Only months before the COVID-19 pandemic ravaged global health systems, the World Health Organization (WHO) released its first guidelines on digital health interventions (2019).[i] The first heading in these guidelines betrays the concerns of the original authors: “Digital health interventions are not sufficient on their own.” Following the recent global pandemic, it is now clear that these were legitimate fears.
Over the course of the pandemic, the implementation of digital health solutions has been done strategically, frequently following political incentives. Surprisingly, these solutions were not always targeted directly at the looming public health threat. In fact, digital health innovations are now frequently used as surveillance technology. A range of countries and regions have started using these technologies, such as mobile apps, to limit population movement, control borders, and enact new levels of surveillance under the aegis of public health concerns. This throws into question the role digital health should play in our societies, and their functionality and purpose as a whole.
Specifically, a number of technological advances have been introduced in the field of digital health governance in Asia. In China, the first mechanism for health status control was launched on 11 February 2020 in Hangzhou city, Zhejiang. Users received a green, yellow, or red code via the app that determined their access and mobility in their localities.[ii] In South Korea, quarantine-software has developed to the point that users’ credit card transactions are tracked, and can be retraced in the event of a positive PCR-test result. Rule-breakers are levied hefty fines, and can face imprisonment for endangering public health.
Haneda Airport, Tokyo Japan.
In Taiwan, a so-called ‘digital fence’ was built to keep track of incoming visitors, in the first stages of the pandemic a primary source of new infections in the region.[iii] Similarly, in Japan, the digital health care app MySOS, initially developed to be deployed domestically, is now a mandatory application to be installed by anyone coming from outside the country.[iv]
These examples show that digital solutions have been used to control domestic virus transmission. However, in some cases, they have more stringently been enacted to govern borders and access to countries, services, and shops, rather than for the direct purpose of public health (e.g. health monitoring, digital consultations, and etc.).
This is even the case in places where this technology is available for everyday use. For policy makers and developers of health technologies, this raises the question: how have these digital health solutions been used in their respective societies and to what effect?
Digital health technologies are now more intrinsically part of how societies are governed. The field, however, is at the forefront of innovations. This means that the study of the effects of digital health is still in its nascent stages, and the level at which these technologies are effective, how they ‘stick’ around, and what consequences they will have on personal well-being in the long run, remains largely unknown.
Importantly, how digital health solutions that have seen a sudden introduction into the daily lived realities of citizens are practiced and used, and how this effects how we design our policies around these issues, remains an open question. This study, therefore, explores how and to what extent digital health has become part of everyday governance strategies.
The use of digital health has had, and will continue to have, a critical impact on daily governance strategies. It is therefore important to understand which choices digital innovators, policy makers, and experts in Asia have made in their pursuit of such solutions. Importantly, public attitudes towards their implementation and use will determine the viability of using digital technologies in daily health governance. It is critical to understand how these two factors have intersected, in order to inform us of how and if digital health can be implemented for public health governance.
Hub for Technological Innovation, Osaka, Japan
Through its scale and diversity, Asia, especially, offers insights. This study attempts to lay the groundwork for an understanding of these issues in this region by analyzing 1) the inception of digital health governance, 2) (public and official) discourses (debates) on digital health technologies, and 3) how this field has developed over the course of the COVID-19 pandemic.
In doing so, this study attempts to create a framework through which developers, policy makers, and experts can understand how digital health functions as a tool for (health) governance, thereby offering warnings and recommendations concerning the implementation of digital health technologies in the future.
RESEARCH QUESTION AND CASE-STUDIES
The study focuses on the following question: how and to what effect has digital health developed in Asia over the course of the COVID-19 pandemic?
This project (currently) focuses on three cases: Japan, South Korea, and Taiwan.
The research will consist of four stages, each with its own methodological approach:
- Creating an overview of the state of the field in digital health governance prior to the COVID-19 pandemic.
- Interviews with health experts and policy makers: an exploratory study of the current state of digital health governance and its future as seen through the eyes of experts and policy makers.
- A descriptive study of how the public and political debates around digital health governance have evolved over the course of the pandemic.
- A qualitative analysis of how technologies are designed, implemented, and used.
By combining these analyses and producing an accessible report, this study aims to provide a solid bearing on the state of digital health governance for developers, experts, stakeholders, and policy makers alike, for informing (new) policy and technological developments, and for the benefit of future studies.
[i] World Health Organization, ‘WHO releases first guideline on digital health interventions,’ News Release WHO, last accessed 12 October 2021, https://www.who.int/news/item/17-04-2019-who-releases-first-guideline-on-digital-health-interventions.
[ii] Xiao-Ben Pan, ‘Application of personal-oriented digital technology in preventing transmission of COVID-19, China,’ Irish Journal of Medical Science vol. 198 (2020): pp. 1145-1146, https://link.springer.com/article/10.1007/s11845-020-02215-5.
[iii] Florian Schneider and Rogier Creemers (eds.), ‘How Asia Confronts COVID-19 through Technology,’ Leiden Asia Centre, May 2020, last accessed 12 October 2021, https://leidenasiacentre.nl/wp-content/uploads/2020/05/LeidenAsiaCentre-How-Asia-Confronts-COVID-19-through-Technology.pdf.
[iv] ‘MySOS’, Allm, https://www.allm.net/mysos/