Serious Game Puts Farmers at the Center of Q Fever Outbreak Response in Western France

When a goat herd in western France begins aborting kids, the diagnosis that follows—Q fever—sets off a chain reaction that extends far beyond the barn. The bacterium Coxiella burnetii, which causes the disease, can drift in contaminated dust from livestock facilities to nearby residents, and the response measures that authorities propose can fracture the trust between farmers, veterinarians, and public health officials. A new study published in PLOS Neglected Tropical Diseases describes an unusual attempt to repair that fracture before it happens: a participatory science project called ZOOJEU, which combines a comic strip and a serious game to bring farmers into the room where disease management strategies are designed.

The project emerged from a transdisciplinary collaboration among researchers in epidemiology, social anthropology, and the public policy sciences, led by Elsa Jourdain, Élodie Rousset, Émilie Ramillien, Patrice Cayre, and Xavier Fourt. Their starting point was a persistent problem in the management of neglected zoonotic diseases—infections that pass between animals and humans and that tend to fall between the cracks of veterinary and medical bureaucracies. Decision-making in these outbreaks is one of the most difficult aspects of control, and while management strategies would ideally account for all stakeholder perspectives, in practice certain groups, notably farmers, are often excluded from the process.

The team chose Q fever in goats in western France as their target system, a region that had recently experienced a human outbreak of the disease. Q fever is caused by C. burnetii, a bacterium that reproduces in enormous numbers in the placental tissue of infected ruminants. When an infected animal gives birth or aborts, the bacteria are shed into the environment in staggering quantities, where they resist desiccation and chemical disinfection and can remain infectious in soil and dust for months. Humans typically acquire the infection by inhaling contaminated aerosols, sometimes from farms kilometers downwind. In animals, the infection is often silent, but abortion storms in goats and sheep can be devastating, and the bacteria can persist in herds for years.

Because the disease sits at the intersection of animal health, human health, and environmental contamination, no single authority holds all the levers of control. Farmers face economic losses and stigma; veterinarians face diagnostic and reporting obligations; public health officials face the risk of human cases; and neighbors face anxiety about airborne exposure. Each of these groups experiences the outbreak through a different professional and personal lens, and each holds partial knowledge that the others lack. The ZOOJEU researchers recognized that a management strategy designed without the farmers who must implement it was likely to fail in the field, regardless of its technical soundness.

The first product of the project was a comic strip, built directly on earlier anthropological research that had documented the different realities of stakeholders in the outbreak region. Rather than presenting Q fever as a purely microbiological problem, the comic rendered the social texture of the situation—the way a farmer interprets an abortion event, the way a neighbor interprets a plume of dust, the way an administrator interprets a regulation. The researchers reported that the comic strip highlighted issues related to Q fever for the stakeholders who engaged with it, serving as a bridge between the anthropological fieldwork and the practical conversations that followed.

The second product was a serious game, designed to foster mutual understanding among stakeholders and to encourage the collaborative co-designing of public health strategies with farmers rather than for them. Constructing the game required the team to compile lists of tangible and intangible elements that characterize stakeholder experiences of Q fever outbreaks—the physical objects and actors on a farm, but also the worries, obligations, and uncertainties that shape decisions. These elements became game figures that players could place, move, and discuss, giving abstract tensions a concrete form on the table.

The game was played by 23 stakeholders divided into three sets of players, with each set including at least one farmer. The scenario was deliberately specific: a goat farm experiencing Q-fever-induced abortions. Players were asked to collectively analyze the situation and to explain their perspectives and actions using the game figures, each of which represented elements that different stakeholders engage with regularly or in the context of a zoonosis. The goal was not to find a single correct answer but to establish a shared vision of what was happening on the farm—a narrative that all participants could recognize as their own, even if it incorporated perspectives they had not previously considered.

The mechanics of such a session reward a particular kind of reasoning. A farmer might place a figure representing a closed barn door next to a figure representing ventilation, prompting a public health official to ask why the door matters; the answer—about dust, about neighbors, about the practical impossibility of sealing a working barn—feeds directly into the design of realistic control measures. A veterinarian might introduce figures representing testing and culling, and the ensuing discussion exposes the economic and emotional costs that a purely epidemiological model would leave invisible. Because every claim must be expressed through a figure on the table, the game forces participants to make their assumptions explicit and negotiable rather than leaving them embedded in professional jargon.

The researchers concluded that the approach appeared effective in establishing a common narrative among participants and in fostering a more democratic approach to public health, one that simultaneously accounted for human, animal, environmental, and social health concerns. This aligns with the broader principles of the One Health framework, which holds that the health of people, domestic animals, wildlife, and ecosystems is interconnected and that effective interventions must operate across those boundaries. What ZOOJEU adds to that framework is a procedural innovation: a structured, playable format in which the perspectives of the least powerful stakeholders can enter the design process on equal footing with those of experts and authorities.

The team also noted that the utility of the approach as an educational tool should be explored further, a suggestion with implications well beyond Q fever. Neglected zoonotic diseases—brucellosis, leptospirosis, Rift Valley fever, and many others—share the structural features that ZOOJEU was built to address: they involve multiple species, multiple authorities, and multiple publics, and their management depends on cooperation from people who rarely sit at the same table. A serious game calibrated to a different disease, a different livestock system, or a different cultural context could, in principle, reproduce the same effect, turning the co-design of outbreak response from an aspiration into a repeatable practice. The 23 players in western France were, in effect, testing whether the table itself could be rebuilt so that everyone has a place at it.

Subject of Research: Participatory science approaches for co-designing management strategies against Q fever, a neglected zoonotic disease, in western French goat farming

Article Title: ZOOJEU: Using Q fever to highlight a participatory science approach for fostering the co-design of management strategies for neglected zoonotic diseases

Article References: ZOOJEU: Using Q fever to highlight a participatory science approach for fostering the co-design of management strategies for neglected zoonotic diseases. (n.d.). https://doi.org/10.1371/journal.pntd.0014618

Image Credits: AI Generated

DOI: 10.1371/journal.pntd.0014618

Keywords: Q fever, Coxiella burnetii, neglected zoonotic diseases, participatory science, serious game, One Health, goat farming, public health, co-design, zoonoses, France, epidemiology