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Hotspot or blind spot? Historical perspectives on surveillance and response to epidemics in the Central African Republic

Abstract

Objectives

The Central African Republic (CAR), a site of recurrent disease emergence, developed a noteworthy epidemiological surveillance system from the colonial period, but its health measures have remained among the world’s lowest. To understand this disparity between surveillance and public health, we examined selected moments in its history of surveillance and changing relations with public health structures.

Methods

We conducted archival research in CAR and French archives and 18 semi-structured interviews with key researchers working in CAR.

Results

We find long-term continuities in privileging surveillance over the health system and population health, making the CAR a “hotspot” for emerging diseases and a “blind spot” of primary health care. From the colonial period, the country attracted considerable support for surveillance, without concomitant investment in public health system. Political disputes and financial constraints have obscured real primary care needs on the ground.

Conclusions

As both a hotspot and a blind spot for global health, the CAR signals the need to reorient health interventions to address the long-term health of Central African people.

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Acknowledgements

PMD wants to thank Guillaume Lachenal for his support. We want to thank Dominique Dupenne and Daniel Demellier for their help at the Department of Archives at the Pasteur Institute in Paris. We are also very grateful to Jean-Pierre Lombart for his welcome at the Institut Pasteur de Bangui. This work was supported by Fonds de Recherche Québécois Société et Culture—FRQSC (2016-B3-189967), the Agence Nationale de la Recherche sur le SIDA et les Hépatites (12288), and the Agence Nationale de la Recherche (ANR 31-CE31-004-001).

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Correspondence to Pierre-Marie David.

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The authors declare no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

This research was approved by the following ethics committees: Comité d’Evaluation Ethique INSERM (IRB000003888), Approval Number 15-273 and the Comité d’Ethique de la Recherche en Santé (Université de Montréal), Certificate Number 18-045 CRERED-D.

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All procedures performed in studies involving human participants were in accordance with ethical standards of relevant institutional and national research committees, as well as with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All informants provided written informed consent prior to participating in the study.

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David, P., Nakouné, E. & Giles-Vernick, T. Hotspot or blind spot? Historical perspectives on surveillance and response to epidemics in the Central African Republic. Int J Public Health (2020). https://doi.org/10.1007/s00038-020-01338-x

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Keywords

  • Surveillance
  • Disease emergence
  • Epidemics
  • Central Africa
  • History
  • Pasteur