Break the digital divide to get virtual health for all

The Covid-19 pandemic has sharply accelerated the use of digital technologies in the health sector. For many who could no longer obtain in-person care, access to virtual health services became a matter of life and death.

This revolution will not end when the pandemic does. But without thoughtful stewardship, a digital divide could exacerbate health inequities. Above all, guiding the future of virtual health so that no one is left behind requires us to learn from the past 18 months and ask the right questions.

From its earliest months, the pandemic triggered a massive shift to virtual health services. In France, the number of telehealth consultations increased from 40,000 to 4.5 million between February and April 2020. In India, online health consultations among people over 50 increased by 502 per cent last year. Global investment in digital health doubled year on year in 2020, to $21.6 billion. And non-governmental and intergovernmental organisations – from the Broadband Commission for Sustainable Development to the World Health Organisation – deepened their focus on the issue.

The surge in virtual health services during the pandemic has entailed many policy changes and new ways of doing business. Some of these were beneficial and will serve as a foundation for further progress. But the rapidity of the changes has often meant haphazard execution and uneven results.

It is still too early to settle on a definitive post-pandemic vision for virtual health services, and how each country approaches it must of course be tailored to local contexts. But we can begin to identify the right questions to ask in shaping this fast-growing global sector’s future.

First, what is the true value that these services can provide? If we regard virtual health as merely a sector-specific example of emerging technology, it may generate efficiencies and even improve outcomes, but it will not realise its full potential.

In many settings, technologies that are already part of people’s everyday lives can empower patients. Virtual services can help people re-centre their health in personalised, familiar, and convenient ways. Whereas going to a health facility can sometimes be a cold, intimidating experience or even logistically impossible, virtual services allow people to engage on their own terms, on comfortable ground. Especially in low- and middle-income countries, expanding telemedicine can help to compensate for lack of physical infrastructure while providing an additional way to connect remote populations with national health systems.

Second, how can virtual care promote equity? The WHO recently identified health equity as one of the four guiding principles of its Global Strategy on Digital Health, calling for investment in infrastructure, education, and resources to help low- and middle-income countries adopt new digital health technologies. And in June 2021, G7 health ministers stressed that virtual health-care services must be “inclusive, comprehensive, and equitable”.

Even within high-income countries, marginalised communities have often borne the brunt of the Covid-19 pandemic, compounding historical and inherited inequities. Fully realizing the promise of virtual health care means leveraging digital connectivity to reach those previously excluded.

Third, which approaches to virtual health services have shown the most promise? Countries with flexible regulatory regimes have had the best results during the pandemic. One key policy change that some countries quickly adopted was to remove the requirement that new patients have an in-person consultation before receiving virtual care. We also know that data and artificial intelligence have been and will remain strong enablers of virtual health care. Real-time monitoring, analysis, and decision-making are possible only if data are appropriately managed at scale.

But data-driven approaches raise important concerns regarding privacy, data storage, and information use that must be carefully considered within the context of human rights and ethical standards. To help governments navigate these concerns, the WHO’s global strategy provides a regulatory framework for ensuring appropriate use of health data, defines key concepts such as health data as a global public good, and outlines principles for equitable data-sharing.

Finally, how should we move forward? By carefully studying the pandemic’s impact on virtual health services, we can identify best practices, build on what worked, and reform as needed. We can provide practical tools to preserve and expand the progress made in virtual health, manage the aftermath of the pandemic-induced surge in demand for these services, and usher in a transformative and equitable future.

To facilitate this analysis, the Novartis Foundation and the WHO are co-leading a new Broadband Commission for Sustainable Development working group on virtual and data-driven health services. Together, we aim to help countries transcend the digital divide, include the formerly excluded, and achieve quality health care for all. — Project Syndicate

Ann Aerts is head of the Novartis Foundation.