1
|
Alkhaldi M, Meghari H, AlBada M. Rethinking the World Health Organization's leadership of global health governance and the global health surveillance systems. Glob Health Promot 2024:17579759231220529. [PMID: 38287270 DOI: 10.1177/17579759231220529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Global health governance is a strategic priority for the World Health Organization (WHO), and the public health surveillance system (PHSS) is a fundamental element of the global health governance structure to timely identify emerging diseases and guide global public health decisions and actions. This analysis explores the overall landscape of global health governance, with a specific focus on the PHSS to understand whether the existing governance landscape facilitates or undermines the WHO's ability to formulate and implement global health policies and initiatives. To achieve this, the existing evidence was reviewed, and synthesized with the experts' perspectives. It is reported that fragmentation is the main drawback of the global health governance landscape, necessitating reorganization and restructuring. The disintegration of PHSS at the global, regional and local levels is associated with a lack of leadership, misalignment with global health priorities, imbalance in coverage of surveillance systems, inadequate innovative technology and digitalization, and fragmented data and information systems. The fragmentation and disintegration of global health governance undermine the effectiveness of the WHO's global health strategic directions and programmes and hinder its ability to govern and guide the global, regional and national public health emergency response. Strategic rethinking of the WHO's governance is essential because strong governance and leadership lead to a robust, aligned and effective PHSS.
Collapse
Affiliation(s)
- Mohammed Alkhaldi
- McGill University, Faculty of Medicine, and Health Sciences, School of Physical and Occupational Therapy, Montreal, Canada
- McGill University, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research (CIHR), Health Systems Impact Fellowship, Ottawa, Canada
- Canadian University Dubai, Department of Public Health, Faculty of Communication, Arts and Sciences, UAE
- University of Basel, Swiss Tropical and Public Health Institute (Swiss TPH), Switzerland
- The University of Oxford, Nuffield Department of Medicine, United Kingdom
| | - Hamza Meghari
- University College London UCL, Institute of Child Health, Infection, Immunity, and Inflammation Department, United Kingdom
| | - Marina AlBada
- The University of Edinburgh, Global Health Policy (MSc), School of Social and Political Science, United Kingdom
| |
Collapse
|
2
|
Hertz MF, Dierst-Davies R, Freire K, Verlenden JMV, Whitton L, Zimmerman J, Honeycutt S, Puddy R, Baldwin GT. Design and Implementation of an Innovative, Rapid Data-Monitoring Strategy for Public Health Emergencies: Pilot of the United States School COVID-19 Mitigation Strategies Project. Public Health Rep 2023; 138:878-884. [PMID: 37675484 PMCID: PMC10576489 DOI: 10.1177/00333549231190050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
During the COVID-19 pandemic, an urgent need existed for near-real-time data collection to better understand how individual beliefs and behaviors, state and local policies, and organizational practices influenced health outcomes. We describe the processes, methods, and lessons learned during the development and pilot testing of an innovative rapid data collection process we developed to inform decision-making during the COVID-19 public health emergency. We used a fully integrated mixed-methods approach to develop a structured process for triangulating quantitative and qualitative data from traditional (cross-sectional surveys, focus groups) and nontraditional (social media listening) sources. Respondents included students, parents, teachers, and key school personnel (eg, nurses, administrators, mental health providers). During the pilot phase (February-June 2021), data from 12 cross-sectional and sector-based surveys (n = 20 302 participants), 28 crowdsourced surveys (n = 26 820 participants), 10 focus groups (n = 64 participants), and 11 social media platforms (n = 432 754 503 responses) were triangulated with other data to support COVID-19 mitigation in schools. We disseminated findings through internal dashboards, triangulation reports, and policy briefs. This pilot demonstrated that triangulating traditional and nontraditional data sources can provide rapid data about barriers and facilitators to mitigation implementation during an evolving public health emergency. Such a rapid feedback and continuous improvement model can be tailored to strengthen response efforts. This approach emphasizes the value of nimble data modernization efforts to respond in real time to public health emergencies.
Collapse
Affiliation(s)
- Marci F. Hertz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | - Sally Honeycutt
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Puddy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | |
Collapse
|
3
|
Metraux S, Modeas AC. Homelessness Among Persons on Delaware's Sex Offender Registry. Dela J Public Health 2023; 9:34-38. [PMID: 37622142 PMCID: PMC10445610 DOI: 10.32481/djph.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
This study provides an in-depth analysis of homelessness among people on the Delaware Sex Offender Registry (SOR) between 2021 and 2023. Delaware's SOR, as a publicly accessible database, offers a uniquely comprehensive window into an unsheltered population among a group that is, collectively, at high risk of experiencing homelessness. We retrieved data from the Delaware SOR on two separate dates, which allowed us to track homelessness among offenders within the state over time. On November 15, 2021, 4.6 percent of the persons on the SOR were homeless. Fifteen months later, this homeless prevalence rate was 5.5 percent. Of the 120 people who reported homelessness on the November date, 56 of them (46.7 percent) were either still homeless or again homeless fifteen months later. This prevalence is significantly higher than rates among the general population, and, once homeless, a substantial proportion remained homeless for extended periods of time. The high rate of unsheltered homelessness among people on the Delaware SOR emphasizes the shortcomings in Delaware's ability to supply shelter for homeless individuals, as well as the additional restrictions people on the SOR experience in their ability to receive these services, which creates hardship for these individuals and reduces communal public safety by increasing the frequency of absconding.
Collapse
Affiliation(s)
- Stephen Metraux
- Center for Community Research & Service, Joseph R. Biden, Jr. School of Public Policy & Administration, University of Delaware
| | - Alexander C Modeas
- Center for Community Research & Service, Joseph R. Biden, Jr. School of Public Policy & Administration, University of Delaware
| |
Collapse
|
4
|
AlKnawy B, Kozlakidis Z, Tarkoma S, Bates D, Honkela A, Crooks G, Rhee K, McKillop M. Digital public health leadership in the global fight for health security. BMJ Glob Health 2023; 8:bmjgh-2022-011454. [PMID: 36792230 PMCID: PMC9933676 DOI: 10.1136/bmjgh-2022-011454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
The COVID-19 pandemic highlighted the need to prioritise mature digital health and data governance at both national and supranational levels to guarantee future health security. The Riyadh Declaration on Digital Health was a call to action to create the infrastructure needed to share effective digital health evidence-based practices and high-quality, real-time data locally and globally to provide actionable information to more health systems and countries. The declaration proposed nine key recommendations for data and digital health that need to be adopted by the global health community to address future pandemics and health threats. Here, we expand on each recommendation and provide an evidence-based roadmap for their implementation. This policy document serves as a resource and toolkit that all stakeholders in digital health and disaster preparedness can follow to develop digital infrastructure and protocols in readiness for future health threats through robust digital public health leadership.
Collapse
Affiliation(s)
- Bandar AlKnawy
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Sasu Tarkoma
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - David Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Antti Honkela
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - George Crooks
- Digital Health and Care Innovation Centre, Glasgow, UK
| | - Kyu Rhee
- CVS Health Corp, Woonsocket, Rhode Island, USA
| | | |
Collapse
|
5
|
Leão LHDC, Siebert P, Trautrims A, Zanin V, Bales K. Eradicating slave labour by 2030: the challenge of worker health surveillance. CIENCIA & SAUDE COLETIVA 2021; 26:5883-5895. [PMID: 34909981 DOI: 10.1590/1413-812320212612.15382021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/28/2021] [Indexed: 11/22/2022] Open
Abstract
Eradicating modern slavery is a relevant scientific, social, and institutional challenge issue. Indeed, efforts are being made globally to understand, map, and eradicate contemporary slavery as a target of the United Nations Sustainable Development Goals by 2030. However, little attention has been given to the Occupational Health Surveillance (VISAT) in the strategies and struggle against exploiting relationships. In order to fill this gap, the paper discusses contemporary slave labor (CSL) and its specificities in Brazil from an occupational health surveillance perspective. We initially highlight the link between CSL, occupational health, and occupational health surveillance (VISAT). We then present three VISAT challenges to addressing CSL: the challenging task of characterizing economic sectors and populations most affected; identifying determinants, risks, and effects on health; and strengthening occupational health practices and services to trigger specific actions regarding formation, information, and intervention in regions of high CSL prevalence. We conclude that Occupational Health Surveillance can play an essential role in the emancipation of workers engaged in slavery relationships.
Collapse
Affiliation(s)
- Luís Henrique da Costa Leão
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Mato Grosso. Av. Fernando Corrêa da Costa 2367, Boa Esperança. 78060-900 Cuiabá MT Brasil.
| | | | | | - Valter Zanin
- Departamento de Filosofia, Sociologia, Pedagogia e Psicologia Aplicada, Padova University. Padova Italy
| | - Kevin Bales
- Rights Lab, Universidade de Nottingham, Reino Unido
| |
Collapse
|
6
|
Althobaiti K. Surveillance in Next-Generation Personalized Healthcare: Science and Ethics of Data Analytics in Healthcare. New Bioeth 2021; 27:295-319. [PMID: 34720071 DOI: 10.1080/20502877.2021.1993055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Advances in science and technology have allowed for incredible improvements in healthcare. Additionally, the digital revolution in healthcare provides new ways of collecting and storing large volumes of patient data, referred to as big healthcare data. As a result, healthcare providers are now able to use data to gain a deeper understanding of how to treat an individual in what is referred to as personalized healthcare. Regardless, there are several ethical challenges associated with big healthcare data that affect how personalized healthcare is delivered. To highlight these issues, this article will review the role of big data in personalized healthcare while also discussing the ethical challenges associated with it. The article will also discuss public health surveillance, its implications, and the challenges associated with collecting participants' information. The article will proceed by highlighting next generation technologies, including robotics and 3D printing. The article will conclude by providing recommendations on how patient privacy can be protected in next-generation personalized healthcare.
Collapse
Affiliation(s)
- Kamal Althobaiti
- Centre for Global Health Ethics, Duquesne University, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Kim ES, Chung JB. Korean mothers' morality in the wake of COVID-19 contact-tracing surveillance. Soc Sci Med 2021; 270:113673. [PMID: 33453628 PMCID: PMC7833862 DOI: 10.1016/j.socscimed.2021.113673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022]
Abstract
The Korean government collects and releases sociodemographic information about people infected with COVID-19, their travel histories, and whether or not the patients wore masks. Korean mothers then upload this information on the boards of online groups called “mom cafes.” Based upon a digital ethnography of 15 “mom cafes,” we examine how Korean mothers understand the travel histories of virus patients and explore the relationships between morality and materiality in the context of infectious disease surveillance. The main findings reveal that mom cafe mothers form moral personhood based on information gathered about artifacts, places, and the mobility of patients. They tie patients' travel histories inextricably to moral identities. Non-maleficence is central to Korean mothers’ morality. This morality appears through the material discourses of artifacts, places, and mobility. A face mask becomes one such hallmark of morality. It is a requisite for moral persons. Those who visit crowded places, such as churches, clubs, and room salons, become immoral because they can be easily infected and spread the virus to their families and communities. To mom cafe mothers, mobile patients, such as clubbers, appear less moral than those who self-quarantine due to the high infection rate of COVID-19. We conclude that morality in this context involves the materiality of artifacts, a sense of place, and the spatial mobility of people.
Collapse
Affiliation(s)
- Eun-Sung Kim
- Department of Sociology, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Ji-Bum Chung
- School of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), UNIST-gil 50, Ulsan, 689-798, Republic of Korea.
| |
Collapse
|
8
|
Degeling C, Chen G, Gilbert GL, Brookes V, Thai T, Wilson A, Johnson J. Changes in public preferences for technologically enhanced surveillance following the COVID-19 pandemic: a discrete choice experiment. BMJ Open 2020; 10:e041592. [PMID: 33208337 PMCID: PMC7677347 DOI: 10.1136/bmjopen-2020-041592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES As governments attempt to navigate a path out of COVID-19 restrictions, robust evidence is essential to inform requirements for public acceptance of technologically enhanced communicable disease surveillance systems. We examined the value of core surveillance system attributes to the Australian public, before and during the early stages of the current pandemic. DESIGN A discrete choice experiment was conducted in Australia with a representative group of respondents, before and after the WHO declared COVID-19 a Public Health Emergency of International Concern. We identified and investigated the relative importance of seven attributes associated with technologically enhanced disease surveillance: respect for personal autonomy; privacy/confidentiality; data certainty/confidence; data security; infectious disease mortality prevention; infectious disease morbidity prevention; and attribution of (causal) responsibility. Specifically, we explored how the onset of the COVID-19 outbreak influenced participant responses. SETTING AND PARTICIPANTS 2008 Australians (general public) completed the experiment: 793 before COVID-19 outbreak onset (mean age 45.9 years, 50.2% male) and 1215 after onset (mean age 47.2 years, 49% male). RESULTS All seven attributes significantly influenced respondents' preferences for communicable disease surveillance systems. After onset, participants demonstrated greater preference for a surveillance system that could prevent a higher number of illnesses and deaths, and were less concerned about their personal autonomy. However, they also increased their preference for a system with high data security. CONCLUSIONS Public acceptance of technology-based communicable disease surveillance is situation dependent. During an epidemic, there is likely to be greater tolerance of technologically enhanced disease surveillance systems that result in restrictions on personal activity if such systems can prevent high morbidity and mortality. However, this acceptance of lower personal autonomy comes with an increased requirement to ensure data security. These findings merit further research as the pandemic unfolds and strategies are put in place that enable individuals and societies to live with SARS-CoV-2 endemicity.
Collapse
Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Caufield East, Victoria, Australia
| | - Gwendolyn L Gilbert
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Marie Bashir Institute for Emerging Infectious Disease and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Brookes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Thi Thai
- Centre for Health Economics, Monash Business School, Monash University, Caufield East, Victoria, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Johnson
- Marie Bashir Institute for Emerging Infectious Disease and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Chiolero A, Buckeridge D. Glossary for public health surveillance in the age of data science. J Epidemiol Community Health 2020; 74:612-616. [PMID: 32332114 PMCID: PMC7337230 DOI: 10.1136/jech-2018-211654] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/15/2020] [Accepted: 02/29/2020] [Indexed: 12/21/2022]
Abstract
Public health surveillance is the ongoing systematic collection, analysis and interpretation of data, closely integrated with the timely dissemination of the resulting information to those responsible for preventing and controlling disease and injury. With the rapid development of data science, encompassing big data and artificial intelligence, and with the exponential growth of accessible and highly heterogeneous health-related data, from healthcare providers to user-generated online content, the field of surveillance and health monitoring is changing rapidly. It is, therefore, the right time for a short glossary of key terms in public health surveillance, with an emphasis on new data-science developments in the field.
Collapse
Affiliation(s)
- Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), Department of Community Health, University of Fribourg, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Observatoire valaisan de la santé (OVS), Sion, Switzerland
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - David Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| |
Collapse
|
10
|
Degeling C, Carter SM, van Oijen AM, McAnulty J, Sintchenko V, Braunack-Mayer A, Yarwood T, Johnson J, Gilbert GL. Community perspectives on the benefits and risks of technologically enhanced communicable disease surveillance systems: a report on four community juries. BMC Med Ethics 2020; 21:31. [PMID: 32334597 PMCID: PMC7183724 DOI: 10.1186/s12910-020-00474-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of:
making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems
Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected.
Collapse
Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia. .,School of Health and Society, University of Wollongong, Wollongong, Australia.
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Antoine M van Oijen
- Molecular Horizons and the Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | | | - Vitali Sintchenko
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, The University of Sydney, Sydney, Australia
| | - Annette Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Trent Yarwood
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia.,Cairns Clinical School, James Cook University, Cairns, Australia.,Rural Clinical School, University of Queensland, Brisbane, Australia
| | - Jane Johnson
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, Australia
| | - Gwendolyn L Gilbert
- The Centre for Infectious Diseases and Microbiology - Public Health, Westmead, Sydney, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, The University of Sydney, Sydney, Australia.,Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
11
|
Aiello AE, Renson A, Zivich PN. Social Media- and Internet-Based Disease Surveillance for Public Health. Annu Rev Public Health 2020; 41:101-118. [PMID: 31905322 DOI: 10.1146/annurev-publhealth-040119-094402] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Disease surveillance systems are a cornerstone of public health tracking and prevention. This review addresses the use, promise, perils, and ethics of social media- and Internet-based data collection for public health surveillance. Our review highlights untapped opportunities for integrating digital surveillance in public health and current applications that could be improved through better integration, validation, and clarity on rules surrounding ethical considerations. Promising developments include hybrid systems that couple traditional surveillance data with data from search queries, social media posts, and crowdsourcing. In the future, it will be important to identify opportunities for public and private partnerships, train public health experts in data science, reduce biases related to digital data (gathered from Internet use, wearable devices, etc.), and address privacy. We are on the precipice of an unprecedented opportunity to track, predict, and prevent global disease burdens in the population using digital data.
Collapse
Affiliation(s)
- Allison E Aiello
- Department of Epidemiology, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435, USA; , ,
| | - Audrey Renson
- Department of Epidemiology, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435, USA; , ,
| | - Paul N Zivich
- Department of Epidemiology, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435, USA; , ,
| |
Collapse
|
12
|
Mutenherwa F, Wassenaar DR, de Oliveira T. Ethical issues associated with HIV molecular epidemiology: a qualitative exploratory study using inductive analytic approaches. BMC Med Ethics 2019; 20:67. [PMID: 31590695 PMCID: PMC6781327 DOI: 10.1186/s12910-019-0403-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background HIV molecular epidemiology is increasingly recognized as a vital source of information for understanding HIV transmission dynamics. Despite extensive use of these data-intensive techniques in both research and public health settings, the ethical issues associated with this science have received minimal attention. As the discipline evolves, there is reasonable concern that existing ethical and legal frameworks and standards might lag behind the rapid methodological developments in this field. This is a follow-up on our earlier work that applied a predetermined analytical framework to examine the perspectives of a sample of scientists from the fields of epidemiology, public health, virology and bioethics on key ethical issues associated with HIV molecular epidemiology in HIV network research. Methods Fourteen in-depth interviews were conducted with scientists from the fields of molecular epidemiology, public health, virology and bioethics. Inductive analytical approaches were applied to identify key themes that emerged from the data. Results Our interviewees acknowledged the potential positive impact of molecular epidemiology in the fight against HIV. However, they were concerned that HIV phylogenetics research messages may be incorrectly interpreted if not presented at the appropriate level. There was consensus that HIV phylogenetics research presents a potential risk to privacy, but the probability and magnitude of this risk was less obvious. Although participants acknowledged the social value that could be realized from the analysis of HIV genetic sequences, there was a perceived fear that the boundaries for use of HIV sequence data were not clearly defined. Conclusions Our findings highlight distinct ethical issues arising from HIV molecular epidemiology. As the discipline evolves and HIV sequence data become increasingly available, it is critical to ensure that ethical standards keep pace with biomedical advancements. We argue that the ethical issues raised in this study, whether real or perceived, require further conceptual and empirical examination.
Collapse
Affiliation(s)
- Farirai Mutenherwa
- School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa. .,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Douglas R Wassenaar
- School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Global Health, University of Washington, Seattle, USA.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| |
Collapse
|
13
|
Degeling C, Johnson J, Gilbert GL. Perspectives of Australian policy-makers on the potential benefits and risks of technologically enhanced communicable disease surveillance - a modified Delphi survey. Health Res Policy Syst 2019; 17:35. [PMID: 30947721 PMCID: PMC6449976 DOI: 10.1186/s12961-019-0440-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 03/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background Event-based social media monitoring and pathogen whole genome sequencing (WGS) will enhance communicable disease surveillance research and systems. If linked electronically and scanned systematically, the information provided by these technologies could be mined to uncover new epidemiological patterns and associations much faster than traditional public health approaches. The benefits of earlier outbreak detection are significant, but implementation could be opposed in the absence of a social licence or if ethical and legal concerns are not addressed. Methods A three-phase mixed-method Delphi survey with Australian policy-makers, health practitioners and lawyers (n = 44) was conducted to explore areas of consensus and disagreement over (1) key policy and practical issues raised by the introduction of novel communicable disease surveillance programmes; and (2) the most significant and likely risks from using social media content and WGS technologies in epidemiological research and outbreak investigations. Results Panellists agreed that the integration of social media monitoring and WGS technologies into communicable disease surveillance systems raised significant issues, including impacts on personal privacy, medicolegal risks and the potential for unintended consequences. Notably, their concerns focused on how these technologies should be used, rather than how the data was collected. Panellists held that social media users should expect their posts to be monitored in the interests of public health, but using those platforms to contact identified individuals was controversial. The conditions of appropriate use of pathogen WGS in epidemiological research and investigations was also contentious. Key differences amongst participants included the necessity for consent before testing and data-linkage, thresholds for action, and the legal and ethical importance of harms to individuals and commercial entities. The erosion of public trust was seen as the most significant risk from the systematic use of these technologies. Conclusions Enhancing communicable disease surveillance with social-media monitoring and pathogen WGS may cause controversy. The challenge is to determine and then codify how these technologies should be used such that the balance between individual risk and community benefit is widely accepted. Participants agreed that clear guidelines for appropriate use that address legal and ethical concerns need to be developed in consultation with relevant experts and the broader Australian public. Electronic supplementary material The online version of this article (10.1186/s12961-019-0440-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of Social Science, University of Wollongong, Building 233.G05D, Wollongong, NSW, 2500, Australia. .,Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Jane Johnson
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Gwendolyn L Gilbert
- Sydney Health Ethics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW, Australia.,Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|