On Thursday, June 18, 2020, the Atlantic Council’s GeoTech Center hosted Mr. Yves Daccord, Former Director General of the International Committee of the Red Cross, Dr. Philippe Gillet, Chief Scientific Officer of SICPA, Mr. Toomas Hendrik Ilves, The former President of the Republic of Estonia, Dr. Idris Guessous, Head of the Division of Primary Care Medicine at the University Hospitals of Geneva, Mr. Peter Rashish, Senior Fellow and Director of the Geoeconomics Program at the American Institute for Contemporary German Studies, Ms. Danielle Tavino, VP and Co-Founder of Code-X, and Dr. Divya Chander, Faculty Chair Neuroscience at Singularity University.
The event was moderated by Dr. David Bray, Director of the GeoTech Center at the Atlantic Council.
The panel discussed the potential for technological and policy innovations to enable a greater degree of trust between medical organizations and supply chain providers by following the example of some of the world’s best practitioners.
Medicine’s trust deficit
Personal and public health, as well as the care and medicine required to maintain them, have always been top priorities for individuals and societies around the world. Amidst the COVID-19 pandemic, concerns over health have become even more prevalent. Yet, as the panel responded, at the same time as more people than ever are seeking reliable information and measures to protect themselves from the novel coronavirus, healthcare systems in the United States and other countries are confronting a crisis of trust emerging in three key ways.
Weak links in medical supply chains
The panel emphasized the way that, as with all issues of trust, the primary difficulties are on a personal level. Individuals have found it increasingly difficult to determine the trustworthiness of medical advice for dealing with COVID-19. With so much disinformation and so many false-but-enticing medical messages floating around the mediasphere, ordinary citizens find it harder than ever to know whether recommendations–from neighbors, medical professionals, or politicians–will actually protect their health.
Relatedly, medical practitioners themselves have increasingly struggled with trusting the information coming to them from researchers, policymakers, and administrators. The panel decried that, whether it be a high-profile scandal at prestigious medical journals like the Lancet, or a smaller-scale policy mix-up or data flaw, doctors struggle to find trustworthy guidelines to inform their medical decisions.
On a systemic level, the medical supply chain recently encountered serious problems as industries found their complex, global supply chains disrupted by local and international crises. In the name of efficiency, hospitals have outsourced the production of essential tools, ranging from personal protective equipment (PPE) or respirators to pharmaceuticals. Unfortunately, with such a dispersed supply chain, it is nearly impossible for hospitals and medical systems to accurately identify their real carrying capacity in times of crisis when many healthcare providers find themselves relying on the same limited suppliers, resulting in unexpected shortages.
The panel explained that, due to the breakdown of trust in the medical system at all three of these levels, the world has failed to effectively respond to COVID-19. Individuals have found themselves unsure of who to trust for medical advice. Doctors are at a loss about where to get reliable information on the growing pandemic. And hospitals and medical systems have run into shortages and are unable to utilize their surge capacity due to the complexity of their supply chains.
Building an economy of trust for medicine
Fortunately, the panel advised, new technological tools can help to restore trust in the medical system at each of these levels. Through the implementation of a data trust for medical and health related information, as envisioned by the GeoTech Center, researchers could access hard data while the studied individuals remain certain that their privacy is not compromised. A data trust system developed by a coalition of public, private, and NGO partners and maintained by citizen-juries and transparent regulations can restore the sacred trust between medical researchers and practitioners and patients. This framework could store data beyond biometrics as well, including records of suppliers and their sources of devices and equipment, to streamline in the medical supply chain.
According to the panel’s vision, a data trust would also enable individuals to take ownership of their data, deciding how and by whom it can be used. Considering the transfer of data a transaction in which the individual has equal agency will help build trust in both the data provided and the conclusions drawn from it, as individuals could choose to only provide their data to projects that would benefit the common good. The unified framework of a large-scale data collection of this nature would also facilitate easy transfer of information and ideas across communities, states, and nations. In this way, the panel envisioned an “economy of trust” in health data that could spread to the entire world, helping build networks of trusted partners within communities and globally. With every medical and data transaction made transparent through the use of technology, medical practitioners could bridge the gap between patients, doctors, and researchers, restoring lost trust through virtually-enabled person-to-person interaction.
A model to follow
Some of the world’s most advanced medical systems have already begun to develope a system-level data trust or other frameworks for building trust in medicine.
One of the most frequently celebrated examples in recent years has been the country of Estonia, whose esteemed former President, Toomas Hendrik Ilves, outlined their medical technology innovations for the panel. In Estonia, all medical records and biometric information are kept on a keyless signature blockchain through which citizens are granted individual ownership over their data, who accesses it, and for what reasons. The system’s design also insulates against potential data manipulation and corruption, meaning doctors and researchers can trust the integrity of the data they receive. With high levels of protected data maintained for every citizen, Estonia can more effectively prepare for health crises and provide individualized care as needed.
Another oft-cited example of pervasive societal trust is Switzerland, represented by Idris Guessous, MD and PhD, of the University Hospitals of Geneva. Though Switzerland is respected around the world for its high citizen participation in government, as well as its low levels of inequality, the UHG system has also begun rolling out technological tools for building trust between citizens, their doctors, and the researchers studying there. Dr. Guessous emphasized how, as the hospital rolled out digitized medical records through which patients were asked before their data could be studied, he was surprised by the number of patients who consented to their data’s use, so long as their information could be leveraged for the public good. The panel emphasized that most individuals would be more than willing to provide their data to doctors and researchers, so long as they could trust that the goals of its use are transparent and worthwhile.
As these examples illustrate, it is technologically feasible even now to develop a data trust akin to the panel’s vision. The obstacle, though, is whether relevant parties can cooperate to develop a system that empowers citizens and builds trust, rather than one that emphasizes individualism, surveillance, and one-sided transactions.
Henry Westerman is an intern with the Atlantic Council’s GeoTech Center and a rising senior at Georgetown University’s School of Foreign Service. His course of study is in Science, Technology, and International Affairs, with a concentration in Security, focusing on the intersection of science and geopolitics, particularly relating to advanced digital infrastructure and outer space development. Previously, Henry has interned at the Library of Congress and the Department of State’s Office of Science and Technology Cooperation. He also works at Georgetown’s writing center, providing free editing and consultations and serves as the historian for Georgetown’s student association.
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