Breaking the under-reporting cycle for zoonotic diseases in low-income and middle-income countries through national-level integration of community-based surveillance and response: insights from Cameroon, Chad, Côte d'Ivoire, and Mali.

Zoonotic diseases remain a major threat to both human and animal populations, especially in low-income and middle-income countries. A key challenge in managing these diseases is insufficient coordination between human and animal health sectors and the communities they serve, which often results in delayed outbreak detection and minimal disease control. Community health workers and community animal health workers can help fill this gap by identifying suspected cases early and facilitating communication between communities and health services. However, challenges, such as a scarcity of resources, political and social barriers, and quantitative evaluation of performance and impact, have hindered the broader deployment of community health workers and community animal health workers. In this Personal View, we highlight the need to better integrate community health workers and community animal health workers into health systems for zoonotic disease surveillance and response and illustrate how this can be achieved with examples from Cameroon, Chad, Côte d'Ivoire, and Mali. The framework we put forward provides a step-by-step approach on how to effectively integrate community-based zoonotic disease surveillance, response, and awareness, both at scale and in a sustainable manner. Ultimately, this practical framework offers a path to more resilient and responsive public and animal health infrastructures in the regions most affected by zoonotic diseases.