Tag Archives: Health

Understanding global diversity in the impact of COVID-19

Having written quite extensively about the dire responses of the British government to the crises surrounding COVID-19 earlier in the year, I have held back from further criticism and writing about this for almost two months. It seems extraordinary, though, how few lessons seem to have been learnt in Europe from our experiences with COVID-19 so far, and how so many people seem to be surprised at its recent resurgence. As many of us have said for a long time, this was only to be expected, and is a direct result of the the behaviour both of individuals and also of governments. Above all, it seems to to reflect the selfish individualism, rather than communal responsibility, that has come to dominate many societies in Europe and North America in the 21st century.

The lack of research as to exactly why different countries have such varying mortality rates is also shocking (see my The influence of environmental factors on COVID-19 written in May). As a global community, very much more attention should have been given to this, so that we could by now have a better understanding of what has worked, and what has failed. Answers to these questions would enable governments now to be implementing better policies across the world to mitigate the COVID-19 related deaths that are becoming ever more numerous.

The chart below indicates the very differing numbers of deaths from COVID-19 per 100,000 population in the countries of the world that have had more than 5,000 deaths as of 21st September 2020 (data from https://coronavirus.thebaselab.com). While all such data are notoriously problematic, reported deaths from COVID-19 are more reliable than are data for case numbers (see my Data and the scandal of the UK’s COVID-19 survival rate written in April). Deaths above the usual average (excess mortality) are probably an even better measure, but are unfortunately much more difficult to obtain at a global scale. Furthermore, it must be emphasised that this sample does not include all those countries that have had far fewer deaths, and that much more research is needed in explaining why it is indeed these 25 countries that have had the most deaths in the first place.

This chart raises many unanswered questions, but does at least show two key things:

  • Some countries have “performed” very much “better” and others much “worse” than average. India, Indonesia, Germany and Pakistan appear to have performed significantly better than Peru and Belgium. Why is it, for example, that Peru has 30 times more deaths per 100,000 than does Pakistan? Yet it is extremely difficult to see what either of these groups of countries might have internally in common.
  • There nevertheless seems to be a broad group of very different countries including Sweden, Spain, the UK, Brazil, Chile, Ecuador and the USA that have so far had between 50 and 70 deaths per 100,000. Again, these countries are very diverse, be it in terms of size, demographic structure, political views, or government policies towards COVID-19, although most seem to be fairly right wing and individualistic. Interestingly Sweden with its much more relaxed policy towards social restrictions during COVID-19 appears to have done neither better nor worse than other countries in this group.

The challenge, of course, is to try to understand or explain these patterns but sadly too little research has been done on this in a systematic way to be able to draw any sound conclusions. Put simply, we do not yet really know why countries have had such diverse fortunes. Nevertheless, it is possible to begin to draw some tentative conclusions:

  • Much has been made of the environmental factors possibly influencing the spread of COVID-19, but very little actual process-based research has satisfactorily shown how viable SARS-CoV-2 actually is under a wide range of environmental conditions (see my The influence of environmental factors on Covid-19: towards a research agenda from May). The data above serves as a cautionary warning: countries with similar broad environments tend to have very differing COVID-19 trajectories. Why, for example, are Latin American countries suffering much worse than those of Africa and Asia, although they share many environmental characteritsics in common?
  • A second challenging conclusion is that the actual policies followed by governments may not be that significant in influencing the spread of COVID-19. It is thus striking that Sweden, which has followed very different policies from its neighbours, has not done significantly better or worse than them or indeed other countries such as the UK and the USA, which are widely seen to have failed in dealing with COVID-19.
  • In searching for explanations, it is also pertinent to see whether these rates could in any way be related to varying levels of inequality. However, using the Gini coefficient as a measure of inequality there seems to be no significant relationship with mortality rates (R2 = 0.027).
  • Religious beliefs and practices, likewise, do not seem to be particularly good at explaining these differenceces, although nominally Christian (or atheist) countries do fill the top 15 places in terms of mortality rates, before Iran in 16th place. Other countries with large percentages of Muslims, including Turkey, Egypt, Indonesia and Pakistan all have less than 10 deaths per 100,000. The difference between India and Pakistan (neighbours in South Asia) is particularly interesting, in that India (predominatly Hindu) has a mortality rate more than double that of Pakistan. No satisfactory explanation for this has yet been identified.
  • There has also been some speculation that individualistic societies, where people care more about themselves than they do about being responsible for their neighbours, are having higher mortality rates than do more communal societies, and in this respect the contrasts between the USA and China are indeed very marked. It is extremelt difficult to measure individualism but correlations between the Geert Hofstede Individualism (IDV) Index and mortality rates do not have a strong correlation (R2 = 0.048).

No single explanation would simply account for all of these differences. An important conclusion must therefore be that there is indeed not a single solution (apart from a vaccine or other medical interventions) that is likely to prevent dramatic increases in the prevalance of COVID-19 in these countries, and that many more deaths are therefore certain over the next six months. As individuals, we all know what can make a difference: avoid large groups, wear masks, stay outside as much as possible, wash our hands regularly, and above all act responsibility with respect to others. At all times we mut act as if we have COVID-19, and imagine how we would feel if we were the other people with whom we were interacting, and they knew that we had COVID-19. If there is any solution to COVID-19, it must be that we act responsibly rather than selfishly (see my A differentiated, responsibilities-based approach to living with the Covid-19 pandemic written in June).


The full list of countries with >5000 deaths by 21st September and therefore included in this analysis is (in descending order of deaths per 100,000) : Peru, Belgium, Spain, Brazil, Chile, Ecuador, USA, UK, Italy, Sweden, Mexico, France, Colombia, Netherlands, Argentina, Iran, South Africa, Canada, Russia, Germany, Turkey, India, Egypt, Indonesia, Pakistan

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Digital-political-economy in a post-Covid-19 world: implications for the most marginalised

Now is the time to be thinking seriously about the kind of world that we wish to live in once Covid-19 has finished its rampage across Europe and North America.[i] Although its potential direct health impact in Africa and South Asia remains uncertain at the time of writing, countries within these continents have already seen dramatic disruption and much hardship as well as numerous deaths having been caused by the measures introduced by governments to restrict its spread.  It is already clear that it is the poorest and most marginalised who suffer most, as witnessed, for example, by the impact of Modi’s lockdown in India on migrant workers.[ii]

This post highlights five likely global impacts that will be hastened by Covid-19, and argues that we need to use this disruption constructively to shape a better world in the future, rather than succumb to the potential and substantial damage that will be caused, especially to the lives of the world’s poorest and most marginalised.  It may be that for many countries in the world, the impact of Covid-19 will be even more significant than was the impact of the 1939-45 war.  Digital technologies are above all accelerators, and most of those leading the world’s major global corporations are already taking full advantage of Covid-19 to increase their reach and their profits.[iii]

The inexorable rise of China and the demise of the USA

http://hiram1555.com/2016/10/21/presidential-debates-indicate-end-of-us-empire-analyst/

Source: Hiram1555.com

I have written previously about the waxing of China and the waning of the USA; China is the global political-economic powerhouse of the present, not just of the future.[iv]  One very significant impact of Covid-19 will be to increase the speed of this major shift in global power.  Just as 1945 saw the beginning of the final end of the British Empire, so 2020 is likely to see the beginning of the end of the USA as the dominant global (imperial) power.  Already, even in influential USAn publications, there is now much more frequent support for the view that the US is a failing state.[v] This transition is likely to be painful, and it will require world leaders of great wisdom to ensure that it is less violent than may well be the case.

The differences between the ways in which the USA and China have responded to Covid-19 have been marked, and have very significant implications for the political, social and economic futures of these states.  Whilst little trust should be placed on the precise accuracy of reported Covid-19 mortality rate figures throughout the world, China has so far reported a loss of 3.2 people per million to the disease (as of 17 April, and thus including the 1290 uplift announced that day), whereas the USA has reported deaths of 8.38 per 100,000 (as of that date); moreover, China’s figures seem to have stabilised, whereas those for the USA continue to increase rapidly.[vi]  These differences are not only very significant in human terms, but they also reflect a fundamental challenge in the relative significance of the individual and the community in US and Chinese society.

Few apart from hardline Republicans in the USA now doubt the failure of the Trump regime politically, socially, economically and culturally. This has been exacerbated by the US government’s failure to manage Covid-19 effectively (even worse than the UK government’s performance), and its insistent antagonism towards China through its deeply problematic trade-war[vii] even before the outbreak of the present coronavirus. Anti-Chinese rhetoric in the USA is but a symptom of the realisation of the country’s fundamental economic and policial weaknesses in the 21st century.   President Trump’s persistent use of the term “Chinese virus” instead of Covid-19[viii] is also just a symptom of a far deeper malaise.   Trump is sadly not the problem; the problem is the people and system that enabled him to come to power and in whose interests he is trying to serve (alongside his own).  China seems likely to come out of the Covid-19 crisis much stronger than will the USA.[ix]

Whether people like it or not, and despite cries from the western bourgeoisie that it is unfair, and that the Chinese have lied about the extent of Covid-19 in their own country in its early stages, this is the reality.  China is the dominant world power today, let alone tomorrow.

An ever more digital world

https://www.forbes.com/sites/columbiabusinessschool/2020/04/21/how-covid-19-will-accelerate-a-digital-therapeutics-revolution/

Source: Forbes.com

The digital technology sector is already the biggest winner from Covid-19.  Everyone with access, knowledge and ability to pay for connectivity and digital devices has turned to digital technologies to continue with their work, maintain social contacts, and find entertainment during the lockdowns that have covered about one-third of the world’s population by mid-April.[x]  Those who previously rarely used such technologies, have overnight been forced to use them for everything from buying food online, to maintaining contacts with relatives and friends.

There is little evidence that the tech sector was prepared for such a windfall in the latter part of 2019,[xi] but major corporations and start-ups alike have all sought to exploit its benefits as quickly as possible in the first few months of 2020, as testified by the plethora of announcements claiming how various technologies can win the fight against Covid-19.[xii]

One particularly problematic outcome has been the way in which digital tech champions and activists have all sought to develop new solutions to combat Covid-19.  While sometimes this is indeed well intended, more often than not it is primarily so that they can benefit from funding that is made available for such activities by governments and donors, or primarily to raise the individual or corporate profile of those involved.  For them, Covid-19 is a wonderful business opportunity.  Sadly, many such initiatives will fail to deliver appropriate solutions, will be implemented after Covid-19 has dissipated, and on some occasions will even do more harm than good.[xiii]

There are many paradoxes and tensions in this dramatically increased role of digital technology after Covid-19. Two are of particular interest.  First, many people who are self-isolating or social distancing are beginning to crave real, physical human contact, and are realising that communicating only over the Internet is insufficiently fulfilling.  This might offer some hope for the future of those who still believe in the importance of non-digitally mediated human interaction, although I suspect that such concerns may only temporarily delay our demise into a world of cyborgs.[xiv] Second, despite the ultimate decline in the US economy and political power noted above, US corporations have been very well placed to benefit from the immediate impact of Covid-19, featuring in prominent initiatives such as UNESCO’s Global Education Coalition,[xv] or the coalition of pharmaceutical companies brought together by the Gates Foundation.[xvi]

Whatever the precise details, it is an absolute certainty that the dominance of digital technologies in everyone’s lives will increase very dramatically following Covid-19 and this will be exploited by those intent on reaping the profits from such expansion in their own interests.

Increasing acceptance of surveillance by states and companies: the end of privacy as we know it.

https://www.wired.com/story/phones-track-spread-covid19-good-idea/

Source: Wired.com

A third, related, global impact of Covid-19 will be widely increased global acceptance of the roles of states and companies in digital surveillance.  Already, before 2020, there was a growing, albeit insufficient, debate about the ethics of digital surveillance by states over issues such as crime and “terrorism”, and its implications for privacy.[xvii]  However, some states, such as China, South Korea, Singapore and Israel, have already used digital technologies and big data analytics extensively and apparently successfully in monitoring and tracking the spread of Covid-19,[xviii] and other coalitions of states and the private sector are planning to encourage citizens to sign up to having fundamental aspects of what has previously been considered to be their private and personal health information made available to unknown others.[xix]

One problem with such technologies is that they require substantial numbers of people to sign up to and then use them.  In more authoritarian states where governments can make such adherence obligatory by imposing severe penalties for failure to do so, they do indeed appear to be able to contribute to reduction in the spread of Covid-19 in the interests of the wider community.  However, in more liberal democratic societies, which place the individual about the community in importance, it seems less likely that they will be acceptable.

Despite such concerns, the growing evidence promoted by the companies that are developing them that such digital technologies can indeed contribute to enhanced public health will serve as an important factor in breaking down public resistance to the use of surveillance technologies and big data analytics.  Once again, this will ultimately serve the interest of those who already have greater political and economic power than it will the interests of the most marginalised.

Online shopping and the redesign of urban centres.

https://www.independent.co.uk/life-style/health-and-families/coronavirus-herd-immunity-meaning-definition-what-vaccine-immune-covid-19-a9397871.html

Source: Independent.co.uk

Self-isolation and social distancing have led to the dramatic emptying of towns and cities across the world.  Businesses that have been unable to adapt to online trading have overnight been pushed into a critical survival situation, with governments in many of the richer countries of the world being “forced” to offer them financial bail-outs to help them weather the storm.  Unfortunately, most of this money is going to be completely wasted and will merely create huge national debts for years into the future.  People who rarely before used online shopping are now doing so because they believe that no other method of purchasing goods is truly safe.

The new reality will be that most people will have become so used to online shopping that they are unlikely to return in the future to traditional shopping outlets. Companies that have been unable to adjust to the new reality will fail.  The character of our inner-city areas will change beyond recognition.  This is a huge opportunity for the re-design of urban areas in creative, safe and innovative ways.  Already, the environmental impact of a reduction in transport and pollution has been widely seen; wildlife is enjoying a bonanza; people are realising that their old working and socialising patterns may not have been as good as they once thought.[xx]  Unfortunately, it is likely that this opportunity may not be fully grasped, and instead governments that lack leadership and vision will instead seek to prop up backward-looking institutions, companies and organisations, intent on preserving infrastructure and economic activities that are unfit for purpose in the post-pandemic world.  Such a mentality will lead to urban decay and ghettoization, where people will fear to tread, and there is a real danger of a downward spiral of urban deprivation.

There are, though, many bright signs of innovation and creativity for those willing to do things differently.  Shops and restaurants that have been able to find efficient trustworthy drivers are now offering new delivery services; students are able to draw on the plethora of online courses now available; new forms of communal activity are flourishing; and most companies are realising that they don’t actually need to spend money on huge office spaces, but can exploit their labour even more effectively by enabling them to work from home.

We must see the changes brought about by responses to Covid-19 as important opportunities to build for the future, and to create human-centred urban places that are also sensitive to the natural environments in which they are located.

Increasing global inequalities

https://gulfnews.com/photos/news/indian-migrants-forced-to-walk-home-amid-covid-19-lockdown-1.1585394226024?slide=2

Source: Gulfnews.com

The net outcome of the above four trends will lead inexorably to a fifth, and deeply concerning issue: the world will become an even more unequal place, where those who can adapt and survive will flourish, but where the most vulnerable and marginalised will become even more immiserated.

This is already all too visible.  Migrant workers are being ostracised, and further marginalised.[xxi]  In India, tens of thousands of labourers are reported to have left the cities, many of them walking home hundreds of kilometres to their villages.[xxii] In China, Africans are reported as being subjected to racist prejudice, being refused service in shops and evicted from their residences.[xxiii]  In the UK, many food banks have had to close and it is reported that about 1.5. million people a day are going without food.[xxiv]  The World Bank is reporting that an extra 40-50 million people across the world will be forced into poverty by Covid-19, especially in Africa.[xxv]  People with disabilities have become even more forgotten and isolated.[xxvi]  The list of immediate crises grows by the day.

More worrying still is that there is no certainty that these short-term impacts will immediately bounce-back once the pandemic has passed.  It seems at least as likely that many of the changes will have become so entrenched that aspects of living under Covid-19 will become the new norm.  Once again, those able to benefit from the changes will flourish, but the uneducated, those with disabilities, the ethnic minorities, people living in isolated areas, refugees, and women in patriarchal societies are all likely to find life much tougher in 2021 and 2022 even than they do at present.   Much of this rising inequality is being caused, as noted above, by the increasing role that digital technologies are playing in people’s lives.  Those who have access and can afford to use the Internet can use it for shopping, employment, entertainment, learning, and indeed most aspects of their lives.  Yet only 59% of the world’s population are active Internet users.[xxvii]

Looking positively to the future.

People will respond in different ways to these likely trends over the next few years, but we will all need to learn to live together in a world where:

  • China is the global political economic power,
  • Our lives will become ever more rapidly experienced and mediated through digital technology,
  • Our traditional views of privacy are replaced by a world of surveillance,
  • Our towns and cities have completely different functions and designs, and
  • There is very much greater inequality in terms of opportunities and life experiences.

In dealing with these changes, it is essential to remain positive; to see Covid-19 as an opportunity to make the world a better place for everyone to live in, rather than just as a threat of further pain, misery and death, or an opportunity for a few to gain unexpected windfall opportunities to become even richer.  Six elements would seem to be important in seeking to ensure that as many people as possible can indeed flourish once the immediate Covid-19 pandemic has dissipated:

  • First, these predictions should encourage all of us to prioritise more on enhancing the lives of the poorest and the most marginalised, than on ensuring economic growth that mainly benefits the rich and privileged. This applies at all scales, from designing national health and education services, to providing local, community level care provision.
  • This requires an increased focus on negotiating communal oriented initiatives and activities rather than letting the greed and selfishness of individualism continue to rule the roost.
  • Third, it is essential that we use this as an opportunity to regain our physical sentient humanity, and reject the aspirations of those who wish to create a world that is only experienced and mediated through digital technology. We need to regain our very real experiences of each other and the world in which we live through our tastes, smells, the sounds we hear, the touches we feel, and the sights we see.
  • Fourth, it seems incredibly important that we create a new global political order safely to manage a world in which China replaces the USA as the dominant global power. The emergence of new political counterbalances, at a regional level as with Europe, South Asia, Africa and Latin America seems to be a very important objective that remains to be realised.  Small states that choose to remain isolated, however arrogant they are about the “Great”ness of their country, will become ever more vulnerable to the vagaries of economic, political and demographic crisis.
  • Fifth, we need to capitalise on the environmental impact of Covid-19 rapidly to shape a world of which we are but a part, and in which we care for and co-operate with the rich diversity of plant and animal life that enjoys the physical richness of our planet. This will require a comprehensive and rigorous evaluation of the harm caused to our world by the design and use of digital technologies.[xxviii]
  • Finally, we need to agree communally on the extent to which individual privacy matters, and whether we are happy to live in a world of omnipresent surveillance by companies (enabling them to reap huge profits from our selves as data) and governments (to maintain their positions of power, authority and dominance). This must not be imposed on us by powerful others.  It is of paramount importance that there is widespread informed public and communal discussion about the future of surveillance in a post-Covid-19 era.

I trust that these comments will serve to provoke and challenge much accepted dogma and practice.  Above all, let’s try to think of others more than we do ourselves, let’s promote the reduction of inequality over increases in economic growth, and let’s enjoy  an integral, real and care-filled engagement with the non-human natural world.


Notes:

[i] For current figures see https://coronavirus.thebaselab.com/ and https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6, although all data related with this coronavirus must be treated with great caution; see https://unwin.wordpress.com/2020/04/11/data-and-the-scandal-of-the-uks-covid-19-survival-rate/

[ii] Modi’s hasty coronavirus lockdown of India leaves many fearful for what comes next, https://time.com/5812394/india-coronavirus-lockdown-modi/

[iii] Jack Dorsey, the founder of Twitter and Square, might well be an exception with his $1 billion donation to support Covid-19 relief and other charities; see https://www.theverge.com/2020/4/7/21212766/jack-dorsey-coronavirus-covid-19-donate-relief-fund-square-twitter

[iv] See, for example, discussion in Unwin, T. (2017) Reclaiming ICT4D, Oxford: Oxford University Press.  I appreciate that such arguments infuriate many people living in the USA,

[v] See, for example, George Parker’s, We Are Living in a Failed State: The coronavirus didn’t break America. It revealed what was already broken, The Atlantic, June 2020 (preview) https://www.theatlantic.com/magazine/archive/2020/06/underlying-conditions/610261/.

[vi] Based on figures from https://coronavirus.thebaselab.com/ on 15th April 2020.  For comparison, Spain had 39.74 reported deaths per 100,000, Italy 35.80, and the UK 18.96.

[vii] There are many commentaries on this, but The Wall Street Journal’s account on 9 February 2020 https://www.wsj.com/articles/u-s-china-trade-war-reshaped-global-commerce-11581244201 is useful, as is the Pietersen Institute’s timeline https://www.piie.com/blogs/trade-investment-policy-watch/trump-trade-war-china-date-guide.

[viii] For a good account of his use of language see Eren Orbey’s comment in The New Yorker, Trump’s “Chinese virus” and what’s at stake in the coronovirus’s name,  https://www.newyorker.com/culture/cultural-comment/whats-at-stake-in-a-viruss-name

[ix] China’s massive long-term strategic investments across the world, not least through its 一带一路 (Belt and Road) initiative, have placed it in an extremely strong position to reap the benefits of its revitalised economy from 2021 onwards (for a good summary of this initiative written in January 2020 see https://www.cfr.org/backgrounder/chinas-massive-belt-and-road-initiative)

[x] Kaplan, J., Frias, L. and McFall-Johnsen, M., A third of the global population is on coronavirus lockdown…, https://www.businessinsider.com/countries-on-lockdown-coronavirus-italy-2020-3?r=DE&IR=T

[xi] This is despite conspiracy theorists arguing that those who were going to gain most from Covid-19 especially in the digital tech and pharmaceutical industry had been active in promoting global fear of the coronavirus, or worse still had actually engineered it for their advantage.  See, for example, The New York Times, https://www.nytimes.com/2020/04/17/technology/bill-gates-virus-conspiracy-theories.html, or Thomas Ricker, Bill Gates is now the leading target for Coronavirus falsehoods, says report, https://www.theverge.com/2020/4/17/21224728/bill-gates-coronavirus-lies-5g-covid-19 .

[xii] See, for example, Shah, H. and Kumar, K., Ten digital technologies helping humans in the fight against Covid-19, Frost and Sullivan, https://ww2.frost.com/frost-perspectives/ten-digital-technologies-helping-humans-in-the-fight-against-covid-19/, Gergios Petropolous, Artificial interlligence in the fight against COVID-19, Bruegel, https://www.bruegel.org/2020/03/artificial-intelligence-in-the-fight-against-covid-19/, or Beech, P., These new gadgets were designed to fight COVID-19, World Economic Forum, https://www.weforum.org/agenda/2020/04/coronavirus-covid19-pandemic-gadgets-innovation-technology/. It is also important to note that the notion of “fighting” the coronavirus is also deeply problematic.

[xiii] For my much more detailed analysis of these issues, see Tim Unwin (26 March 2020), collaboration-and-competition-in-covid-19-response, https://unwin.wordpress.com/2020/03/26/collaboration-and-competition-in-covid-19-response/

[xiv] For more on this see Tim Unwin (2017) Reclaiming ICT4D, Oxford: Oxford University Press, and for a brief comment https://unwin.wordpress.com/2016/08/03/dehumanization-cyborgs-and-the-internet-of-things/.

[xv] Although, significantly, Chinese companies are also involved; see https://en.unesco.org/covid19/educationresponse/globalcoalition

[xvi] For the work of the Gates Foundation and US pharmaceutical companies in fighting Covid-19 https://www.outsourcing-pharma.com/Article/2020/03/27/Bill-Gates-big-pharma-collaborate-on-COVID-19-treatments

[xvii] There is a huge literature, both academic and policy related, on this, but see for example OCHCR (2014) Online mass-surveillance: “Protect right to privacy even when countering terrorism” – UN expert, https://www.ohchr.org/SP/NewsEvents/Pages/DisplayNews.aspx?NewsID=15200&LangID=E; Privacy International, Scrutinising the global counter-terrorism agenda, https://privacyinternational.org/campaigns/scrutinising-global-counter-terrorism-agenda; Simon Hale-Ross (2018) Digital Privacy, Terrorism and Law Enforcement: the UK’s Response to Terrorist Communication, London: Routledge; and Lomas, N. (2020) Mass surveillance for national security does conflict with EU privacy rights, court advisor suggests, TechCrunch, https://techcrunch.com/2020/01/15/mass-surveillance-for-national-security-does-conflict-with-eu-privacy-rights-court-advisor-suggests/.

[xviii] Kharpal, A. (26 March 2020) Use of surveillance to fight coronavirus raised c oncenrs about government power after pandemic ends, CNBC, https://www.cnbc.com/2020/03/27/coronavirus-surveillance-used-by-governments-to-fight-pandemic-privacy-concerns.html; but see also more critical comments about the efficacy of such systems as by Vaughan, A. (17 April 2020) There are many reasons why Covid-19 contact-tracing apps may not work, NewScientist, https://www.newscientist.com/article/2241041-there-are-many-reasons-why-covid-19-contact-tracing-apps-may-not-work/

[xix] There are widely differing views as to the ethics of this.  See, for example, Article 19 (2 April 2020) Coronavirus: states use of digital surveillance technologies to fight pandemic must respect human rights, https://www.article19.org/resources/covid-19-states-use-of-digital-surveillance-technologies-to-fight-pandemic-must-respect-human-rights/ ; McDonald, S. (30 March 2020) The digital response to the outbreak of Covid-19, https://www.cigionline.org/articles/digital-response-outbreak-covid-19. See also useful piece by Arcila (2020) for ICT4Peace on “A human-centric framework to evaluate the risks raised by contact-tracing applications” https://mcusercontent.com/e58ea7be12fb998fa30bac7ac/files/07a9cd66-0689-44ff-8c4f-6251508e1e48/Beatriz_Botero_A_Human_Rights_Centric_Framework_to_Evaluate_the_Security_Risks_Raised_by_Contact_Tracing_Applications_FINAL_BUA_6.pdf.pdf

[xx] See, for example, https://www.bbc.com/future/article/20200326-covid-19-the-impact-of-coronavirus-on-the-environment, https://www.msn.com/en-gb/news/world/the-environmental-impact-of-covid-19/ss-BB11JxGv?li=BBoPWjQ, https://www.theguardian.com/world/2020/mar/26/life-after-coronavirus-pandemic-change-world, and https://www.scientificamerican.com/article/how-the-coronavirus-pandemic-is-affecting-co2-emissions/.

[xxi] See The Guardian (23 April 2020) ‘We’re in a prison’: Singapore’s million migrant workers suffer as Covid-19 surges back, https://www.theguardian.com/world/2020/apr/23/singapore-million-migrant-workers-suffer-as-covid-19-surges-back

[xxii] Al Jazeera (6 April 2020) India: Coronavirus lockdown sees exodus from cities, https://www.aljazeera.com/programmes/newsfeed/2020/04/india-coronavirus-lockdown-sees-exodus-cities-200406104405477.html.

[xxiii] Financial Times (13th April) China-Africa relations rocked by alleged racism over Covid-19, https://www.ft.com/content/48f199b0-9054-4ab6-aaad-a326163c9285

[xxiv] Global Citizen (22 April 2020) Covid-19 Lockdowns are sparking a hunger crisis in the UK, https://www.globalcitizen.org/en/content/covid-19-food-poverty-rising-in-uk/

[xxv] Mahler, D.G., Lakner, C., Aguilar, R.A.C. and Wu, H. (20 April 2020) The impact of Covid-19 (Coronavirus) on global poverty: why Sub-Saharan Africa might be the region hardest hit, World Bank Blogs, https://blogs.worldbank.org/opendata/impact-covid-19-coronavirus-global-poverty-why-sub-saharan-africa-might-be-region-hardest

[xxvi] Bridging the Gap (2020) The impact of Covid-19 on persons with disabilities, https://bridgingthegap-project.eu/the-impact-of-covid-19-on-people-with-disabilities/

[xxvii] Statista (Januarv 2020) https://www.statista.com/statistics/269329/penetration-rate-of-the-internet-by-region/

[xxviii] For a wider discussion of the negative environmental impacts of climate change see https://unwin.wordpress.com/2020/01/16/digital-technologies-and-climate-change/.

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Donor and government funding of Covid-19 digital initiatives

Masai children 2We are all going to be affected by Covid-19, and we must work together across the world if we are going to come out of the next year peacefully and coherently.  The world in a year’s time will be fundamentally different from how it is now; now is the time to start planning for that future. The countries that will be most adversely affected by Covid-19 are not the rich and powerful, but those that are the weakest and that have the least developed healthcare systems.  Across the world, many well-intentioned people are struggling to do what they can to make a difference in the short-term, but many of these initiatives will fail; most of them are duplicating ongoing activity elsewhere; many of them will do more harm than good.

This is a plea for us all to learn from our past mistakes, and work collaboratively in the interests of the world’s poorest and most marginalised rather than competitively and selfishly for ourselves.

Past mistakes

Bilateral donors and international organisations are always eager to use their resources at times of crisis both to try to do good, but also to be seen to be trying to do good.  Companies and civil society organisations also often try to use such crises to generate revenue and raise their own profiles.  As a result many crises tend to benefit the companies and NGOs more than they do the purportedly intended beneficiaries.

This was classically, and sadly, demonstrated in the Ebola outbreak in West Africa in 2014, especially with the funding of numerous Internet-based initiatives – at a time when only a small fraction of the population in the infected countries was actually connected to the Internet.  At that time, I wrote a short piece that highlighted the many initiatives ongoing in the continent.  Amongst other things this noted that:

  • “A real challenge now, though, is that so many initiatives are trying to develop digital resources to support the response to Ebola that there is a danger of massive duplication of effort, overlap, and simply overload on the already stretched infrastructure, and indeed people, in the affected countries”, and
  • “Many, many poor people will die of Ebola before we get it under control collectively. We must never make the same mistakes again”.

I have not subsequently found any rigorous monitoring and evaluation reports about the efficacy of most of the initiatives that I then listed, nor of the countless other digital technology projects that were funded and implemented at the time.  However, many such projects hadn’t produced anything of value before the crisis ended, and most failed to many any significant impact on mortality rates or on the lives of those people affected.

In the hope of trying not to make these same mistakes again, might I suggest the following short-term and longer-term things to bear in mind as we seek to reduce the deaths and disruption caused by Covid-19.

Short-term responses

The following five short-term issues strike me as being particularly important for governments and donors to bear in mind, especially in the context of the use of digital technologies:

  • Support and use existing technologies.  In most (but not all) instances the development and production of new technological solutions will take longer than the immediate outbreak that they are designed to respond to.  Only fund initiatives that will still be relevant after the immediate crisis is over, or that will enable better responses to be made to similar crises in the future.  Support solutions that are already proven to work.
  • Co-ordinate and collaborate rather than compete. Countless initiatives are being developed to try to resolves certain aspects of the Covid-19 crisis, such as lack of ventilators or the development of effective testing kits (see below).  This is often because of factors such as national pride and the competitive advantage that many companies (and NGOs) are seeking to achieve.  As a result, there is wasteful duplication of effort, insufficient sharing of good practice, and the poor and marginalised usually do not receive the optimal treatment.  It is essential for international organisations to share widely accepted good practices and technological designs that can be used across the world in the interests of the least powerful.
  • Ensure that what you fund does more good than harm.  Many initiatives are rushed onto the market without having been sufficiently tried and tested in clinical contexts.  Already, we have seen a plethora of false information being published about Covid-19, some out of ignorance and some deliberate falsification.  It is essential that governments and donors support reliable initiatives, and that possible unintended consequences are thorouighly considered.
  • Remember that science is a contested field.  Value-free science does not exisit.  Scientists are generally as interested in their own careers as anyone else.  There is also little universal scientific agreement on anything.  Hence, it is important for politicians and decision makers carefully to evaluate different ideas and proposed solutions, and never to resort to claiming that they are acting on scientific advice.  If you are a leader you have to make some tough decisions.
  • Ensure that funding goes to where it is most needed.  In many such crises funding that is made available is inappropriately used, and it is therefore essential for governments and donors to put in place effective and robus measures to ensure transparency and probity in funding.  A recent letter from Transparency International to the US Congress, for example, recommends 25 anti-corruption measures that it believes are necessary to ” help protect against self-interested parties taking advantage of this emergency for their own benefit and thereby undermining the safety of our communities”.

In the medium term…

Immediate action on Covid-19 is urgent, but a well thought-through and rigorous medium-term response by governments and donors is even more important, especially in the context of the use of digital technologies:

  • We must start planning now for what the world will be like in 18 months time.  Two things about Covid-19 are certain: many people will die, and it will change the world forever.  Already it is clear that one outcome will be vastly greater global use  of digital technologies.  This, for example, is likely dramatically to change the ways in which people shop: as they get used to buying more of their requirements online, traditional suppliers will have to adapt their practices very much more rapipdly than they have been able to do to date.  Those with access to digital technologies will become even more advantaged compared with those who cannot afford them, do not know how to use them, or do not have access to them.
  • Planning for fundamental changes to infrastructure and government services: education and health.  The impact of Covid-19 on the provision of basic government services is likely to be dramatic, and particularly so in countries with weak infrastructures and limited provision of fundamental services.  Large numbers of teachers, doctors and nurses are likely to die across the world, and we need to find ways to help ensure that education and health services can be not only restored but also revitalised.  Indeed, we should see this as an opportunity to introduce new and better systems to enable people to live healthier and more fulfilled lives.  The development of carefully thought through recommendations on these issues, involving widespread representative consultation, in the months ahead will be very important if governments, especially in the poorest countries, are to be able to make wise use of the opportunities that Covid-19 is creating.  There is a very significant role for all donors in supporting such initiatives.
  • Communities, collaboration and co-operation.  Covid-19 offers an opportunity for fundamentally different types of economy and society to be shaped.  New forms of communal activity are already emerging in countries that have been hardest hit by Covid-19.  Already, there are numerous reports of the dramatic impact of self-isolation and reduction of transport pollution on air quality and weather in different parts of the world (see The Independent, NPR, CarbonBrief).  Challenges with obtaining food and other resources are also forcing many people to lead more frugal lives.  However, those who wish to see more communal and collaborative social formations in the future will need to work hard to ensure that the individualistic, profit-oriented, greedy and selfish societies in which we live today do not become ever more entrenched.  We need to grasp this opportunity together to help build a better future, especially in the interests of the poor and marginalised.

Examples of wasteful duplication of effort

Already a plethora of wasteful (in terms of both time and money), competitive and duplicative initiatives to tackle various aspects of the Covid-19 pandemic have been set in motion.  These reflect not only commercial interests, but also national pride – and in some instances quite blatant racism. Many are also very ambitious, planning to deliver products in only a few weeks.  Of course critical care ventilators, test kits, vaccines and ways of identifying antibodies are incredibly important, but greater global collaboration and sharing would help to guarantee both quantity and quality of recommended solutions.  International Organisations have a key role to play in establishing appropriate standards for such resources, and for sharing Open Source (or other forms of communal) templates and designs.  Just a very few of the vast number of ongoing initiatives are given in the reports below:

Critical care ventilators

Testing kits

Despite criticisms of the replicative and wasteful nature of many such initiatives, there are a few initiatives at a global scale that do offer hope.  Prime among these must be Jack Ma’s donation of 20,000 testing kits to each of 54 African countries, which will go some way to reducing the need for these to be domestically produced across the continent.  But this is sadly only a small shower of rain on an otherwise parched continent.  Working together, we have much more to be achieved, both now and in the months ahead.

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Crowdsourcing Covid-19 infection rates

Covid-19, 19 March 2020, Source: https://coronavirus.thebaselab.com/

Covid-19, 19 March 2020, Source: https://coronavirus.thebaselab.com/

I have become increasingly frustrated by the continued global reporting of highly misleading figures for the number of Covid-19 infections in different countries.  Such “official” figures are collected in very different ways by governments and can therefore not simply be compared with each other.  Moreover, when they are used to calculate death rates they become much more problematic.  At the very least, everyone who cites such figures should refer to them as “Officially reported Infections”

As I write (19th March 2020, 17.10 UK time), the otherwise excellent thebaselab‘s documentation of the coronavirus’s evolution and spread gives mortality rates (based on deaths as a percentage of infected cases) for China as 4.01%, Italy as 8.34% and the UK as 5.09%.  However, as countries are being overwhelmed by Covid-19, most no longer have the capacity to test all those who fear that they might be infected.  Hence, as the numbers of tests as a percentage of total cases go down, the death rates will appear to go up.  It is fortunately widely suggested that most people who become infected with Covid-19 will only have a mild illness (and they are not being tested in most countries), but the numbers of deaths become staggering if these mortality rates are extrapolated.  Even if only 50% of people are infected (UK estimates are currently between 60% and 80% – see the Imperial College Report of 16th March that estimates that 81% of the UK and US populations will be infected), and such mortality rates are used, the figures (at present rates) become frightening:

  • In Italy, with a total population of 60.48 m, this would mean that 30.24 m people would be infected, which with a mortality rate of 8.34% would imply that 2.52 m people would die;
  • In the UK, with a total population of 66.34 m, this would mean that 33.17 m people would be infected, which with a mortality rate of 5.09% would imply that 1.69 m people would die.

These figures are unrealistic, because only a fraction of the total number of infected people are being tested, and so the reported infection rates are much lower than in reality.  In order to stop such speculations, and to reduce widespread panic, it is essential that all reporting of “Infected Cases” is therefore clarified, or preferably stopped.  Nevertheless, the most likely impact of Covid-19 is still much greater than most people realise or can fully appreciate.  The Imperial College Report (p.16) thus suggests that even if all patients were to be treated, there would still be around 250,000 deaths in Great Britain and 1.1-1.2 m in the USA; doing nothing, means that more than half a million people might die in the UK.

Having accurate data on infection rates is essential for effective policy making and disease management.  Globally, there are simply not enough testing kits or expertise to be able to get even an approximately accurate figure for real infections rates.  Hence, many surrogate measures have been used, all of which have to make complex assumptions about the sample populations from which they are drawn.  An alternative that is fortunately beginning to be considered is the use of digital technologies and social media.  Whilst by no means everyone has access to digital technologies or Internet connectivity, very large samples can be generated.  It is estimated that on average 2.26 billion people use one of the Facebook family of services every day; 30% of the world’s population is a large sample.  Existing crowdsourcing and social media platforms could therefore be used to provide valuable data that might help improve the modelling, and thus the management of this pandemic.

Crowdsourcing

[Great to see that since I first wrote this, Liquid Telecom has used Ushahidi to develop a crowd sourced Covid-19 data gathering initiative]

The violence in Kenya following the disputed Presidential elections in 2007, provided the cradle for the development of the Open Source crowdmapping platform, Ushahidi, which has subsequently been used in responding to disasters such as the earthquakes in Haiti and Nepal, and valuable lessons have been learnt from these experiences.  While there are many challenges in using such technologies, the announcement on 18th March that Ushahidi is waiving its Basic Plan fees for 90 days is very much to be welcomed, and provides an excellent opportunity to use such technologies better to understand (and therefore hopefully help to control) the spread of Covid-19.  However, there is a huge danger that such an opportunity may be missed.

The following (at a bare minimum) would seem to be necessary to maximise the opportunity for such crowdsourcing to be successful:

  • We must act urgently. The failure of countries across the world to act in January, once the likely impact of events in Wuhan unravelled was staggering. If we are to do anything, we have to act now, not least to help protect the poorest countries in the world with the weakest medical services.  Waiting even a fortnight will be too late.
  • Some kind of co-ordination and sharing of good practices is necessary. Whilst a global initiative might be feasible, it would seem more practicable for national initiatives to be created, led and inspired by local activists.  However, for data to be comparable (thereby enabling better modelling to take place) it is crucial for these national initiatives to co-operate and use similar methods and approaches.  There must also be close collaboration with the leading researchers in global infectious disease analysis to identify what the most meaningful indicators might be, as well as international organisations such as the WHO to help disseminate practical findings..
  • An agreed classification. For this to be effective there needs to be a simple agreed classification that people across the world could easily enter into a platform.  Perhaps something along these lines might be appropriate: #CovidS (I think I might have symptoms), #Covid7 (I have had symptoms for 7 days), #Covid14 (I have had symptoms for 14 days), #CovidT (I have been tested and I have it), #Covid0 (I have been tested and I don’t have it), #CovidH (I have been hospitalised), #CovidX (a person has died from it).
  • Practical dissemination.  Were such a platform (or national platforms) to be created, there would need to be widespread publicity, preferably by governments and mobile operators, to encourage as many people as possible to enter their information.  Mutiple languages would need to be incorporated, and the interfaces would have to be as appealing and simple as possible so as to encourage maximum submission of information.

Ushahidi as a platform is particularly appealing, since it enables people to submit information in multiple ways, not only using the internet (such as e-mail and Twitter), but also through SMS messages.  These data can then readily be displayed spatially in real time, so that planners and modellers can see the visual spread of the coronavirus.  There are certainly problems with such an approach, not least concerning how many people would use it and thus how large a sample would be generated, but it is definitely something that we should be exploring collectively further.

Social media

An alternative approach that is hopefully also already being explored by global corporations (but I have not yet read of any such definite projects underway) could be the use of existing social media platforms, such as Facebook/WhatsApp, WeChat or Twitter to collate information about people’s infection with Covid-19. Indeed, I hope that these major corporations have already been exploring innovative and beneficial uses to which their technologies could be put.  However, if this if going to be of any real practical use we must act very quickly.

In essence, all that would be needed would be for there to be an agreed global classification of hashtags (as tentatively suggested above), and then a very widespread marketing programme to encourage everyone who uses these platforms simply to post their status, and any subsequent changes.  The data would need to be released to those undertaking the modelling, and carefully curated information shared with the public.

Whilst such suggestions are not intended to replace existing methods of estimating the spread of infectious diseases, they could provide a valuable additional source of data that could enable modelling to be more accurate.  Not only could this reduce the number of deaths from Covid-19, but it could also help reassure the billions of people who will live through the pandemic.  Of course, such methods also have their sampling challenges, and the data would still need to be carefully interpreted, but this could indeed be a worthwhile initiative that would not be particularly difficult or expensive to initiate if global corporations had the will to do so.

Some final reflections

Already there are numerous new initiatives being set up across the world to find ways through which the latest digital technologies might be used in efforts to minimise the impact of Covid-19. The usual suspects are already there as headlines such as these attest: Blockchain Cures COVID-19 Related Issues in China, AI vs. Coronavirus: How artificial intelligence is now helping in the fight against COVID-19, or Using the Internet of Things To Fight Virus Outbreaks. While some of these may have potential in the future when the next pandemic strikes, it is unlikely that they will have much significant impact  on Covid-19.  If we are going to do anything about it, we must act now with existing well known, easy to use, and reliable digital technologies.

I fear that this will not happen.  I fear that we will see numerous companies and civil society organisations approaching donors with brilliant new innovative “solutions” that will require much funding and will take a year to implement.  By then it will be too late, and they will be forgotten and out of date by the time the next pandemic arrives.  Donors should resist the temptation to fund these.  We need to learn from what happened in West Africa with the spread of Ebola in 2014, when more than 200 digital initiatives seeking to provide information relating to the virus were initiated and funded (see my post On the contribution of ICTs to overcoming the impact of Ebola).  Most (although not all) failed to make any significant impact on the lives and deaths of those affected, and the only people who really benefitted were the companies and the staff working in the civil society organisations who proposed the “innovations”.

This is just a plea for those of us interested in these things to work together collaboratively, collectively and quickly to use what technologies we have at our fingertips to begin to make an impact.  Next week it will probably be too late…

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