Fig 1: Screen showing Covid-19 prevention messages in a UN office in Ouagadougou. Photo credit: Charles Somé.

A few days ago, I came across a rather unusual document. It is a compilation of different technologies put together by the European Investment Bank, entitled Covid-19: Africa’s digital solutions[1]. It was published last year, with the support of the United Nations Development Programme (UNDP), and it sets out to identify the digital solutions currently on offer in the response to Covid in Africa. Several things strike me as I read this document: firstly, the breadth of these initiatives seems to reflect a faith in the ability of technology to respond to the health crisis. The inventory reports that about 100 digital solutions have already been ‘implemented’ or tested as of 20 June 2020. It also gives an estimate of the investment needed to implement such ‘high-impact’ solutions.

Then, there are different types of tools being promoted in different countries. There are collaborative tools such as Zoom and Skype, which have multiplied greatly, and use messaging apps such WhatsApp in professional contexts such as education, has also gone up. Traditional media, such as television, for example, has remained important due its ability to reach a great number of people during the crisis. Innovations also include tracking applications based on geographic information technology for epidemic surveillance purposes. On page 15 of the document, contact tracing apps are described as follows: “These applications, which often use geolocation data from telecommunications companies, help to identify contacts of people who have tested positive and help to locate areas where the virus is spreading.” We learn that applications have been developed and put to use in Kenya, Morocco and Rwanda among other countries. FabLab, an innovation hub in Kenya, has developed an application called Msafari, which can track public transport users.

Other digital tools have been used for mass communication and self-assessment of risks and symptoms. In Sierra Leone, for example, an existing public platform using unstructured supplementary service data (USSD) has been expanded to allow citizens to self-assess their symptoms and get alerts on developments on the COVID-19 front in the country.

The use of drones has also been experimented with to deliver pharmaceutical products or to transport PCR tests from remote areas to laboratories in big cities like Abidjan in Côte d’Ivoire or Kigali in Rwanda.

But are all these innovations and techno-digital solutions going to make a difference in the medium or long term? Firstly, let us recall that there is a gap between the international presence and publicity around various technological innovations, some of which can even be award-winning, and what actually happens on the ground.  Throughout our 18 months of fieldwork in Yaoundé for the ASSA project, we noted this significant gap, which says something about the difficulty of digital applications and solutions when it comes to capturing the attention of users.

The profile of a young Snapchat user in Cameroon. The screen shows various COVID-19 messages superimposed onto a photo of the user. Photo sent to the author by research participant.

In most of these countries, although tracking applications were received with curiosity, they nevertheless worried public opinion because they raised problems of data use and privacy. Not only are they worrying, but they are not always seen as appropriate solutions for the local context. Interfaces such as the one in the picture above, where COVID-19 related messages fit into the user interface seamlessly, work well in the context because they fit into the social media landscape. Young people want to show concern about the virus and they might adopt features of a social media network that support COVID-19 messaging for a few hours occasionally during the outbreak. But for that, they also need to be reminded by other channels of support and communication that the crisis is still there. The resonance of this issue is strongly linked to the strategic orientations of African countries in terms of their politics, economic situation and sensitivity to innovations.

Another part of the current debate concerns the mistrust of not only technological solutions but also of vaccines against COVID-19. For example, medical anthropologist Alice Desclaux and a team of French researchers [2], who undertook an exploratory study among 215 people in four African countries this year, found that 2 out of 3 participants said they would refuse to be vaccinated against Covid-19. They say: “reasons for refusal included firstly fear of any side effects hidden by the pharmaceutical companies, and secondly the perception of the vaccine as a tool in a plot by Bill Gates to reduce the African population or by a coalition of the powerful (states, global institutions) to enslave populations and ensure a “new world order” using corrupt authorities in African countries (“coronabusiness”). The study also found there was a preference for endogenous solutions to control SARS-CoV2, such as traditional medicine or the protection provided by religion.” There is therefore an urgent need to study more seriously the sources of the constant doubt surrounding the surveillance of epidemics, which are reflected and accentuated at pivotal moments such as Ebola or recently, Covid-19.

The central hypothesis of this is that the operational responses of nation-states are aligned with a policy of systematically using surveillance (biometric) and the tracing of infected persons (mHealth) as the preferred institutional response to emerging epidemics. However, this response has underestimated the capacity for the circulation of alternative interpretations of epidemics favoured by an abundance of content conveyed via social networks and smartphones. The direct access of the public to this content reinforces a widespread suspicion of local governments that are seen as corrupt and that accept servile compromises with the leaders of large pharmaceutical groups to the detriment of ‘African solutions’. Therefore the solution for helping people accept technological and digital solutionism to the crisis is not just to blame them for pharmaceutical nationalism, or their non-openness to innovations, but rather like anthropology and the ASSA team’s approach, making an effort to understand and carefully analyse not only people’s perceptions of the vaccine and the Covid outbreak, but also the intertwining of the logics behind them.

References

[1] European Investment Bank (EIB): Africa’s digital solutions to tackle COVID-19, found at: https://www.eib.org/en/publications/african-digital-best-practice-to-tackle-covid-19

[2] Desclaux A, 2021, « Covid-19: En Afrique de l’Ouest, le vaccin n’est pas le nouveau « magic bullet », available at: https://vih.org/20210202/la-mondialisation-des-informations-et-la-fabrique-des-opinions-sur-les-traitements-du-covid-en-afrique/

Photo by Negative Space, Stocksnap.io

During my ethnographic research in Milan between 2018-2019, from interviews with patients and doctors, consulting regional, national and EU reports, and participation in hospital meetings, I learnt about the development of digital health in the city of Milan, the region of Lombardy, and across Italy. Digital or mobile health (mHealth) has been developing in and across Italy in recent years[i]. Since 2016, a few regions such as Lombardy, Emilia-Romagna, and Tuscany have been particularly active in this field, and Lombardy’s activity in digital healthcare is above the national average.[ii] Developments in this area have since been impacted by the coronavirus pandemic during 2020, in Italy, and in Lombardy in particular, which saw the highest number of cases in Italy in early 2020. Digital technologies have played a significant role during the pandemic in a number of core areas relating to health from regional and national healthcare access communication and delivery and nascent public-private partnerships, to the everyday experience of lockdown. Amid the pandemic, the country has witnessed an increase in state engagement with the digital, including a range of public-private partnerships that, for example, offer ‘digital solidarity’ packages to citizens[iii] and seek to warn against ‘fake news’ about the virus that has been shared across social media. In March 2020, the Italian Ministry of Health published a warning list of ten particularly pertinent ‘fake news’ items about the coronavirus that were circulating across the Italian social web, urging the public to be vigilant about this issue.[iv]

During my broader ethnographic research studying ageing, care, and smartphones in Milan, I found that formal and informal policies and practices exist within a nexus of an emerging digital health scene ‘from above’, and a diverse adoption of digital practices by people of different ages and backgrounds ‘from below’. Amongst research participants who were smartphone users, googling for information about health and using WhatsApp to communicate with and care for others, for example, could be popular activities not wholly distinct from broader uses of smartphones for care and communication. Concurrently, these practices could also go hand in hand with the spread of mis/disinformation[v].

As such, although Milan and Lombardy are leading sites within Italy for healthcare and digital innovation, a range of factors continue to affect the equity of healthcare access, delivery and uptake, online and offline; such as income, socio-economic factors, regional location, and language; and these factors all play a role in the differentiated experience of living and ageing with smartphones in Milan that I explored during my research in Italy, and which are core themes in my forthcoming book as part of the ASSA book series with UCL Press, Ageing with Smartphones in Urban Italy: Care and Community in Milan and Beyond (2021).

References

[i] The uptake of mHealth in Italy has been reported as steady while slower than in other European countries such as Estonia and Denmark. Kostera, Thomas. 2019. ‘Digital health – Europe is moving at different speeds’. The Digital Patient (blog), 25 April. https://blog.der-digitale-patient.de/en/digital-healtheurope/. Accessed 23 November 2020.

[ii] See Postelnicu, Leontina. 2019. ‘Q&A: How Italy is working to digitise healthcare’. Healthcare IT News, 23 October. https://www.healthcareitnews.com/news/europe/qa-how-italy-working-digitise-healthcare. Accessed 23 November 2020.

[iii] In Italy during the Covid-19 pandemic in 2020, ‘digital solidarity’ packages were offered to bridge some of the socio-economic and digital gaps highlighted and perpetuated by the virus, at a time when digital practices of care and communications had taken on heightened significance. See Agenzia per l’Italia Digitale. 2020. ‘Solidarietà Digitale al servizio di studenti e commercianti’. Solidarietà Digitale. https://solidarietadigitale.agid.gov.it/#/. Accessed 21 November 2020.

[iv] See Ministero della Salute 2020 Salute (Ministry of Health). ‘Covid-19, occhio alle bufale’. http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4380. Accessed 23 November 2020.

[v]The distinction between misinformation and disinformation has been defined in terms of intentionality. The former describes the sharing of information regardless of intention, while the latter involves the intention to mislead, misinform and/or manipulate. See: https://www.dictionary.com/e/misinformation-vs-disinformation-get-informed-on-the-difference/ and https://en.unesco.org/fightfakenews