Precision Global Health in the Digital Age

Shall we continue to discover new epidemics of emerging infectious diseases weeks or even months after their beginning or will we be able to better predict their risks? Shall we continue to apply the same classical – poorly reliable and far from precise – methods in monitoring vaccination policies, leaving large segments of unvaccinated, unreached populations, or will we help those in charge of these vaccination campaign by offering new tools for guidance and control? Shall we leave the power of crowdsourcing and exposure of the population only for marketing and financial purposes, or will we leverage these new techniques of participatory research for the sake of improving health interventions? Shall we continue to drain health care professionals from many LMICs, particularly in Sub-Saharan Africa, when these countries experience huge local needs in trained human resources, or will we propose to apply innovative teaching methods at massive and affordable scale?

It is no longer effective nor efficient to continue to use only the classical way of collecting data, with often poor quality on health metrics. We now need to use various sources of massive data, which have often been collected for other purpose than health, and to analyze, model and visualize them with new, effective tools. The large amount of investments dedicated to global health, e.g. in the field of vaccination, emerging infectious diseases, neglected diseases, antimicrobial resistance, non communicable diseases (including cancers and mental health), universal health coverage, health in migrants, deserve better precision and efficiency in guiding action and targeting interventions.

International Geneva gathers a unique set of international organizations dedicated to global health (WHO, UNAIDS, UNITAID, ICRC), NGOs (e.g. MSF), UN Permanent Missions of more than 140 countries; Public-private partnership institutions like the Global Funds against HIV, Malaria and Tuberculosis, GAVI, FIND, DNDi; Philanthropic Foundations or Private companies. There is no other place in the world where, every year in May, Health Ministers and their delegations come from all WHO Member States to attend the World Health Assembly, to debate and decide during two weeks on health policies at a global scale. There is no other place in the world which concentrates such a number of bodies, corporations, institutions, skills and competencies in global health.

The University of Geneva and HUG, in partnership with EPFL, the Universities of Lausanne, Basel, Bern, and Zürich have decided to serve, with its academic perspective, this quasi-monopoly of global health located in Geneva, by organizing the 2018 edition of the Geneva Health Forum and focus on Precision Global Health in the Digital Age.


What does Precision Global Health in the Digital Age actually mean?

Precision Global Health in the Digital Age is a disruptive and transformative approach bringing the right interventions on healthcare and prevention, at the right time, to the right segments of population. Instead of sprinkling development aid for global health purpose in a “one size fits all” approach, Precision Global Health uses cutting edge digital technologies and innovations to better target informed-based interventions to health needs of populations.

The transdisciplinary nature of the participants makes the Geneva Health Forum (GHF2018) a conference which is unique, by its location at the epicenter of global health, the heart of International Geneva. It gathers the best of Swiss academic competencies in global health and digital epidemiology, computer science, clinical science and virology, but also in ethics, law, public policy, governance, economics, and major (public or private) non academic actors in global health, among them, the World Health Organization (WHO), ICRC, the Global Fund for fighting HIV infection, Malaria, and TB, UNAIDS and UNITAID, the Vaccine Alliance (GAVI), and Médecins sans Frontières (MSF).

The GHF2018 will present experiences where care professionals are equipped with data collection and decision-support devices used during patient care. These devices share some information with public health information systems, which are then complemented by external sources (satellite imaging, air quality measurements, news feeds, disease models, etc.), in order to identify and locate abnormal situations that would necessitate specific public health interventions. These systems are also connected to personal mobile devices that can forward personalized messages to their owners, and can also inform the system with user-generated data and observations. This data ecosystem is further enriched by social media, internet-based sources, genome sequencing, sensors, etc., thus providing additional context, dimensions, and granularity to be exploited by big-data analytical engines and artificial intelligence algorithms. This leads to new ways to forecast, simulate, recommend, deploy, and evaluate individual or population-wide precision health interventions.

Non-classical sources of data, useful for health but not initially collected for that purpose are made available and analysed using machine learning techniques, in order to help guiding global health policies and interventions in the field with more precision: data from participatory surveillance, remote sensing data, data from cell phones, data from social network, Google search terms and data from Wikipedia, environmental data, data on immunization coverage, data from health care centers and insurance companies. A few examples, described here below, for such use of massive amount of data will be presented and discussed during the project thanks to the transdisciplinary structure of the forum. Rapid access and feedback from the field allow from direct expression of needs and systematic evaluation of proposed solutions, with high level of competencies and resources in data science, and global health.

  • Participatory disease surveillance allows the capture of early warning signals of outbreaks of infectious diseases, such as influenza or vector-borne diseases. These techniques, relying on social networks and citizen sciences adapted to food and nutrition, can help promoting healthy behaviors in terms of nutrition, one of the major - although largely unknown - tool for fighting non communicable diseases.
  • Remote sensing data provides environmental clues from satellites, which have proven useful in feeding predictive models for emerging infectious diseases, such as Rift Valley Fever, Zika, or West-Nile Virus. These latest products of research will be demonstrated for guiding interventions, such as vector control measures taken at global scale. Because it is now possible to predict with high geographical and temporal precision the risk of occurrence of outbreaks of several devastating vector-borne diseases thanks to remote sensing combined to other sources of available data, it becomes possible to work on better preventing these foreseen outbreaks.
  • Planning immunization campaigns at global level, the classical “one size fits all” approach remains the standard. To reach overall vaccine coverage objectives, repeatedly, years after years, progresses, if any, can only be incremential. Today, there are still children who do not receive all the vaccines they need. It is not due to funding issues, nor to product shortage: we simply don’t know how to reach those who need them. We need to help identifying those undeserved segments of population, thanks to new existing tools, which have most often not been designed for the purpose of global health: Twitter, Facebook, Google, cell phone data... it may happen that these pockets of remaining undervaccinated populations live in remote and secluded areas of the planet, where many barriers limit access to vaccine. Experiences using drones dedicated to bring vaccines to local health care professionals in due time, and in respect to cold chain, to increase vaccine coverage will be presented.
  • Diet is one of the four major risk factors for non-communicable diseases (NCDs), the other being alcohol misuse, smoking tobacco and physical exercise. However, there is large amount of evidence that smoking tobacco, or abuse of alcohol kill; exposure for both risks is relatively easy to measure and quantify; and interventions for controlling these risks are rather well known, although implementation of effective measures may be difficult even in developed countries. Regarding diet, it is much more difficult to quantify exposure to risky behaviors, much more difficult to propose evidence-based control interventions, and difficult when some food component are known to be unhealthy to change behaviors. Diet is one of the key drivers for the occurrence of many NCDs, including cardio-vascular diseases, but also obesity, diabetes and cancers, covering the highest proportion of morbidity and mortality in the world. It is urgent to discuss new approaches in measuring exposure, assessing and modelling risk and changing behaviors, through participatory research, including use of apps and social networks.
  • Mental health is one of the most neglected disease although it represents a major burden of disease worldwide (the first cause in developed countries). In many low income countries however, there is very few psychiatrists, and options to cover minimal needs in mental health will be discussed: task shifting toward paramedics, telemedicine and robot assistance to provide help in diagnosis and care to the underqualified staff in the field and/or to patients themselves.

The GHF2018, co-organized by the University of Geneva and the University Hospital of Geneva, will be an opportunity to reinforce collaborations between International Organizations based in Geneva, Swiss academic institutions, public and private partners in a transdisciplinary approach. The GHF2018 is aligned with the Federal Council strategy (2016-19) prioritizing the development of International Geneva, and with Swissnex in Geneva which “would put forward Swiss science as source of solutions to global issues, spreading the face of an innovative Switzerland” (translated from a post in Foraus - Forum de politique étrangère – La Genève Internationale, un atout Suisse. N°18, Novembre 2013)