Exploratory actor mapping of social interactions within tick risk surveillance networks in France.

Ticks are important zoonotic disease vectors for human and animal health worldwide. In Europe they are the principal vector of public health importance, responsible for Lyme disease, the most prevalent and widespread tick-borne disease (TBD). Tick presence and TBD incidence are increasing, questioning the effectiveness of existing surveillance systems. At the European level TBD burden is likely underestimated as surveillance differs amongst and within countries. France created its first national public health policy in 2016 to tackle TBDs, prompted by growing concern from the public, medical professionals and the scientific community for the lack of knowledge on tick-borne pathogen risk on the population. With global changes, France currently faces risk for TBD emergence (e.g. Crimean-Congo hemorrhagic fever) and re-emergence (e.g. tick-borne encephalitis), in addition to increasing Lyme disease cases. We conducted 13 semi-structured interviews with French tick risk surveillance actors to characterize how the national surveillance system functions. Qualitative descriptive analysis was conducted on interview transcripts to create actor maps and identify the barriers and levers for actor interactions. We identified four tick risk surveillance processes: surveillance-oriented research, risk evaluation, policy creation and policy application, to which interdisciplinary, intersectoral and multi-level actor interactions contribute. Actors express a pervasive need to reinforce intersectoral interactions between human, animal and environmental sectors for early risk detection, as well as multi-level interactions to accurately estimate risk and disseminate prevention information. Transdisciplinary, social-ecological system approaches may offer an adaptive framework for locally relevant surveillance activities in diverse social-ecological contexts.