Since its emergence in late 2019, the COVID-19 pandemic has reached almost every corner of the globe. By April 20, 2020, the number of recorded cases worldwide had reached 2.4 million with over 161,000 resulting deaths.
As the virus spreads, so do the technological responses. Never before has a global crisis been so digital. From remote work, mobile surveys and needs assessments, online education, digital contact tracing, and digital immunity certificates – new realities, ideas, and innovations for the COVID-19 situation are popping up everywhere.
In this context, we decided to move Technology Salon online with a series called: Tech in the Time of Coronavirus to bring together the global tech, humanitarian, and development communities to learn from one another and from past efforts to respond to and recover from crises. Salons have always been in person and off the record, and we’ve tried to re-create that experience as much as possible in this virtual format.
Learn more from experts in the video above.
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Report Back on the Salon
The first virtual Salon in the Series kicked off on April 16, 2020, with over 100 participants. Our introductory topic “How Can the Technology Sector Respond to COVID-19?” was aimed at answering questions like:
- How can technologists engage in the most useful ways?
- How can COVID-19 digital responses have a positive short- and long-term effect?
- Which different tools, applications, platforms, and devices address the most critical needs?
- How can we avoid mistakenly doing harm when we intend to do good?
- Where can technologists find quality opportunities to meaningfully contribute their skills?
The first hour highlighted past lessons, insights, and frameworks that could help to improve digital responses to COVID-19. Our speakers were:
- Merrick Shaefer, Digital Health Lead, USAID;
- Larissa Fast, Senior Lecturer, HCRI, University of Manchester;
- Alanna Shaikh, Principal Consultant, Global Public Health at Tomorrow Global;
- Allana Nelson, Director, Principles for Digital Development, Digital Impact Alliance.
This portion was recorded for wider dissemination. The second hour consisted of off-the-record breakout groups for a Salon-style, open discussion.
Key Points from Speakers
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Merrick Shaefer, USAID
Merrick started out his career in the tech sector, moved into the development sector at UNICEF and the World Bank, and later joined USAID to work on the Ebola response in West Africa. He spoke about what he had learned from failures.
“Getting tech to work in any setting is hard. Getting it to work in settings you’re not familiar with or settings that have major resource constraints is even harder.”
The failures Merrick described happened despite good intentions and even after the team had done careful testing. For example, while at UNICEF, his team ran a hackathon. “In the course of an afternoon, we had built everything you needed to run your own community radio station.” The team took their prototype out to test in a number of villages that had prior experience with community radio. “The reaction was amazing. People cried, they laughed. It was such a powerful experience.” The team celebrated their success — they had created a low-cost solution that impact!
However, “the idea was a complete failure.”
Why? “We didn’t involve anyone else from UNICEF in this.” UNICEF staff had been doing community radio for years and could have offered input, but the team only focused on the tech. Unfortunately, a small scale, directionally limited radio station wasn’t something anyone that UNICEF worked with needed, so there was no way to integrate it into programs.
“The second reason it failed was that it was illegal”
On top of that, it was not a legal set up. “In most countries, you can’t just spin up radio stations! There are policies and regulations, like our own FAA here in the US, that limit you from just being able to spin up a radio station! We had built this amazing and cool tool, that worked out of the box, and was cheap. It worked in the environments that we were trying to work in, but it wasn’t providing any value at all to UNICEF’s programs.”
These types of stumbles are not just silly, fun stories. They can have a detrimental impact on programs and on frontline workers. In the COVID response, for example, creating tech that has direct or secondary health or other risks would be extremely dangerous. Getting technologies to work is hard enough on its own. We all need to avoid creating second order challenges by unleashing unproven and untested technologies into environments where they could cause harm.
“I love making mistakes – I hate making the same mistakes again and again and again.”
Failure can lead to success, but only if we learn from it. One of the most important frameworks for designing technology in development contexts (the Principles for Digital Development) resulted from frustration that failures and lessons learned were not being shared more widely. These Principles can help anyone working on tech to avoid repeating mistakes.
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Larissa Fast, Humanitarian Conflict and Response Institute, University of Manchester (UK)
Larissa was embedded as a researcher with a USAID team that focused on data and technology in the Ebola crisis. Her assessment of the response drew out key lessons as well.
“Tech is important, but even more important are people and processes.”
Technology is only one part of a successful digital intervention, and successful uptake requires humans, institutions and systems to enable it. “You might have a tool, but will people know how to use it? Will they trust the technology you’re trying to deploy?” Will the people who need to be trained to use a new tool or system have the time or availability for training when they are already overwhelmed with responding to the crisis?
“Crisis is not a time to introduce massive change because people are already trying to cope with uncertainty and change.”
The Ebola team learned that even simple tools might not work. For example, Excel was the backbone of the Ebola response, but there were so many missing information points that it was not always effective. “People would report zero cases to denote missing data, and that skewed the reporting.” In the West Africa context for Ebola, weak infrastructure, unreliable electricity and digital connectivity, and poor roads hindered information sharing for even the most basic things like case data.
“Tech needs to be embedded in the local context — organizational, cultural, and national.”
Another critical aspect in the Ebola response was trust. This is key also for the COVID response since so much disinformation and misinformation is circulating. Trusted actors are extremely important when sharing information and prompting people to change their behaviors to prevent or control an epidemic or pandemic. Trust is linked to both social relationships and the political context.
“Do people have trust in the authorities, and will they believe the information that is coming out from those government authorities?” Technology solutions need designed for specific local and national contexts if they are to really address the needs. It’s important to think about support for local actors. Tech should amplify local action and not usurp it. In places with intermittent connectivity, tech needs to function seamlessly in both online and offline environments.
“One size fits all solutions are unlikely to work.”
Additionally, there will likely be lots of actors and potential “solutions.” Local and national authorities as well as other trusted actors like community leaders and faith leaders will have already been responding in their communities. Their work will inevitably be more contextually appropriate than someone who is coming in from the outside, and their work and presence is likely to continue long after those of us who are not from that context leave.
Tech that is introduced in a crisis is not likely to be game changing, but it could bring incremental improvements. During the Ebola crisis, feedback loops sent by mobile phone allowed Ministries of Health to share information with local health workers and for individuals to report rumors and misinformation that could then be addressed through official messaging and trusted messengers.
“Think incremental as opposed to ‘game changing.’”
Fragmentation can also be a problem during a crisis. Too many systems create information overload. It is often more effective to reuse existing tools than to create new ones. Standards are also important. During the Ebola crisis, data was collected, used and stored in many forms – both paper and digital. In both formats, there were key gaps.
For example, the lack of a unique ID meant that someone could go to one Ebola treatment center, be sent home, then go to another center, and be counted as two cases not one. Definitions were another challenge – for example, countries had different parameters for counting cases. In the COVID outbreak, there is a similar problem with numbers. Some countries include only people who die in hospitals, whereas others also include those who die at home or in nursing homes.
“We shouldn’t be experimenting with new tools and tech on populations that are already vulnerable.”
Lastly, data protection is very important. What data is being collected, how it will be stored, shared, and used really matters. Data responsibility is about privacy and data protection, but also about not collecting more data than is needed and using the data that is collected. Data privacy and protection are individual as well as group in their nature. It’s not enough to protect individual privacy – it’s important to also consider the privacy of entire groups who are vulnerable. This is particularly critical when data sets are merged as this can lead to re-identification. Additionally, vulnerable populations suffering from a crisis should not be viewed as a playground for experimenting with tech. (Join us for the April 30 Salon on data ethics)
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Alanna Shaikh, Tomorrow Global
Alanna spoke about what developers should know when creating apps to support the COVID-19 crisis. We are seeing a proliferation of consumer apps and apps designed for healthcare workers. “There is the idea that every problem can all be solved with a phone app.” Some apps have run into trouble already for implying that they can diagnose people for COVID simply by asking questions through a phone. Many of these apps have issues with data privacy and data sharing.
Two sets of users who could benefit from a COVID-19 related app. One is an individual who wants to get health information. The second is an agency that is collecting demographic information for a government or health department. There are major issues arising with apps for both of these groups.
One challenge is that COVID-19 related information is very location specific. For example, in the US, information on who should get tested, when, and where varies by state. Policies around quarantine, self-isolation, and how to behave while self-isolating are also municipality specific in the US and elsewhere. There’s a tendency among app developers to assume that they can provide general health information. Yet “even information on masks differs across countries, and things that seem like they should be consistent are not.” It’s hard to provide generalized yet location-specific enough information for it to actually be valuable.
Another issue is that some apps could be exacerbating mental health issues. Apps that encourage people to input possible COVID-19 symptoms every day in order to know if they should be tested could contribute to stress if testing and treatment are not available. “A health app should actually be good for you,”
“The stuff that keeps people coming back and logging into apps regularly is not necessarily good for mental health.”
Apps that track symptoms once a diagnosis has been made would be more valuable, as then people could take some kind of action. Collection of Personally Identifiably Information (PII), particularly health data, needs to be considered up front as well, and companies who have not designed health apps might not be aware of what the laws are for health data protection.
In terms of meeting the needs of municipalities and other levels of government, while it might be handy to have demographic and health data to help predict how hard COVID-19 might hit an area, reliable granular information on populations is not always available. Additionally, there are serious privacy implications with combining these kinds of data for predictive models, and people who are inputting personal health data into this type of app would need to know and consent to their information being shared.
Given the excitement about COVID-19 apps and the potential for harm, it’s important to think more about the role of tech solutions in COVID-19 and downstream effects more generally. Needs are not straightforward and frontline responders are best placed to help identify whether there is a role for an app and what that role is. It might be that non-tech efforts are actually more useful.
“It comes down to thinking outside the obvious. There are going to be weird little niches, empty gaps where there is a tech solution if you can identify it.”
For example, health workers are obliged to wears masks for 12-14 hours per day, and skin irritation can lead to them adjusting their masks in ways that can put them at risk and can affect infection control. There is an initiative to get high quality skincare products to them to reduce the irritation.
In West Africa during the Ebola crisis, there was an initial fear that the virus was getting through health workers’ personal protective equipment (PPE). That wasn’t the issue, however. “It was that due to the heat, people were getting very sweaty inside the PPE, and they were cracking it open so they could breathe a little, and the virus was getting in that way.” Doctors without Borders started providing ice vests for health workers to wear inside their PPE so that they could last a lot longer inside the PPE comfortably.
Alanna’s key points were: “Don’t try to make people use something brand new when they are desperately constrained. And talk to your users. If COVID-19 responders don’t have time to talk to you, think about how you can respectfully tap into them and respect their time. And remember that health apps have very specific privacy requirements.”
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Allana Nelson. Digital Impact Alliance
Allana also worked on the Ebola response. She gave a brief outline of the Principles for Digital Development, a set of guidelines for technology design, and described how they could be used during the COVID crisis. Though there are 9 Principles, Allana focused on the five that are currently the most applicable to COVID-19.
The first is Design with the user. In any context, it’s critical to understand the target user group. “We are hearing about fake news all the time here in the US, and we don’t necessarily trust the information that we’re getting from our government. When you’re thinking about tech solutions, you have to think about all the ways that people are receiving information. You should be building tech with them and be informed by their needs — we can’t assume that we always have the right answers, or that our answers to a problem are the right answers.”
“Users won’t adopt or sustain a tool that isn’t useful to them, that they don’t trust, or that doesn’t meet their specific needs.”
The second Principle that Allana focused on was Understand the existing ecosystem. It’s important to understand what tools are already being used, what challenges they address, and what other organizations are already doing rather than always trying to create something from scratch.
This leads directly to a third Principle, Reuse and improve. Allana re-iterated that emergencies are a terrible time to trial and pilot new digital tools and programs. Frontline workers don’t have time for new processes.
“Some people are being predatory and opportunistic in addressing their bottom line. That is not the best way to support during a crisis.”
“When healthcare systems across the globe are overwhelmed with meeting the needs of their citizens, they don’t have time to listen to tech pitches or evaluate proposed technology.”
Instead, we should be investing more deeply in adapting our proven, existing systems and tools to the current context. She gave the example of mHero, a mobile communications and reporting tool that was created to respond to Ebola, It was built on the back of RapidPro, a mature SMS messaging platform. mHero used a system that was already in place in many Ebola-affected countries. Currently, the Ministry of Health in Liberia is adapting mHero for coronavirus surveillance.
“They took a tool that health workers already know how to use and adapted it for use during COVID. They are now putting it into practice rather than creating a new app.”
Address privacy and security is the fourth Principle that Allana spoke about. It is a cornerstone for responsible data management. It’s important to balance human rights and privacy needs with saving lives. “There isn’t an easy answer to this one, which is why it’s so important to take it seriously and have a policy in place early on about how you plan to protect users.” (Sign up for our April 30 Salon on Data Ethics for a deeper discussion on this aspect)
Finally, Allana raised the Principle of Be collaborative. It’s important to work with others rather than competing. Partnering with other organizations can lead to better digital products. There is no one organization that can solve the COVID-19 crisis, “but if we partner and work together, we have a chance of solving it sooner and saving more lives.
“Emergencies aren’t the time to go it alone or to try to increase your bottom line. Collaboration is more important now than ever before.”
In closing, Allana suggested using the Principles for Digital Development to inform how to approach and address the development or re-use of tech during the current pandemic. The Principles existed before COVID and they continue to be informed by the wider community. “These are meant to be living guidelines. These principles were identified as being important for a reason, and I hope we use them for the COVID crisis.”
Break Out Room Discussions
After hearing from the speakers, participants moved into five virtual break out rooms for off the record discussions. Key issues and challenges discussed are summarized below.
How can we do user-centered design during the COVID crisis?
- Organizations are struggling with the challenge of designing with the user while also being sensitive to the face that frontline responders are busy responding or getting much-needed rest. Additionally, the physical distancing nature of COVID means that designing with the user cannot be done in person, and designers cannot physically observe or learn “on the ground.”
- One point here was that the principle of Reuse goes beyond just tech and can be applied to reuse of knowledge and experience. Organizations should focus their attention on thematic and geographical areas that play to their existing cultural and contextual strengths and experiences. Applying cross-sectoral knowledge to their work is a good thing, but now is not the time for organizations to dive into new thematic areas (e.g., suddenly trying to work in health if they never have before) or new communities where they don’t have experience.
Existing networks and ecosystems
- Working with partners and existing networks and systems is recommended. Faith leaders were a critical part of the Ebola response, for example, and helped to get key messages out about prevention. Ebola networks immediately re-formed in the face of COVID, for example, and these networks will be critical in the response in West Africa. Similar networks can be engaged in the response in other places. New York City, for example, is working to engage immigrant and non-English speaking communities through grassroots organizations already active in at the community level.
- It is difficult to know what the ecosystem looks like, and what tools already exist and what has been proven to work. UNICEF and DIAL are working on combining different lists of tools. There is also a list of global digital health The issue is that there are so many lists that people are still feeling information overload.
What can large private sector companies do?
- Private sector partnerships can play a role. For example, during Ebola, Coca Cola’s supply chain was used to take critical supplies out. In India, a local start-up similar to Uber has provided their platform to the Indian government to use for tracking supply chain and delivery logistics during COVID-19.
- The role of the private sector and large tech companies doesn’t have to be building more tech. Their other assets and infrastructure could be put to use during the crisis. Google busses in San Francisco might transport healthcare workers, Tech companies could provide funds. Hotels can be used to house essential workers or the homeless. The private sector can think about reallocating its large office or factory spaces and retraining and job reallocation to meet needs during the pandemic.
How much “new” is too much “new”?
- Everyone wants to jump into making and building something, but no one wants to tap into what was there before. Yet, we are not using the tools we already have. Maintenance can also be an issue in a crisis situation when everyone is rushing to develop new tools and systems and people are stretched for time.
- Sometimes the best solution is to not introduce tech solutions.
- Rather than developing new tools and/or forcing them on people, donors should be driving funding streams towards existing tools and the addition of new features in tools people are already using rather than rolling out new ones. Some technology companies are rapidly adding additional layers of functionality to their tools so that they apply to the COVID-19 situation. This makes the learning curve much lower. It’s about amplifying, expanding, and enabling the existing ecosystem.
To open source or not to open source?
- The use of open source is a commonly debate in the sector, and there are pros and cons. Though it is a way to rebuild and reuse and collaborate, open source requires skills that are not always available or attainable during a crisis.
- There is also a lack of understanding about how software works, how to assess what is needed, what is a good fit, what resources would be required to get something up and running, and how to sustain it over the long-term.
- So when deciding on open source, it’s important to weigh a lot of aspects and to understand the context and existing skill sets and experiences,
How do we design based on data and evidence during COVID-19?
- There is a rush to get things “out the door” and many are not using existing research, for example behavioral research on how to effectively communicate messages during a crisis.
- People are overloaded with the crisis response at the personal and professional level, and it’s hard to get people to fill out surveys so that programs and information can be targeted correctly to needs and information gaps.
Accountability can suffer when everything is remote
- When organizations cannot be physically present — governance and accountability issues can crop up. For example, there have been reports of essential goods being co-opted by local power structures and not reaching the most vulnerable. Social distancing and lockdowns mean that there is no presence of a third party to monitor distributions, so this is sometimes an issue.
How to frame responses in a systems approach as opposed to thinking and working in silos?
- Rather than individual apps, a whole systems approach could help reduce the current duplication of efforts and the creation of apps that do not align with a country strategy or a country-level response. A whole government approach could help us to reuse foundational investments that have already been made.
Access the list of resources shared at the Salon.
Tech in the Time of Coronavirus Series
The Tech in the Time of Coronavirus Series is co-organized and supported by Technology Salon in conjunction with ThoughtWorks, Pivotal Act, and the UN Foundation’s Digital Impact Alliance (DIAL). It aims to bring together the wider technology sector with humanitarian and crisis response sector experts, specifically those who have worked on past crises situations, to highlight good practices and to avoid repeating well-documented mistakes and re-inventing wheels.
We also hope that through connections made at these Salons we can find effective and impactful ways to work together on the COVID-19 response. The first part of each Salon is recorded so that it can be publicly shared. For the second hour, participants are divided into moderated, off-the-record break-out groups for frank and open discussions aimed at identifying and working through challenges and moving towards collaboration.
We will cover several topics over the next few months, including the issue of responsible and ethical use of data during COVID-19; effective ways to volunteer; the role of the corporate, foundation, and other donors; the impact of COVID-19 on online education, economy and jobs, domestic abuse and gender violence, mental health and substance abuse, and other emerging secondary effects of the pandemic.
We will also cover topics that aim to help agencies working on the crisis to move towards effective digital response necessitated by the need to avoid face-to-face contact with communities and one another and government mandates to quarantine to avoid spreading the virus.
Read about future Salons in the series:
- April 16. COVID-19 Challenges for Refugee Settings and Low-Income Countries
- April 30. Data Ethics, Power and Privacy in the COVID-19 Digital Response
- May 14. How to Volunteer Your Skills for COVID-19 Digital Response?
- May 21. How to Use Digital Behavior Change Communications for COVID-19 Response
- June 4. What is the role of funders in supporting the COVID-19 digital response?