As Governments and healthcare professionals around the world grapple with how to manage the COVID-19 pandemic, Louisa Bartoszek discusses how blockchain technology can help.
At the time of writing I am in isolation at home in London following the UK Government’s historic decision to restrict the movement of its citizens in response to the accelerating Covid-19 pandemic.
These are unprecedented times and whilst healthcare professionals and politicians rightly focus their energy on how to flatten the curve and save lives, my mind turns to the future and how can technology help mitigate future pandemics?
I concur with Microsoft founder Bill Gates, who recently wrote in an op-ed for The New England Journal of Medicine that world leaders have two equally important responsibilities.
Solve the immediate problem. Stop the same from happening again.
The first is more urgent, yet the second is more crucial in that it has longer-term consequences. Both societal and economic.
Who to Trust in a Crisis?
One over-riding theme which I’m seeing across the many issues is there is no clear “single source of truth”. A truth which can be unequivocally trusted and relied upon so that decision-makers, from politicians to the emergency services, can use to make rapid response decisions.
Data is everywhere. But it is owned, stored and inaccessible to others outside the company which owns a specific data set. Whether that be Governments, drug manufacturers, to distributors, to hospitals and pharmacies.
Conversely, there is a lack of real-time personal health data available, limiting expert forecasting and mapping the potential spread of a virus in a pandemic situation.
Specifically, being able to rapidly collect and analyse health data to identify symptoms, assess behavioural insights, conduct patient profiling and determine geographic impact to inform decisions and ultimately deploy evidence-based solutions to stem the tide of a health crisis.
This is where distributed ledger technologies, like blockchain and decentralised identity, can help.
Blockchain briefly explained
Before I dive in, for those who may not be familiar with the technology or confuse it with Bitcoin, which is a digital currency built using blockchain technology, not the technology itself.
Blockchain is a secure, digital ledger of data, organised into blocks that are linked together sequentially (hence the name).
There are three key attributes of blockchain which are helpful to know when thinking about supply chains – which is what we are predominantly talking about here.
First, each link in the blockchain is completely secure and unbreakable. Once you add a link, it cannot be changed, moved, or deleted.
Second, blockchains are decentralised and distributed.
Parties can share data and execute transactions, with full security, without having to rely on any central authority or service provider to act as a clearing house.
Third, the data on a block can be more than a simple ledger of facts—it can contain what is called a ‘smart contract’.
Smart contracts allow you to put instructions on the blockchain for execution at a later date.
Taking these attributes into account – this is why blockchain is often described as a “single-source of truth”.
There are three ways in particular, thinking about the COVID-19 crisis, in which having healthcare supply chains and national health systems use distributed ledger technology could help improve how Government’s respond to a pandemic.
1. Medicine and Protective Health Equipment
If all medicines, personal protective and healthcare equipment were stored and logged on a distributed ledger, Governments (and other required parties) could have immediate access to valuable data around available resources.
Understanding where the resources are and how much the country has available to citizens.
Improved transparency could help to expedite a strict rationing, for example, of medicines in short supply to avoid shortages in the event of panic buyers rushing out and hoarding goods. As we have sadly seen in many parts of the world in recent weeks.
It can also help to inform decision-making around the redeployment of medicines to more severely infected parts of a country with Governments able to track and trace the movement of medicines and equipment in real time.
In addition, improved transparency in healthcare supply chains could help monitor country-wide stock levels.
Specifically, around pending expiration dates and the need to replace stocks ahead of expiry, as well as improve the rotation of stocks to avoid waste.
Notwithstanding a thorough assessment of protective medical equipment for frontline doctors and nurses, such as masks, aprons and goggles. Ensuring a country has enough supplies in readiness for a future pandemic.
QR Codes can help with the ‘track and trace’ of medication. And the good news is they are imbedded into a large portion of the global pharmaceutical supply chain as a result of increased regulation in recent years, for example the European Union’s Falsified Medicines Directive.
But how accessible is this data in a global pandemic? Where is all the data stored? Can Government’s track and trace resources? At the moment, it’s difficult.
Blockchain could radically transform Governmental understanding of available medicines and resources.
2. Symptom tracking of citizens
In the words of Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation: “You can’t fight a virus if you don’t know where it is”.
Speed is of the essence, and three things are crucial.
I think one of the key issues emerging from the COVID-19 pandemic is the fact that we have a conservative figure on how many people have been infected.
I say this because many who could be infected are not going into their hospitals to be tested.
Indeed, people with coronavirus symptoms in the UK should only call 111 if they "cannot cope", the NHS has said.
Guidelines on the NHS website advises those with a high temperature or a new, continuous cough to simply stay at home and not contact them or visit their GP.
Many are therefore showing symptoms and self-isolating to protect others. Just in case.
I am one of those people. Who is tracking these people, like myself, and assessing the data for patterns to better inform decision-making?
They are, as a consequence, unrecorded as they are untested and unknown.
As with other coronavirus outbreaks in Europe, the UK’s epidemic has progressed at different speeds across different regions.
Governments and health professionals need the whole picture and instead are working from a partial picture in what is showing to be a life or death situation for many of the most vulnerable.
Symptom tracker apps – is your data safe?
I was pleased to see the launch of a new app in the UK on Tuesday (24 March) called the C-19 Covid Symptom Tracker, asking people to self-report their symptoms in an effort to start to gather more of that detail.
I was even more pleased to see the app go viral and record over 650,000 downloads in 24 hours.
But how accessible is this data to Government and needed decision-makers? And how quickly?
Governments need to be able to build a more complete heat map of a crisis rapidly, enabling better informed and faster decision-making.
Which could ultimately save more lives and reduce the negative financial impact on both businesses and the economy.
Then there is a rather sensitive question of the security of data the COVID-19 app collects and how personal data is used, both now and in the future.
Is it compliant with data privacy regulations like GDPR? And what happens to user data? Have the public agreed (and fully understand) how their data is to be used? Or are they expected to read detailed legal policies which, given the desire and urgency of the public to help, are unlikely to read?
In an interview with TechCrunch, a spokesperson for Zoe, the company behind the app, noted that their data policy is GDPR compliant but also noted that personal data could travel outside the EU, not just for analytics but to be shared with other research partners.
What does this mean in reality?
With the best of intentions, users who volunteer personal health information to help in a pandemic do not know how the data they freely submit could be used in the future when handed off from one party to another. That’s the issue.
I’m not criticising Zoe, as their initiative is terrific and the reality is, nor do they know what happens once the personal data they collected is passed on.
In their FAQs in the “Who will be using my data” section, they say that data may be shared with research institutions and “some of these research institutions are in the US, and so are not governed by GDPR”.
This is actually not true. All data gathered in the UK is governed by the Data Protection Act 2018, which incorporated the GDPR into UK law. US institutions who receive the data would still need to comply with their data controller or data processor obligations, due to the extraterritorial effect of the Data Protection Act.
Only if the data was rendered completely anonymous would it be able to be processed by research facilities in the US.
However, the Symptom Tracker app pairs each individual with a pseudonymous identifier. This is pseudonymisation which is not the same as anonymisation.
Transparency, data security and truth, is something which distributed ledger technology, specifically a technology known as decentralised identity, can solve with verified identity credentials.
A verifiable credential enables an individual to definitely prove a fact about themselves by combining personal data with an immutable signature from a blockchain.
Want to prove that you have been tested for Covid-19, quickly share your verified credential with a healthcare worker. Want to show that you are an essential worker which needs to commute into the city, use a verifiable credential.
By giving individuals this level of cryptographic trust, the containment of the virus can be better managed by Government, who could mandate the use of verifiable credentials for healthcare and essential workers.
3. Bed Space, Staffing and Volunteers
Here in the UK, how can the Government accurately predict the rapidly changing needs of the NHS and assess the availability of beds in the many hospitals, private healthcare practices, care homes and the likes across the country with partial information?
Knowing where spare beds are; as well as what the medicinal situation is in those locations too.
As well as how many doctors and nurses are available and where volunteers might be needed in the most severely hit locations?
At the time of writing, the Government announced the NHS will soon treat COVID-19 patients in a makeshift field hospital in the ExCel Centre in East London to accommodate the surge in cases.
An exhibition space which will be staffed by NHS medics with the help of the military and will initially provide 500 beds equipped with ventilators and oxygen.
Terrific for those in the south east of England. But what about the rest of the UK?
The largest number of cases as of today are in the south east, but the virus is spreading. Where might be the next best move, assuming a next move is needed?
The same applies to volunteers.
Prime Minister Boris Johnson announced at his daily news conference on March 25 some 405,000 people have signed up in 24 hours to volunteer with the NHS after a recruitment drive to help the vulnerable.
Helpers are needed for delivering food and medicines, driving patients to appointments and phoning the isolated.
Absolutely amazing news. But do they all live in the locations with the most urgent need?
Are the volunteers able to be deployed? Not immediately.
NHS volunteers will need to undertake a DBS (Disclosure and Barring Service) criminal records check.
There is a substantial surge in undertaking these important checks for the hundreds of thousands of volunteers.
What could aid this process is if the individuals could take a photo of their relevant documentation and receive a digital ‘credential’ of authenticity from a local government hub in return.
Then individuals could use their verifiable credentials when signing up to and completing volunteering tasks.
This way, everyone receiving care, deliveries or other volunteer support could trust the volunteer is legitimately verified by the local council hub.
Plan today so you can save lives tomorrow
Human beings tend to overreact to immediate problems and underreact to longer-term threats that build slowly. Putting off tomorrow’s problems for another day.
There is no denying building national blockchain healthcare systems, let alone a connected global blockchain system is a herculean task.
There are many technical, financial and, diplomatic obstacles.
It will demand international collaboration, as well as partnership between the public and private sectors.
But it can be done.
Thinking of a possible comparison, the same energy and focus was needed in building the global financial system.
Ultimately, the investment made in building a new global blockchain-based healthcare system will significantly outweigh the economic pain that a pandemic can impose.
As yet we are unable to fully quantify the financial impact of COVID-19 as the crisis is still unfolding; but we can already understand the scale. It’s billions of dollars.
Plus, some things which are so incredibly precious, a price simply cannot be placed upon them. The lives of loved ones.
There is no time to waste.
Today we all need to focus on the crisis and saving as many people as we can.
And as soon as we are able, Governments and the healthcare industry urgently need to leverage available technology – the trifecta of blockchain, decentralised identity and artificial intelligence - and execute a plan to create a more resilient and transparent global healthcare system to help us combat pandemics in the future.
We’re going to need it.