LONDON – The World Health Organization (WHO) aims to hit back at anti-vaccination campaigners and take a role in ensuring the safety of consumer-targeted health apps, as part of a broader push to exert more influence in shaping digital technologies to meet global public health needs.

Without greater involvement of WHO there could be a "negative outcome" of the use of digital technologies and a risk that health gains achieved through WHO programs to eliminate infectious diseases, including polio and measles, are lost, said Bernardo Mariano, director of WHO's department of digital health.

The untamed health app frontier

The proliferation of digital health apps is being driven by a tech industry that is very much consumer-focused and largely unregulated, Mariano said. "We need to make sure [the apps] harm no one."

At the same time, "People can post anything online," including inaccurate health advice. As one stark example of the damage this can cause, the anti-vaccine movement "is creating a situation where global public health gains are being reversed," said Mariano. WHO needs to build greater expertize in digital technologies and a greater presence on social media, to counter this. "The absence of WHO in the digital ecosystem is a problem," he said.

Mariano was speaking following the first meeting last week of a panel of independent technical experts convened by WHO to advise it on digital technologies. The group includes experts in artificial intelligence (AI), virtual reality, medical devices, robotic surgery and wearable technologies on the tech front, alongside specialists in health, ethics, governance, security, economics and law. It was set up as part of a broader strategy for digital health, which was endorsed earlier this year by WHO member countries. Also, as part of the strategy, WHO formed the department of digital health headed by Mariano. (See BioWorld MedTech, April 12, 2019.)

Broader strategy

While Mariano singled out countering anti-vaccination campaigns and ensuring the safety of consumer health apps, the overall strategy is more far-reaching. It includes developing a framework for countries to validate, implement and scale-up digital health technologies and setting out recommendations for how these technologies can be used to strengthen national health systems, improving the quality and the coverage of care.

"There is a lot WHO can do to support the transition to digital health at a country level," said Steve Davis, co-chair of the technical advisory group. At its first meeting, the group scoped the goals and principles it will apply as it helps WHO shape its policies over the next year.

Davis, who until the end of December holds the post of president and CEO of the global health charity, Seattle-based PATH, said the major obstacle facing WHO is adjusting to digital health timescales.

"I work a lot in vaccines and drugs and devices," said Davis. Here, development is phased and there is time to take advice. For digital technologies, "we need a model which is much more agile and adaptive – in good digital health tools the algorithm is changing by the second," he said.

"The good news is that many people are working on this already," Davis said. By bringing together expertise from the tech industry and health care providers, it will be possible to build on these insights, form a unified view and position WHO as a broker between industry and health systems.

"The real issue is to stop [viewing] this as a two-sided issue and see how, if we can provide the governance structure, both sides can benefit greatly," Davis said. "The best apps will come from the private sector – we've got to engage and make sure there are good models and guidance."

Digital health critical to universal coverage

Both Mariano and Davis pointed to digital technologies as being central to WHO's ambition of achieving universal health coverage – providing tools for remote consultations, better, faster diagnoses, empowering health care workers with full and timely information and increasing their productivity.

Davis saw several implementations of digital technologies, such as paperless medical records and electronic supply chains for drugs, on a swansong visit to Africa as PATH CEO earlier in the month.

"This isn't a pipe dream; this is happening. There are already extraordinary examples," he said.

WHO also can position itself as broker in data governance, striking a balance between open data and protecting patient privacy, against industry's need to turn a profit. Extracting the full benefits of digital health requires the application of AI. "AI requires data, therefore, data governance is key," Mariano said.

The perspective of people on the health care side is that, given appropriate privacy and ethical principles are respected, data should be freely available. But the private sector with its need to monetize data, wants to build proprietary products. These opposing motivations must be finessed to ensure personal health data can be part of the global good.

"Maybe we should talk about an equitable share of the revenue from data. We have a two-edged sword. We want free data flows for global good, but then there are companies with business models heavily relying on data. We need to bring the two together, to create a governance structure that [addresses] the two perspectives," said Mariano.

One of the reasons for forming the technical advisory group is to help WHO breakaway from its traditional response mode, Mariano said. "We want to challenge the way we normally operate. We don't want a report no one reads, or recommendations nobody follows, or strategies no one can implement."

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