There exists a tension between the optimism and promise of new technologies, and the reality of working in low resource environments. This tension has an important bearing in global health security, where there is an urgent need to guide and operationalise technological innovations for individual and collective health security. However, new technologies are also creating new tensions and new inequities. Leveraging these tensions – between profits and people, between private and public goods – is a key challenge for global health security today, a challenge that many lives may depend on. Rachel Thompson and Andre Heller Perache reflect on these issues, as explored at a recent Chatham House conference on global health security and technology.
As we mark 100 years since up to 40 million people were killed by the influenza outbreak of 1918-19, it is daunting to acknowledge that, despite huge gains in health and medical technologies, the world remains ill-prepared for the next pandemic. For the 50% of the world’s population lacking access to essential health services these risks are amplified. As with other global challenges (most notably, climate change), ‘business as usual’ is no longer an option for those working in global health security. This is true for states, who have the responsibility to fulfil the right to health; for UN agencies mandated to support global goals like Universal Health Coverage; and for the plethora of state and non-state actors who are committed to deliver Agenda 2030, and its grand pledge to achieve equity by ‘leaving no one behind’.
The private sector – and the innovations it enables – is vital to the positive disruption of this global status quo that has left us all at risk from health threats. However, unlike governments and international organizations, private sector actors are not bound by legal or other frameworks to deliver products or services in a way that is equitable. While improved health security may be an outcome of innovation, current market logic does not prioritize based on global health needs; and however progressive a company may claim to be (e.g. in terms of delivering social impact), its ultimate purpose is to maximize return on investment.
Through research and events, The Centre on Global Health Security at Chatham House examines such issues. In 2017, the Centre hosted a conference on the role of the private sector in global health, looking at the opportunities, challenges, and tensions that arise when mixing commercial interests with public health ones, for example in Public Private Partnerships. Last week, the discussions continued, with a specific focus on harnessing the role of technology in global health security. For the first time, a wide range of practitioners, academics, policy makers, and developers from the private sector came together to explore how new technologies (medical and non-medical) are being utilized towards global health security. Representatives from international agencies including World Health Organization, Bill and Melinda Gates Foundation, United Nations Development Program, and the Global Fund, sat alongside innovators from a range of tech companies, who offered insights as to how their work could positively reinforce health security.
The conference heard about methods to keep vaccines cold in contexts without regular electricity; about how artificial intelligence (AI) can drive efficiency gains in healthcare and epidemic forecasting, and how empowering health workers through better data can improve patient care and stem the spread of disease outbreaks. But we also heard about the challenges and obstacles that are impeding progress. For example, there is often a disconnect between the developers’ perceptions of new technologies and those of the end users. This disconnect may result in a product or service being deployed to a country where there is no expertise for its maintenance; or an appliance being developed for the wrong voltage. How often do developers in the global north consider the very real problem of dust when designing for LIMCs? Does everyone actually have a smartphone? Even if they do, is there reliable electricity to charge it?
The conference also highlighted how existing inequities – for example, around access to connectivity and infrastructure – are being reproduced and amplified in the development and deployment of innovative tech. When it comes to R&D, ‘diseases of the poor’ like TB and cholera (and, until very recently, Ebola) are systematically neglected by private funding bodies, due to lack of commercial incentive. New ways of supplementing the market logic are thus needed to progress developments in global health security – for drugs, for diagnostics and for better data. AMR was highlighted as a ‘market failure’; a symptom of the shortcomings in the current system, but the impact of which will affect both rich and poor.
The current regulatory environment inhibits the adoption of existing technologies in the developing world. Key unanswered questions here include: how can incentives around risk-taking be reversed so that the benefits of scientific advances are not held back for years, or even decades? How can business be incentivised to pursue social as well as financial goals? How can technological innovation itself ultimately become a global public good, as asserted by Mariângela Batista Galvão Simão?
Big data holds big promises for global health security. For example, AI is enabling us to move from disease surveillance to ‘disease intelligence’. There is also great potential for healthcare workers to be empowered through their use of technology. By accessing real-time analytics of the data their work generates, those on the front line can make evidence-driven decisions without sacrificing time to centralised, ineffective or slow information systems. If this new technology is to be adopted, it must be tailored to the environments where it will be deployed and, to put it simply, users have to like using it. On top of this, we must balance individual ethics and privacy concerns – as one speaker put it, “the right to be not counted” as part of general data ownership and management. How to share data efficiently, and ethically, will also be crucial.
But if one issue emerged most clearly throughout the conference, it was this: the optimistic spirit of the tech sector, and the potential of the technology itself, is in conflict with the world’s politics and power structures, and this conflict keeps those at the bottom end of the equation out of view. The politics of technology in global health security are a reflection of politics in general: the best new tech is concentrated in wealthy countries, and serves best the interests of the powerful.
We must not fall into “a critical app-ification” of solutions to global problems; there are no easy solutions or magic bullets when facing the entrenched social, economic and political issues that produce health inequity. The internet has not ended poverty, drones have not solved procurement problems in countries with poor infrastructure and blockchain technology has not ended corruption. As ever smarter phones, AI, blockchain, and other technologies become the norm, we must not forget that “technology will have the most impact for global health security when it reaches those with the most insecurity” (Rosamund Southgate, MSF). Technology that relies on a reliably functioning power supply or a robust public health system may only ever have limited impact in many contexts. Yet, it is in these contexts, where systems are weakest – where health security is weakest – that people have the most to gain from access to better technologies, whether existing or new.
If necessity is the mother of invention, how can we ensure those in most need gain most benefit from today’s inventions? This is the challenge for our time and make no mistake, your health security depends on it.