How the technology sector is changing epidemiology.
It is the long history of humankind (and animal kind, too); those who learned to collaborate and improvise most effectively have prevailed. – Charles Darwin
Simple innovations in technology can bring opportunity for further development in the most unexpected ways. Digital technology has evidently opened up opportunities for global public health to an extent that we previously couldn’t have imagined. When any public health innovation solves a problem, the use of the experience and information gained through solving that problem opens up new doors, one of which is a way of improving and streamlining the management and control of disease; digital epidemiology.
Digital epidemiology arguably saw its beginnings in 2008 with Google Flu Trend. It worked on the basis that when people come down with influenza they would take to the internet to confirm their symptoms, using Googles search engine in the process. This enabled the search giants to map outbreaks by location and timing. Google have also gone on to produce a map for Dengue fever activity based on their search results. In recent years however we have seen a shift in digital epidemiology. Moving away from direct patient data such as search engine results, there is significant research from entrepreneurs and academics alike into integrating models of digital epidemiology with the work of frontline health services. This is often in order to see real-time mapping that helps control and even predict outbreaks of infectious diseases.
Penn State University scientists at the Center for Disease Dynamics released an article in 2013 explaining the importance of digital epidemiology to potential global pandemics such as the Coronavirus and Avian Influenza H7N9. Scientists were able to use digital data collected during the outbreaks of both diseases and use it to inform frontline health services, effectively controlling the disease. For Marcel Salathé at Penn State, the importance of digital epidemiology, and it’s effectiveness, grows as more of the global population gains access to everyday digital tools such as mobile phones.
With 6.8 billion mobile-phones and 2.9 billion people online, it’s getting increasingly difficult for any micro-organism to spread undetected for long. – Marcel Salathé, Penn State University biologist.
The next step for health tech is combining a digital epidemiology framework into direct innovation. Smartphone based medical applications have significant potential to achieve this, and those that are realising that potential have created what the Nominet Trust calls the « medical mobile momentum ». The upshot of the « medical mobile momentum » we are seeing with innovations such as eCompliance, EYENETRA and xRapid is that they not only provide a lower cost and more easily distributed medical solution, but that they have outstanding potential for data collection. Smartphones by their very nature are multi-functional, and medical apps are able to access all of these functions to improve their product thereby opening the door for a holistic approach to digital epidemiology.
At xRapid, we believe our malaria diagnostic app can be influential in how digital epidemiology is approached when mapping outbreaks of malaria. Using a mobile device for rapid diagnosis opens up new opportunities to collect real time data through several important metrics on the disease. Mobile networks in many malaria endemic zones are growing fast, and as Marcel Salathé says, the more mobile devices in the world, the more relevant those metrics become.
As a result of realising this potential for xRapid, we decided to explore these opportunities further by attending the Royal Society of Tropical Medicine and Hygiene conference on Modern Digital Methods in Epidemiology. The conference included talks from several experts in tropical medicine on digital epidemiology and how it is being used to transform disease control and covered a large range of topics relevant to this field.
Dr Andrew Tatem spoke about how novel digital sources of data are helping us understand malaria outbreaks through human migration patterns and how they vary over time, space and demographic group.
There was also a piece by Dr Catherine Moyes on the use of internet data to ensure predictive disease maps are continually updated. Dr Moyes and her colleagues at the University of Oxford have created an automated system to take digital data captured from online sources and process it for use in spatial models that then produce automatically updated maps.
Finally, Professor Chris Drakeley from the London School of Hygiene & Tropical Medicine presented a very interesting piece of research on integrating the spatial epidemiology of Plasmodium knowlesi malaria. This simian parasite has been an increasing cause of deadly human malaria in Southeast Asia. Whilst research is ongoing on this dangerous strain of the disease, Dr Drakeley presented a multidisciplinary programme in order to elucidate the epidemiology of P. knowlesi that incorporates a variety of digital data to map the outbreak, including factors such as deforestation causing an increased link between primates, mosquitoes and humans.
The topics discussed at the RSTMH conference are all relevant to what we are trying to achieve at xRapid. Through fast, accurate diagnosis of malaria on a smartphone with the capability to measure the degree of infection, xRapid could potentially provide invaluable information that could contribute to any malaria study or control initiative straight from the point of an outbreak in real time. In many ways, the RSTMH conference gave us confirmation on how valuable this function could be.
As Charles Darwin says; « those who have learned to collaborate and improvise most effectively have prevailed ». The current direction of health technology appears to be moving along these lines. We are constantly improvising ingenious solutions to global health problems; one example would be taking smartphones and turning them into doctors. We achieve these things through collaboration between academics, medical professionals, developers, educators and entrepreneurs. We are hardwired to solve problems when we are faced with them, and because the world around us is shrinking under advances in communication and information technology we are able to see problems that are huge both in scale and complexity with a more lucid perspective. This wider scope enables us to implement these new innovations in order to strengthen current systems of epidemiology. The real hope is that this process can help us move towards finally prevailing over some of the worlds biggest and most dangerous infectious diseases.