Digital technologies for the surveillance, prevention and control of infectious diseases - A scoping review of the research literature
New developments in information and communication technologies (ICT), particularly in digital technologies, have the potential to significantly improve the speed and accuracy of key public health functions such as infectious disease diagnostics, surveillance, forecasting, outbreak detection and response. It is important to understand the range and types of digital technology available, as well as contextual insights such as disease and geographical areas of application, when attempting to assess the benefits and risks of digital technologies to deliver public health functions. The objective of this scoping review is to obtain an estimate of the size and nature of the scientific literature available on digital technologies with the potential to benefit or disrupt key public health functions, focusing on infectious disease surveillance, prevention and control.
We conducted a scoping review of the literature published between 2015 and 2019 on the use of digital technologies for the surveillance, prevention and control of infectious diseases. The scoping review protocol was developed following the PRISMA-ScR checklist. We ran peer-reviewed search strategies in PubMed, Scopus, the Cochrane Database of Systematic Reviews and the ACM Digital Library. We also searched CORDIS – the European Commission's primary public repository – to identify relevant EU-funded research projects and conducted targeted searches in Google. Study selection was based on pre-defined inclusion criteria and included a pilot screening exercise to ensure a consistent approach among all members of the study team. Using a pre-designed extraction template, we extracted data from each study on publication details, geographical context, digital technologies, infectious diseases, key public health functions, and the potential benefits, obstacles and negative impacts of using the digital technologies in the given context. Digital technologies were categorised according to 15 high-level technology groups. These include cognitive technologies such as artificial intelligence, and autonomous devices and systems such as drones. Technologies were also classified against six key public health functions of relevance to infectious disease control, for example surveillance, signal detection and outbreak response. The database/repository searches returned a total of 5 780 unique references. A further 14 relevant articles were identified through CORDIS, and 31 from targeted Google searches. Of these, 502 articles were identified as eligible for inclusion.
The broad nature of the scoping review helped identify relevant knowledge gaps, highlight possible areas for future research (e.g. in-depth systematic reviews or reviews of reviews into the application of one or more technologies to support a specific public health function), and determine the next steps for ECDC’s strategy in relation to the use of digital technologies to deliver key public health functions. In some areas there appears to be sufficient primary studies to conduct a systematic review. These are: infectious disease surveillance and forecasting using either cognitive technologies such as artificial intelligence, data analytics including big data, or simulation technologies. For specific infectious diseases, there appears to be sufficient evidence to conduct systematic reviews on the use of digital technologies to forecast dengue, or malaria, and the same applies to for the forecasting and surveillance of influenza. In one area – use of data analytics for the surveillance, monitoring and detection of infectious disease trends and outbreaks – eight systematic reviews were identified, which may be sufficient to conduct a review of reviews. The technologies identified (33 in this review) were grouped into 15 high-level technology groups to facilitate data extraction and presentation. However, the broad spectrum of technologies and the large variation of study designs and outcomes, suggest that it could be challenging to systematically collate sufficient information on the application of one or more technologies to a specific public health function. In addition, a large number (almost three quarters of the articles identified) described digital technology intervention at the conceptual or piloting phase, suggesting a lack of information relating to implementation and evaluation. The review identified several barriers to successful roll-out of digital technologies for key public health functions as described in the articles selected. These were grouped into categories: access to good quality data; technological and human resources; physical and network infrastructure; safety and ethics, and a range of interrelated political, social and environmental issues. The broad spectrum suggests that the use of digital technologies to support and
improve key public health functions will require a systems approach to be successful and have a positive impact on public health outcomes.
Despite the identification of several areas where the next step could be a systematic review, the points listed above suggest that additional desk searches and reviews would probably not be the most appropriate use of time and resources. A more appropriate next step would be to complement the scoping review by mapping the digital technologies being researched and/or implemented to support key public health functions. It would also be useful to gather lessons learned across the EU/EEA through surveys, interviews and consultations, given that a similar exercise had to be cancelled in 2020 due to a lack of resources as a result of the pandemic. At the same time, we would aim to establish closer contacts with different stakeholders active in those fields relevant to digital public health. In 2021, ECDC is holding consultations with EU and Member State representatives to exploit the momentum that came with the COVID-19 pandemic in order to bring public health onto the digitalisation agenda at EU and national level. This will help us to gain a better understanding of the current state of play, and facilitate contact and exchange between the relevant stakeholders in digital and health/public health policy, regulation and practice.
The COVID-19 pandemic has accelerated the digitalisation of many aspects of everyday life, and Europe has been one of the epicentres of the pandemic ever since the spring of 2020. It is therefore an appropriate time to explore the impact of COVID-19 on the digitalisation of health and public health in Europe, as well as the effectiveness of digital public health interventions in a more structured and systematic manner.