Optimism Meets Realism: The Politics of Technology Innovation in Global Health Security
There is a tension between the 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 operationalize technological innovations for individual and collective health security. However, new technologies are creating new inequities. Leveraging these tensions — between profits and people and between private and public goods — is a key challenge for global health security today — a challenge that many lives depend on. Rachel Thompson and Andre Heller Perache reflect on the issues.
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 per cent 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 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 global health needs. However progressive a company may claim to be, for example in terms of delivering social impact, its ultimate purpose is to maximize a return on investment.
‘While improved health security may be an outcome of innovation, current market logic does not prioritize global health needs.’
Through research and events, The Centre on Global Health Security at Chatham House has been examining such issues. In 2017, the Centre explored the role of the private sector in global health, looking at the opportunities, challenges and tensions that arise when mixing commercial interests with those interests of public health, for example in public-private partnerships. The discussions have continued with a specific focus on harnessing the role of technology in global health security. At a recent conference, a wide range of practitioners, academics, policymakers and developers from the private sector came together to explore how new technologies are being utilized towards global health security. From methods to keep vaccines cold in contexts without regular electricity, to how artificial intelligence (AI) can drive efficiency gains in healthcare and epidemic forecasting, to how empowering health workers through better data can improve patient care and stem the spread of disease outbreaks.
However, there are still a number of challenges that are impeding progress. For example, there is often a disconnect between the perceptions of developers of new technologies from those of the end-users. This disconnect may result in a product or service being deployed in 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 problem of dust when designing for low and middle income countries (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 technology. When it comes to R&D, ‘diseases of the poor’ like tuberculosis (TB) and cholera and, until very recently, Ebola, are systematically neglected by private funding bodies due to a lack of commercial incentives. New ways of supplementing the market logic are therefore needed to progress developments in global health security — for drugs, for diagnostics and for better data. Antimicrobial resistance (AMR) was highlighted as a ‘market failure’ and a symptom of the shortcomings in the current system which will impact both the rich and the poor. The current regulatory environment also inhibits the adoption of existing technologies in the developing world. Key unanswered questions 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? And how can businesses be incentivized to pursue social as well as financial goals?
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 centralized and ineffective or even 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 such as ‘the right to be not counted’ as part of general data ownership and management. How to share data efficiently, and ethically, therefore will be crucial.
‘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.’
But one issue, above all, has emerged as the most important: the optimistic spirit of the technology sector, and the potential of technology itself, is in conflict with the world’s hegemonic 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 of the new technology is concentrated in wealthy countries and serves the interests of the powerful.
There are no 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. While smart phones, AI, blockchain, and other technologies are becoming 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’ as said by Rosamund Southgate at 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 the most benefit from today’s inventions? This is the challenge for our time, and make no mistake, your health security depends on it.
A version of this article appears on International Health Policies Network.