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La lutte antivectorielle en France

 | 
Didier Fontenille
, 
Christophe Lagneau
, 
Sylvie Lecollinet
, 
et al.

Tools for risk management and anticipation

From initial training to career-long training1

Texte intégral

  • 1 In this chapter, references to the CD-ROM concern question 12: “What are the existing training pro (...)

1In 2005, there were only an estimated 100 or so medical entomologists in France, half of whom were over 50 years of age. The fall in the number of specialists in this field and in vector control has led to the abandonment of whole swathes of activities where France used to have an internationally recognized expertise. At present, not one entomologist devotes himself full-time to the taxonomy of medically important insects, whereas the taxonomy, even of groups of insects that are supposedly the best known, is in need of a far-reaching revision (on this alarming situation, see especially the reports by the French Academy of Sciences of 2000 and 2006, which to date have not been acted upon).

2Several reasons can be mentioned: reorganization of life sciences teaching and research, disengagement from research on vectors in the tropical countries, or insufficient finance. Scientifically, at the end of the xxth Century research work on arthropods of interest to medicine or the veterinary field became themes taken in with other branches such as integrative biology, genetics and more recently immunology, genomics and evolutionary sciences. The “butterfly net” entomologist was henceforth the victim of a pejorative image whereas, in parallel, the job supply dwindled owing to a drastic reduction in joint projects with countries of the South and an underestimate of the problems existing over national territory.

3France nevertheless still has a high research and operational potential. This resides mainly in the various research institutes that work in the tropical countries: IRD, CIRAD, the Pasteur Institute network and the Institut de Médecine Tropicale du Service de Santé des Armées, or Military Health Service Institute of Tropical Medicine (IMTSSA). Potential also exists in the universities, in some private companies and operational agencies such as département councils, the DDASSs or the EIDs.

EXISTING TRAINING IN FRANCE

4Design of really effective vector control must be founded on a solid entomological base and within a precisely structured organizational context. It must then be implemented and assessed. The knowledge and skills required at these different stages are not the same and do always depend on the same paths of education and training.

Initial training

5Initial training consists of curricula leading to the award of a Masters degree, an advanced technical qualification or the grade of technician.

The Masters

6The International Masters in medical and veterinary entomology (MIE) offers the most comprehensive advanced-level training in France and the French-speaking countries. Its objectives are to equip students from the Northern hemisphere and the countries of the South with an education that opens the way to research in vector biology, taxonomy or ecology, on population genetics, genomics and post-genomics and in vector control. The MIE programme involves the partnership of two universities: Abomey Calavi University (Benin) and Montpellier-II. It is supported by the IRD, the overall leader of the project, the Institut Régional de Santé Publique, or “Regional Institute of Public Health” (IRSP) at Ouidah (Benin) and the Centre de Recherche en Entomologie de Cotonou, “Cotonou Centre for Entomology Research” (CREC). Between 2005 and 2008, 45 students of various nationalities originating from three continents (Africa, Europe and South America) took this Masters course. In this way, they developed a common culture, in the same manner as with similar training programmes abroad (see Box).

7Again in Montpellier, specialist modules or seminars are offered as part of other Masters courses in the speciality “Biodiversity and microbial and parasite interactions”, of the Sciences for the environment Masters: Animal health and epidemiological surveillance in the countries of the South organized by CIRAD and the Toulouse Veterinary School; Infectious, vector-borne and food-related diseases at Kasetsart University in Thailand, in partnership with the Pasteur Institutes and CIRAD; Epidemiological surveillance of human and animal diseases (SEMHA), jointly with Paris-XI University, CIRAD and the École Vétérinaire of Maisons Alfort, France; also Dynamics of parasite-host-environment interactions.

Training programmes abroad
■ A Masters given in English in Medical Entomology and vector Control was launched in June 2008. It is held at the University of Gezira (Sudan) with the participation of the Blue Nile National Institute for Communicable Diseases (BNNICD). This Masters also has the support of the WHO regional office based in Cairo (Egypt). Its objective is to cover the training needs in medical entomology and vector control for the countries of North and East Africa, but also those of Middle-Eastern countries that have English and Arabic languages in common.
■ A 12-month Masters course run in Spanish, in Medical Entomology and Vector Control is proposed each year at the Pedro-Kouri Institute in Havana (Cuba). It covers the training requirements for medical entomology and vector control in the central and South American countries that have Castilian as common language. It benefits from the support of the WHO regional office, the Pan American Health Organization (PAHO).
■ Several European universities offer modules, short courses and training courses in medical entomology (see details on CD-ROM).
■ In the USA, very strong investment in control against vectors and nuisance organisms shows up in the manifold training programmes offered. Such courses range from Masters in medical entomology (Universities of Florida, California, Louisiana among others) to theoretical and practical sessions of a few hours for individuals (in insecticide application for instance) organized by bodies such as the Environmental Protection Agency (EPA), or the Centers for Disease Control (CDC). The American Mosquito Control Association, which has a strong presence in the field, moreover allocates grants in partnership with the States involved in vector control (including California, Florida, New Jersey, Louisiana).

8Also, the University of Tours offers a Masters 2 degree (Control and observation of insect populations) within which a number of hours are devoted to medical and veterinary entomology and vector control (see details on CD-ROM).

9A Masters in Transmissible diseases and tropical pathologies, which includes a section on medical entomology, is proposed at the University of Marseille and a two-month intensive theoretical course on vectors is offered by the Paris Pasteur Institute and the IRD. That course, which pursues international recruitment, is intended for holders of Masters degrees or PhDs.

Other Masters- and Engineer-level courses

10Other than the optional programmes offered by the Montpellier Medical School (30 hours of medical entomology), three types of educational establishment incorporate some aspects of entomology and/or vector control in their courses: the veterinary schools, the schools of agronomy and agriculture and the health engineering schools.

11The veterinary schools provide students with basic instruction in veterinary entomology concerning the principles of vector control, bio-ecology and vector identification. On top of that come elements on vector-borne diseases and also on the different classes of insecticide. However, it would be useful to complement these aspects with specific training in veterinary entomology especially targeted on problems that arise in France and its territories.

12The agronomic and agricultural schools do not provide courses on vector control. Some of them touch on pesticides, including insecticides and their modes of action and methods of application, but against arthropod pests that attack crops and not vectors.

13As for the health engineering schools, they deal only briefly with vector control as part of courses in other public-health related disciplines. For example, 8 hours are devoted to vector risks and vector control in the hygiene courses of the École des Hautes Études en Santé Publique (EHESP).

14The IMTSSA of Marseille, for its part, organizes every year a 40-hour training programme in medical entomology, plus a course on malaria control.

15An important finding is that there are no modules or seminars that deal with the legal aspects of vector control.

Training of technicians

16At the time of writing, there are no specific courses in France for training technicians (professional baccalaureate level) or higher technicians (diplomas such as DUT or BTS, or the professional Licence at Bachelor degree level) on vectors and vector control.

17Nevertheless, since January 1st 1996, a professional certificate is compulsory for any establishment that provides services (including distribution and application) in the sector of plant health products or biocides (by the decree of 5 October 1994, and orders of 6 and 13 March 1995). This certificate is delivered by the Regional Plant Protection Services (SRPV) under the condition that two criteria are satisfied: the company must have at least one permanent approved agent out of 10 assigned to this type of service; it can prove that it is covered by a professional civil responsibility insurance.

18The Application operatives’ certificate for antiparasitic and similar products (CAPA), and the Certificate for distributors and application operatives for antiparasitic products (DAPA) are documents of approval delivered under the sole name of the agent. The latter certificate can be obtained with an acquired qualification or after a process of validation of acquired competence and experience (VAE) of a minimum of five years, in the sector of activity concerned or in an approved Centre for professional training and agricultural promotion (CFPPA). It must be renewed every five years on the basis of a formal application and an updating of knowledge.

19Furthermore, some private companies conducting insect- and other ver-min control operations provide targeted modules devised for professional agents in the sector.

TRAINING NEEDS

20Training is needed as much for technicians as at senior and management level.

Training for management level

21For senior and management personnel, programmes such as the Masters offered at Montpellier or Tours should in part respond to the need for reinforcement at the higher technical staff level. However, local expertise could be significantly improved by grants for Masters and theses oriented towards vector control, especially in France’s tropical departments. That has already been suggested in several previous reports (see for example the 2006 mission report by the epidemiologist Antoine Flahaut). Educational programmes with considerably more vector-control content should also be introduced in schools of agronomy, agriculture and veterinary studies, and also in training for management-level personnel in public health (like that of the EHESP).

Training for technicians

22There are considerable deficiencies in training for technicians. The health and hygiene technicians of the DDASSs, recruited by competitive examination, all have widely different initial training. Few of them have done the exams for the hygiene technician role. The Ministry of health technicians are overall insufficiently well trained in environmental health. The situation is identical in the Departments of Veterinary Services (DSV). It is therefore essential to establish continuous training schemes focused on the operational aspects and training modules in the existing curricula and continuous training programmes, preferably of the professional baccalaureate or technical diploma (DUT) type.

23This observation was already pointed out in the IRD expert group report of 2003 on dengue in the FDAs. This general recommendation is still relevant, but it is also fundamentally important that these training programmes give agents an opportunity not only to improve their operational skills, but also to benefit from career development (given the often high degree of discomfort involved in this work). The result of this will be the possibility for devising real strategies of recruitment which at present are too often lacking in the vector control services.

24The instruction provided should cover: vectors and diseases, hygiene and safety, techniques of vector control, social communication, mapping (geographical information systems). Once trained, some people could pass on information (as instructors in their turn) to initiate municipal agents or hotel-complex personnel.

Continuous training

25In terms of continuous training the CAPA/DAPA certificates started from a good idea but its content is now too general. It should be more accurately adapted for each professional function and harmonized across the different training centres. Besides this, for updating knowledge, a frequency of every five years is probably not enough. Similarly, the requirement to have only one certified agent for ten operators assigned to vector control is far from sufficient.

26It would also be worthwhile if the CNFPT, under the combined impulse of the Department of Health and the food agency DGAL, the département councils and municipalities concerned, could develop the provision of continuous training adapted for agents of vector control services, with the possible participation of EHESP.

27The initiatives launched in Martinique could be taken as an example. Training sessions have been organized for some years, intended for municipal personnel (“municipal mosquito destruction mediators”) by the vector control service (one week of initial training followed by a permanent process of updating). Subsequently, these “municipal mediators” intervene in the field, on their own or alongside vector control agents. Contacts are being made with the management centre and the local CNFPT in order that such training schemes can be validated and taken into account in career assessment.

28On the organization side, the training programmes could be provided by broad region (Indian Ocean, Antilles-French Guiana and so on), while for implementation the services of experts from scientific networks could be called upon (like Montpellier Vectopôle, ADEGE).

RECOMMENDATIONS
Make sure that at least one management-level person from each vector control operator organization (EIDs, département councils, large local authorities, State departments and services) takes advanced-level training, of the Master in entomology type, or recruit someone who has gained such a qualification.
Promote better theoretical and practical training on all aspects of vector control among management-level public health and veterinary personnel (doctors, veterinary surgeons, health engineers, nurses). Continuous training of senior public health staff could be taken on by EHESP, with the help of French experts (from the Montpellier Vectopôle, high-level personnel of operational structures and so on).
Reinforce and organize a structured provision of continuous training for technical agents in order to integrate the changes and developments of techniques, regulations and risks from vectors and epidemics. It could be organized on a regional basis by the CNFPT by calling upon local skills and knowledge, themselves strengthened by professional networks like ADEGE and the centres of expertise. The main drive behind this and the assessment role must be under the control of the Department of Health (DGS) and the food agency DGAL.

Notes

1 In this chapter, references to the CD-ROM concern question 12: “What are the existing training programmes and further training needs?”.

© IRD Éditions, 2009

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