a researcher in epidemiology and disease ecology at Institut Pasteur. Interview.
Could you briefly introduce the project?
CARE (Community Awareness and Response to Emerging zoonotic outbreaks) is an interdisciplinary project combining anthropology and social sciences, epidemiology, zoonotic disease ecology, and economics. The idea is first to work with communities to understand risk behaviours and prevention measures, and then examine how the involvement of community actors influences surveillance. Our ambition is to develop a system that is better adapted to local contexts, more responsive, and more effective – to strengthen zoonotic disease surveillance and prevention in different contexts.
To do this, we are working in four countries: France, Cameroon, Côte d’Ivoire and Zimbabwe, which have very different socio-economic, cultural and ecological contexts. The objective is to test this strengthened system in these different settings and using three zoonotic diseases with different transmission dynamics: avian influenza, Crimean-Congo haemorrhagic fever and rabies. While rabies is not an emerging zoonotic disease, it remains endemic in many African countries and therefore is relevant in this context.
In the three African countries, we will work with community health workers who are affiliated with the Ministry of Health and who live within the communities they serve, working directly in the field. They often carry out sensitization activities on diseases such as malaria, or work on improving child health. There is also an equivalent in the animal health sector, known as community animal health workers. In France, the context is different. There are no community health workers or animal health workers in France. We will therefore collaborate with other relevant community representatives, including, for example, farmers, forest rangers, as well as general practitioners and pharmacists for the public health side.
What are the main challenges, and what makes the project original?
One of the first challenges is to understand risk behaviours and prevention measures that could be implemented in each context. We will then use this information to work with community representatives so that they can identify these risk behaviours, suspected cases and appropriate prevention measures. Therefore, the goal is to use a bottom-up approach in which surveillance and prevention measures are co-designed with the communities themselves.
We will then assess the added value of this strengthened system using epidemiological and economic models. The objective is to determine whether involving community representatives can improve the prevention of outbreaks and their early detection.
The first year will be largely devoted to the anthropological component. We will then work with community representatives to collect data on suspected cases, risk behaviours and prevention measures over an 18-month period. At the end of this period, we will use these different data types to carry out an epidemiological and economic evaluation of the system.
If the results show that this strengthened system provides real added value and is economically viable, we will make the tools and protocols available to local authorities so that they can integrate them into their surveillance systems if they wish to do so. It is very important that the project has an impact beyond research and be useful to the countries and territories in which we work.
How and why did you become a researcher? What motivated you to choose your field of research?
I have always been fascinated by wildlife, which led me to pursue a bachelor’s degree in Zoology. During a 12-month internship as part of this degree, I started working on infectious diseases in wildlife, which was when I developed a real interest in studying the ecology of infectious diseases in animals and humans. I subsequently pursued a Master’s degree in Ecology in the US, followed by a PhD in Veterinary Epidemiology. During my PhD, I worked on antimicrobial resistance (AMR) in wildlife, focusing particularly on the role of urbanisation in influencing the epidemiology of AMR in urban mesocarnivores.
I then obtained a Postdoctoral fellowship to work in Kenya, where I researched the epidemiology of rabies, particularly its transmission between domestic dogs and wild carnivores. This was where I encountered the challenges of surveillance systems and data collection in rural and remote areas.
Over the course of my career, I therefore gradually moved towards zoonotic diseases, One Health, and global health research.
Looking back over your career, is there a result or project you are particularly proud of?
It would probably be the work I did in Kenya. Together with local collaborators, we first thought about how to strengthen surveillance systems in rural and remote areas to try and get better visibility on suspected cases in those areas. I then had the opportunity to work in the field with community representatives, students and local teams to implement the approach. We found that in an area where no cases of rabies had been reported for several years, the strengthened community-based surveillance approach enabled us to detect five diagnostically-confirmed positive animal cases and one suspected human case in just six months.
What particularly struck me was that after I left, the community-based surveillance continued, which I learnt through staying in touch with the teams there. It was an experience that taught me a great deal, particularly about the patience required to set up this type of system, but also about its value.
This interview was conducted by Lise Poulet