Rise of Global Cities and the Creation of Cosmopolitan Diseases
Over the past three decades, the global community has witnessed a rise in global cities due to widespread increase in air travel and globalization in every aspect of our lives. Today, airport hubs connect all the major cities around the world from Berlin to New York to Abu Dhabi. This has not just created global cosmopolitan citizens but also cosmopolitan diseases such as SARS which have swept the world from 2002 to 2004, H1N1 from 2009 to 2010, MERS which is an ongoing epidemic since 2012, and COVID-19 since last year. During the last few months, we have realized how unconnected we are when it comes to dealing with global pandemic. This is not only limited to import/export measures of medical supplies but also lack of communication among governments with regards to sharing health data has shown what we need to do to fight future pandemics. Many countries are still restricting foreign travelers as COVID-19 testing results cannot be digitally shared across borders which can ease international commute in this time of pandemic. While
OECD has been conducting Open Government Data Initiatives for 7 years now and WHO published a call for researchers for data sharing during emergencies, the global community couldn’t see palpable results of these data sharing initiatives from global organizations and national governments before COVID-19 pandemic.
History sheds light on the importance of thorough investigation based on data in finding the solutions to epidemics. John Snow’s report on London Cholera outbreak in 1854 is one of the best examples. Due to rapid urbanization followed by industrial revolution, – which can be compared to today’s rise of global cities followed by globalization – when Cholera hit hard, London was unprepared. To this end, John Snow’s “Report on the Cholera Outbreak in the Parish of St. James, Westminster, during the Autumn of 1854” led to the enactment of The Public Health Act. The act was a stepping stone for municipally regulating urban living conditions through government policies which focused on the maintenance of urban hygiene. When infectious diseases that cannot be transmitted through air such as COVID-19 and MERS become more prevalent through increased travel (here cosmopolitan diseases) - global healthcare community and healthcare policy makers need to be equipped with legitimate information on living and hygiene conditions of the diseases’ epicenters and its spreading routes. For this, there is a need for a better coordination between national and regional governments in sharing data about these regions. Whereas, the centralized role of international organizations such as WHO needs to be revisited and strengthened. While some countries already regularly update the detailed information of confirmed patients’ routes and their possible contracted areas either by tracking applications or by online websites, sharing this and other related information across borders is still from realization to globally govern the flow of diseases. Mapping the cosmopolitan diseases through tracking applications at the global level might also lead to enhanced living conditions of the entire world like never before.
Healthcare as Global Public Goods in the Digital Age
Thankfully,
our past experiences of viruses have made us more prepared in dealing with COVID-19 pandemic. Immediate response to COVID-19 in Taiwan was largely based on its past experience during SARS epidemic while South Korea’s success of containing COVID-19 was based on its response during MERS epidemic. As we’ve learned the importance of central and regional government’s role for public health from Cholera outbreak in London and the importance of quarantine from Plague pandemic in the 14
th century, this pandemic highlights the importance of intergovernmental institutions’ mutual policy crafting and equal cooperation from national governments in implementing global health policies. Global institutional cooperation such as the Access to COVID-19 Tools (ACT) Accelerator has also been promising in working on various aspects of COVID-19 pandemic from diagnostics, treatment, vaccines to strengthening of healthcare systems. OECD recently published a study on harmonization of clinical trials on COVID-19 therapeutics. When COVID-19 vaccine becomes available, it needs to be recognized as public health goods so that it can be readily available for all impacted by the virus. Leveraging digital technologies through sharing and utilizing Electronic Health Data (EHR) and applying AI for pandemic researches might one day lead us to what may be the equivalent of the public health act 1875 which can greatly improve the hygiene of all the regions around the world. When International Public Health Law is relatively a nascent field of international law, we can also expect to see strengthening of global public health law as an important subcategory of International Law during and after COVID-19 pandemic.
When global community started to discuss more about AI for medicine, questions on how we can protect data privacy while the governments and other organizations are maximizing the power of health data also becomes critical to be addressed. With high degree of sensitivity within it, electronic health data needs to be protected at all cost from unauthorized access or for maleficent use, without consent from the data subjects. As EHR interoperability is still being studied within and across the nations we are lacking national laws and international consensus on health information privacy. It is a long way to go for the global community to utilize this health data to its fullest potential. With the widespread adoption of precision medicine and the digitization of health information to make more personalized medical care possible, the rights to the personal health data need to be guaranteed across the full lifecycle of these personal data. The more publicly available this data becomes as in the case of EHR sharing across the borders, the more privacy measures are required. It’s not just about developing technologies such as de-identification of health data but also about enabling legislation on the use of these health data at the global level. National or supranational laws on protecting privacy such as EU GDPR – which even designates data concerning health as a special category or organizational efforts such as Understanding Patient Data can be leading force for strengthened health data privacy. How we, as one global community, respond to COVID-19 pandemic might drastically change our future for global cooperation and mutual prosperity.
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