Executive Summary
Huge progress has been made globally in building digital-health infrastructure, including the use of technology and digital systems to support the delivery of health-care services. The World Health Organisation began formally advising countries to develop digitally enabled health systems in 2005, a process that was then accelerated by the Covid-19 pandemic and the rollout of vaccination programmes around the world. This has helped to further realise the potential of digitalised health systems, such as improving the quality of health care, increasing process efficiencies, expanding the accessibility of health services, and enhancing data-driven analytics and evidence-based medicine. We highlight throughout this paper examples of the use of digital-health tools and analytics that advanced population health goals, including in response to the pandemic.
Despite the advances made during the pandemic in the development of more effective digital-health tools including vaccine infrastructure, challenges emerged with regard to engaging and reaching different patient populations, securing supply chains and training the clinical workforce at scale. In some ways, the challenges in engaging the entire population for preventative medicine should have been foreseen. Two-thirds of global health funding to low- and middle-income countries (LMICs) before the pandemic was focused on HIV, tuberculosis (TB) and malaria, together with maternity, neonatal and child health care. While addressing these patient populations and disease areas is crucial, those programmes primarily focus on a minority of the total population of LMICs, meaning that an effort to comprehensively reach the adult population with Covid vaccines could not rely exclusively on infrastructure already developed through investments in global health.
The Global Health Security Consortium’s One Shot campaign is an initiative that seeks to develop a permanent and preventative global public-health programme with life-course vaccinations and prophylactic injectables at its core. Unlike previous global health efforts, One Shot is designed to focus on the global adult population so that comprehensive disease-prevention infrastructure is in place and “always on” – both to manage routine care and to reach patients in response to future outbreaks or pandemics.
This type of population-level programme will require countries to take a far more ambitious and coordinated approach to storing, using and sharing electronic health information. That means a new digital toolbox that includes expanded immunisation registries, appointment registration, patient communication, clinical-trial enrolment, integration with diagnostics and labs, clinical-decision support, population targeting and collection of real-world evidence to support products.
These tools will require the ability to store, integrate and access vast amounts of data on platforms that can securely handle sensitive patient information and link to other sources of data such as viral genomic sequences (to track viral epidemiology) and patient records. While cloud-based technology has significant benefits in terms of cost, security and scalability, many governments have concerns about dependency on offshore data storage.
Potential data-storage solutions must also take into account the needs of different countries and contexts, including in settings where resources are limited. For example, telecom and mobile networks can offer viable and practical solutions where internet access is otherwise limited. When possible, LMICs should seek to leapfrog straight to state-of-the-art digital infrastructure and capitalise on the fact that they start with fewer legacy systems and investments than found in many developed economies.
The creation of this digital ecosystem can also be a first step towards a wider and deeper transformation of digital health globally. Longitudinal records that can be developed from immunisation registries and a master patient index would contribute to the One Shot programme and would be foundational for a wide range of health-care use cases.
How Do We Take Action?
Ministries of health should take a holistic view of their digital-health strategy, allowing for both primary data uses (those guiding individual care) and secondary data uses (those that go beyond individual care) by a range of stakeholders, and invest in secure, cloud-based technology when appropriate and consistent with existing laws and regulations. They should specifically invest in adult-immunisation registries and build on digital tools launched or scaled during the pandemic. They should prioritise the digitisation of existing paper-based systems and also invest in the digital infrastructure needed to conduct epidemiological research and surveillance to inform life-course immunisation programmes.
Regulators, including ministries of health, should create a regulatory environment that can mandate the collection and sharing of relevant data, with the necessary privacy protections and security in place. They should specifically ensure regulations create life-course immunisation registries, allow for the creation of longitudinal patient records that are built off or link to these registries, and foster innovations in patient- and population-health management (including for novel products such as adult vaccines). Regulators should also develop tailored strategies to harness the power of cloud-based technologies while upholding national data-sovereignty laws.
Industry should develop new digital tools and business models and, more broadly, use its technical expertise to support governments and regulatory bodies with standards development and product implementation. Industry should further capitalise on the momentum created by Covid-19 adult-vaccination initiatives to build new use cases and support governments in overcoming regulatory and technical challenges.
Global and regional health organisations, together with their partners and donors, should commit to investing in national digital-health strategies, integrated health-system strengthening, the creation of globally available digital-health products and the sharing of information among peers.
These efforts must build on the valuable lessons, challenges and successful experience in applying digital tools in response to Covid-19 at the global, regional and country levels. Gavi, the Vaccine Alliance has notably developed a “Digital Health Information Strategy Technical Brief Series” related to vaccine delivery for Covid-19 and routine immunisations, including for children. Throughout this paper, we highlight examples of where Gavi’s recommendations accord with recommendations for strengthening digital-health infrastructure for adult vaccinations.