Public health measures, including travel restrictions and social distancing, have been re-imposed in many parts of the world to curb the growing incidence of the highly transmissible SARS-CoV-2 variant Omicron, putting a damper on celebrations to usher in 2022. Since the World Health Organization (WHO) declared the outbreak of Covid-19 a global pandemic on 11 March 2020, almost 5.5 million deaths across the globe have been attributed to it. Apart from its high degree of infectivity, little is known about the Omicron variant, first reported to the WHO by South Africa on 24 November 2021.
The grim persistence of the pandemic may well have turned initial ambivalence towards a proposal for a new international treaty on pandemic preparedness and response (PPR Treaty) into a decision on 1 December 2021 by the WHO’s 194 member states to set up an intergovernmental body to begin work on a draft accord. Under its constitution, the WHO (through the World Health Assembly) has the power to adopt conventions or agreements on matters that fall within its purview. This rarely invoked power successfully established an international convention on tobacco control, which remains binding on 182 countries. It is still too early to say if the proposed PPR Treaty would garner sufficiently wide support but there are many challenges ahead.
There is clearly a need to address the inequities that the pandemic has made manifest, whether in terms of access to crucial supplies such as vaccines and ventilators or gross inequalities in income or gender, among others. These and related concerns are perhaps redolent of the inequities that were already apparent in a succession of recent epidemics, notably SARS, H1N1, Ebola and Zika.
What is different with this pandemic is the application of digital technologies either as or in support of public health countermeasures, as well as to sustain a variety of day-to-day work and social interactions. Not surprisingly, these digital modalities are similarly tainted by inequities reflected in the generic term “digital divide”.
At a practical level, the proposed PPR Treaty is expected to include measures that will seek to prevent, or at least mitigate, the many and deep inequities laid bare by the pandemic. At a more fundamental level, the treaty will have an even more challenging task of fostering multilateralism in the global health architecture.
We highlight here the need for the proposed PPR Treaty to address emerging digital inequalities that arise from the different capabilities of health systems to harness the benefits and/or address the pitfalls of digitalization. In considering the experiences of a number of health systems in Asia with the digitalization of contact tracing, we hope to show that the capability to support public health intervention through digital means should be a component of pandemic preparedness, and should not itself become another source of inequality, particularly between health systems that are digitally enabled and those that are not.
Digitally supported countermeasures
Social distancing measures, including drastic shelter-in-place orders in some cities, were quickly introduced across China in the early phase of the Covid-19 outbreak in January 2020. Other East Asian health systems followed suit. But, unlike during the SARS outbreak of 2003, many public health measures for infection control and surveillance of at-risk individuals have been enhanced by digital technologies. Public health agencies use digital platforms, including social media, news outlets and dedicated websites to disseminate public health interventions, rules and information. Digital tools, including artificial intelligence (AI)-powered chatbots, have been deployed to shift part of healthcare provision away from hospitals and to support the self-management of chronic disease in the community. With the closure of schools and adults working from home, digital technologies have sustained many aspects of professional and social life at a pace and scale not seen in previous outbreaks.
Digital tools that are used to monitor health conditions were previously applied primarily in limited and controlled settings such as health-related research. With the intensive use of digital technologies and the resulting data amassed during the pandemic, in some already increasingly digitalized societies, these technologies will have a fundamental role in shaping post-pandemic public health and healthcare landscapes, as well as other aspects of social life. By “digitalized” and “digitalization”, we refer to the added value of applying digital technologies such as data analytics, AI and robotics to interventions directed at meeting healthcare, public health and, more broadly, social goals.