The COVID-19 pandemic has shone a very bright light on the role effective data and data sharing can play in the delivery of services - in this case, understanding where to target lockdown measures, getting visibility into the impact of virus on healthcare, pursuing contact tracing, and more recently in understanding how to roll out vaccines in a meaningful way.
However, companies and public sector organisations that aren't putting data privacy and ethics front and centre of these endeavours will face a reckoning once the pandemic is over. Economic consequences will follow and trust will be diminished amongst users/citizens.
That's the view of Dr Ashwini Zenooz, Chief Medical Officer at Salesforce, who also believes that technology has a critical role to play in rapidly rolling out vaccines - in an equitable way - globally.
We got the chance to speak with Dr Zenooz this week, to discuss the challenges facing countries in the rollout of the COVID-19 vaccines, as they come available, and how companies like Salesforce are playing a role. Salesforce released Work.com for Vaccines towards the end of last year, which is now being used by 30 federal, county and local organisations to help distribute vaccines to citizens.
Dr Zenooz noted that as the pandemic progressed, technology companies and governments around the world found themselves grappling with difficult ethical debates, as it relates to data use. For example, the UK government initially attempted to create a COVID-19 exposure and notification app for citizens, using a centralised database. The argument for it was that it would help to map local outbreaks, but there was ongoing concern that using data in this centralised way could lead to citizen privacy infringements. Ultimately the UK opted for the Google/Apple distributed model.
Dr Zenooz said:
Do we have manual contact tracing or automated contact tracing? That was a big debate. Do we start having passports for people that have been tested versus not? And what are the conversations for the haves and have nots? These are all ethical conversations, privacy conversations.
I think that's really, really important. A year ago if someone had said to me ‘share your data to tell us where you are and we will give you some good information', I would have said no thank you. But when I received a notification recently from the State of California asking me that same question, to find out if I had been near someone that had been exposed, I was like ‘yeah, I want to know that'. I think I'm much more open to sharing data now than I was a year ago.
There have been surveys tracking the public's attitude towards data sharing since COVID-19 hit the US and the UK, and there is evidence to suggest that people are increasingly willing to share their information as a result of the pandemic. If this attitude persists post-pandemic, companies and organisations will likely see opportunity. However, Dr Zenooz warns that ethics needs to remain front and centre, otherwise there will be consequences. She said:
I'm pretty confident that we will overcome this pandemic, and then there is going to be a reckoning if you've abused the data. People are not going to forget it. So the things you do during this time, in terms of trust and data privacy, these are at the forefront. If you haven't thought about this, then there will be economic consequences and this will be top of mind for anybody touching people's data.
It’s worth highlighting that it was also announced this week that a coalition called the Vaccine Credential Initiative - which includes Salesforce, Oracle, Microsoft and healthcare non-profit Mayo Clinic - is developing a ‘vaccination passport’, which will allow individuals to obtain an encrypted digital copy of their immunisation. This will be stored on a digital wallet, or for those without a smartphone will be held on a paper copy with QR codes.
The role of technology in vaccine distribution
Countries around the world - most notably in North America and Europe - have been rapidly looking to approve the effective COVID-19 vaccines that have become available and are now getting to grips with the huge challenge of distribution. Whilst vaccine distribution is something that is done annual by many countries for the flu, it's widely acknowledged that the scale of the COVID-19 vaccine distribution is (and I hate to say it) unprecedented.
Vaccine distribution on this scale is going to require the work of local, health, federal, national and international organisations to get this global public health crisis under control. And while mistakes will inevitably be made, it's critical that countries by and large get this right.
And it's unsurprising that technology will need to play a role in all of this. Not only to understand who has been vaccinated and when, in order to get a view of when herd immunity has been achieved, but also for challenging tasks such as logistics. This is particularly true when you consider that some of the vaccines available have to be held at certain temperatures and used within certain timeframes.
Dr Zenooz said:
This is the largest public health initiative that we've probably ever taken on from a global health perspective. This is a very complicated process, where in under 12 months, since the start of the pandemic, you have two or three vaccines on the market, depending on where you're looking at from a global perspective. Some of those are single dose, some are double dose. Some of them require certain temperatures. Vaccines can only be out for six hours. You have to distribute it in a certain amount of time, so it's a very complex logistical challenge.
You've got to get it out to billions of people now and you've got to make sure that once you take it out of the freezer, you have to thaw it, you have to administer it in six days, you've got to know who you are giving it to, when you're giving it to them, when they need to come back. How do you tell them to come back? How do you track all of this to see if you're anywhere near to herd immunity? I think that's a logistical nightmare in some sense. And I think we are seeing the consequences of some countries being unprepared, today.
Dr Zenooz said that her and her colleagues on the frontline in the US are seeing people given the vaccine, but are being monitored and tracked using very manual processes. For example, they've seen people get vaccinated just using a very traditional yellow or white card, which has been used for vaccines in the past - where on it, it has your name, date, type of vaccine, and when to come back. She added:
We are still in that low tech mind frame in a lot of counties and countries, depending where you are today.
Unsurprisingly, Salesforce feels that it can play a role here, given that its core business is based around CRM - which could be applied to citizen relationship management. Dr Zenooz argues that the Salesforce platform is more effective than manual processes in tracking who has been vaccinated, but also then maintaining contact with them afterwards to ensure that they return for their vital second dose. She explained:
In September we rolled out Work.com for Vaccines. Initially the conversations were, why do we need this? Now it's becoming really evident, as we have 30 federal, state and county level organisations that are using this globally. It's somewhere around 50 million people are using this. And what it is, is an end-to-end vaccine management platform. Everything from looking at logistics and inventory, to scheduling the appointment, to tracking the appointments and the doses, to tracking outcomes. That is really what is needed.
That's not just what is needed at a local hospital or county level, you really need it at a federal level. And then at the end of the day you need to be collaborating with the WHO, or another organisation at a global level, to be able to say how many of your people are vaccinated. For you to have intelligent conversations around who has been vaccinated, you need data and you need data that you can action upon. And in my mind, you can't have that if you're working with paper cards. You really need that technology framework.
Equitable distribution and trust
Salesforce is also working with GAVI, a membership organisation that focuses on the equitable distribution of vaccines around the world - which is now focusing its efforts on the COVID-19 pandemic. GAVI uses the Salesforce platform in this process, but more broadly, Dr Zenooz is urging countries not to forget the important role that trust plays in vaccine distribution.
She argues that this will require a huge collaborative effort on the both the part of public and private organisations, in order to bring COVID-19 under control on an international scale. Dr Zenooz said:
Equity within your own country is really, really important. Here in the US we have populations of colour that are generally left out - of research, pharmacological therapy. That was abundantly clear when we looked at the data of people dying from COVID. We've got to address those things. Those people don't trust the government, don't trust the hospitals, they don't trust doctors, because people have experimented on them in the very recent past.
So I think we need to address in the pockets of each country which parts of the population are being left out, to make sure you're equitably distributing - because this is needed to reach herd immunity.
You also need to make sure you gain the trust of people - for their data, for them to come back. You have to really educate people on what's happening, very openly, and be very transparent about the process.
From a broader perspective, you need tech at the table. If you're giving out paper cards, you don't know who you gave it to, you don't know when they're going to come back, what vaccine they got. How are you going to get them back? These aren't difficult technology problems, these are leadership and logistical problems. You bring the right type of people together, the right types of companies, trusted organisations, you can get there.