Estimation of survival is used in many medical studies that aimed to estimate the prognostic of patient, the impact of some variables on the disease under study. More generally, estimation of survival is a valuable indicator of progress in disease control. For chronic diseases, more especially for cancer, the creation of registries has permitted to increase the knowledge in the epidemiology of the diseases under study. Over the past decade, population-based cancer registry data have been used increasingly worldwide to evaluate and improve the quality of cancer care. In this context, analyses are generally performed using methods of estimation of excess mortality that aimed at estimating and modelling the excess mortality to which a studied group of patient’s cancer is subjected and at estimating their net survival (i.e. the survival corrected for all the other causes of death). In this context, the objective of the modelling is to estimate the impact of prognostic factors on the excess mortality risk and to assess the cure rate in different subgroups of patients. Estimation of the survival of cancer’s patients, obtained from population-based data collected by cancer registries, are analysed regularly and published by the different European countries. Comparisons between countries are justified only if the methods used for that have taken into account bias relative of observational studies and if they are the result of a thought and a strategy adopted by all the partners. The development and the homogenisation of such methodology are totally justified in this context. The overall aim of this project is to improve the current methods for estimating net survival and to broaden their field of application in order to obtain i) tools to model complex data, and ii) more accurate estimates that enable to have information on survival for a studied disease and on its public health impact. More precisely, there are three main research axes devoted to: (1) propose new methodological developments to answer questions that are the result of our works during our previous project (MESURE); (2) extend and assess new statistical methods; (3) transfer net survival methods used in cancer to some other specific applications. These themes correspond to some of the actual challenges in the estimation of net survival. Following our previous project, CENSUR project is more ambitious, considering the scope of the methods investigated and the new development that are envisaged. While the focus is on methodological aspects, the network implies also members that have skills in epidemiology and in population-based data analyzes with the objective to produce survival statistics useful in Public Health. This project will allow to reinforce a network including 5 French team, 3 European and 1 Canadian, having complementarities, internationally known, and having experience in the framework of excess mortality and the development of statistical methods. At the end of this project, in order to optimize the use of methods to estimate net survival, we will organize a course. Furthermore, free-licensed statistical programs derived from our work will be available for the scientific community. If the project goes on well, it will allow to propose an adapted methodology in order to obtain correct estimates of the excess mortality for a disease under study and to its determinants. This methodological approach is a preliminary condition for a rational management of disease, on its medical and socio-economic aspects, that will be obtained from registries data, clinical data, or enterprise data.

Presentation and referral of symptomatic patients from primary into secondary care has been dramatically impacted by lockdown of the population due to the COVID-19 pandemic. That involved in particular de-prioritization of non-emergency clinical services, including diagnostics and elective specialist surgery. Managing cancer patients during the COVID-19 pandemic was a particular challenge as they were designated as a particularly vulnerable subgroup of the population for which the challenge were also to minimize virus exposure. In literature, it was demonstrated that even short delays (3 months) between diagnosis and surgery have a significant impact on patient survival. However, even for cancers of comparatively favourable prognosis, a delay of 6 months will result in significant summed attributable deaths as many of these cancers are common. Our project focuses on two poor prognosis population with complex care pathway (glioblastoma and pancreatic cancer) for which the impact of the COVID-19 pandemic outcomes is probably important and it’s primordial to provide a comprehensive and complete evaluation. That’s the aim of our project: to study in detail the impact of the crisis on the diagnosis, care and survival of this very vulnerable population of patients with glioblastoma and pancreatic cancer for which any delays and changes have major impact on the outcome. To achieve this result, we will collect information about the care pathway from patient files for patient diagnosed and treated between 2018 and 2020 in expert centers. Patients diagnosed in 2018 and early 2019 will serve as controls while the patients diagnosed in late 2019 (and treated in 2020) and 2020 will have faced the disorganization. These changes in the patients’ management pathways could have an impact on the cost of patient care. If we can make the hypothesis that this may have decreased some costs of patient hospital care at least in the short term, there is an important concern that delaying care could lead to more complications later, worsen health outcomes and therefore induce higher spending later. The impact of COVID-19 on the cost of cancer management needs to be documented, as well as the factors driving costs higher or lower.

Monkeypox, an emerging Orthopoxvirus with a similar disease presentation to smallpox, is a zoonotic virus which can spread from person to person. Although to date, monkeypox events have erupted in West and Central African rainforests, their frequency, size, and geographic scope have expanded substantially in recent years. Imported cases have been detected in multiple locations, including Europe. Yet many aspects of this emerging infectious disease remain unclear, including its animal reservoir, its risk factors for zoonotic and interhuman transmission and ecological characteristics that may facilitate monkeypox emergence. As a result, the 2018 WHO Research & Development Blueprint designated monkeypox as an emerging disease requiring “accelerated research & development and public health action”. The AFRIPOX collaboration will mobilize an international, multidisciplinary One Health partnership spanning epidemiology, anthropology, zoology, environmental ecology, virology and mathematical modelling to tackle four research objectives investigating monkeypox at the human-animal-ecosystem interface: - Identify the animal reservoir and secondary hosts of monkeypox in areas of Central Africa where monkeypox is known to circulate - Identify risk factors for zoonotic and human-to-human monkeypox transmission during outbreaks using quantitative and qualitative methods; determine interhuman transmissibility of monkeypox and its epidemic potential - Understand differences in viral strains circulating in animals and human populations; strengthen diagnostic and response capacities, develop field diagnostic and next generation sequencing capacities for monkeypox in areas of Central Africa where the virus is known to circulate - Determine ecological factors associated with monkeypox emergence in Central Africa and its potential geographic scope in this region The partners’ extensive field experience and knowledge, their internationally recognised expertise, and their existing collaborations will ensure achievement of these objectives. Systematic outbreak investigation and response will improve outbreak control and identify risk factors for spillover and for human-to-human transmission. Studies of past and on-going outbreaks will yield deeper understanding of recent trends in the epidemic potential of the disease and strengthen infection prevention and control measures. An ethno-historical approach will excavate local knowledge about monkeypox and about the ecological and animal behavioural changes that precede or accompany outbreaks; such insights can point to new, unexplored investigations of ecological/zoological dynamics of monkeypox emergence. Investigation of local understandings of human transmission will permit the development of locally acceptable risk communications and prevention measures. The virology work package will conduct phylogenetic analysis to compare human and animal viral strains; it will also improve diagnostic capacities by developing a specific serological assay and field diagnostic test. With strengthened surveillance and field-adapted methods, our study will reduce the time to response, critical for controlling monkeypox and reducing the importation risk, as well as for containing other viral emergence. Understanding the animal species and environmental characteristics which contribute to the emergence of monkeypox will help to pinpoint zones at risk of zoonotic spillover and enhance outbreak preparedness activities there. Through its investigation of monkeypox, AFRIPOX will set the critical foundations for understanding and controlling a global infectious threat. Our multi-disciplinary collaboration will address research about monkeypox and preparedness to outbreaks: it will develop crucial scientific knowledge, identify appropriate response, and strengthen Central African Republic capacity to manage this and other emerging zoonotic diseases, beyond the duration of the project.

Rational: Despite the development of unofficialy occupied living-places ("squats") in France and Europe, there is a lack of scientific data concerning these invisible living situations and precarious housing conditions that are difficult to reach. Hypotheses: People living in unofficialy occupied places in the city of Marseille are numerous and heterogeneous, combining complex life and health histories with precarious and risky living conditions. Objectives: This project is co-constructed by associations and community organizations, involved people, public authorities and scientific laboratorie. It aims to estimate the population of people living in squats in the city and to describe their pathways. The main objective is to understand their living conditions, to identify barriers and levers to access to essential social and health services, and to characterize existing resources and empowerment strategies. Methodology: The project will use a mixed, participatory and community-based methodology with: 1) a quantitative part using Respondent Driven Sampling (RDS) and a questionnaire survey (n=400) associated with the capture/recapture method and; 2) a qualitative part based on semi-structured interviews (n=30), focus groups and observations with the use of mind mapping. Expected results: This cross-analysis of statistical and empirical data aims to improve understanding of the situations of people living in squats, and to propose targeted actions to reduce risks and vulnerabilities and empower residents. The results of the triangulation and integration of quantitative and qualitative data will be discussed with all project partners, and will be the subject of scientific publications and presentations to the different stakeholders - institutional, community, associative and academic. This interdisciplinary and intersectoral (science-society) project is in line with the major priority issues of INSERM (Public Health), CNRS (Health and Environment) and INSHS (Shared Sciences and Experimental Approaches in SHS).

Plasmodium falciparum malaria persists in Sahelian Africa, where incidence follows a highly seasonal pattern. In the near-absence of mosquito vectors, parasites depend on human hosts to survive the dry season. This carriage is generally asymptomatic and remains untreated allowing parasites hosted by chronically infected individuals to reignite transmission when favourable conditions return. An intervention depleting this reservoir could fill a gap in existing malaria control strategy. To exploit the dry season transmission bottleneck efficiently, we need to understand: - how transmission restarts at the onset of the rainy season - how to intervene most efficiently against this carriage - how to integrate such intervention in ongoing control strategies. We will address these challenges in a population study conducted in Kedougou region, Senegal. We will conduct a pilot trial comparing 4 intervention villages receiving mass drug administration (MDA) to deplete the reservoir to 4 control villages, followed over 18 months (2 transmission seasons). We will evaluate feasibility, safety, acceptability, effectiveness of the intervention, and its process. We will compare transmission dynamics between depleted (intervention) vs full parasite reservoir (control). We will assess the contribution of parasite importation (newcomers and mobile inhabitants) and of infection persistence throughout the dry season) with highly sensitive molecular detection tools and genomics. We will integrate these results into relevant evidence for Malaria Control Programs and Health Systems of Sahel countries, by analysing the cost-effectiveness of the proposed strategy, and conducting a regional geoepidemiological analysis of onset dynamics to propose target intervention areas. Our results will shed light on the community-level dynamics of transmission restoration, and provide evidence to design high impact interventions towards malaria elimination.