Dashboards of inequities

These are eye-openers on how social histories of medicine are shaping perceptions, evaluations and processes around the pandemic

By Author Pramod K Nayar   |   Published: 14th May 2021   12:03 am Updated: 13th May 2021   11:04 pm

Artificial Intelligence has proved to be a boon in the Covid era. AI-driven data collection and collation, from cases reported in local news to the numbers of the vaccinated to region-wise mapping has been examined by epidemiologists, physicians, policymakers and others.

Aggregating this data for public consumption and monitoring eventually resulted in the best-known (for now) Covid-19 Dashboard on the Covid pandemic, hosted by Johns Hopkins University as the Corona Virus Resource Centre.

Covidian Data

With its ‘Covid 19 in Motion’, the daily cases reported is available to all. Then there are US and global maps of the rampaging condition. There are also vaccine efforts, US and global, tracking trends across the world, testing processes and data, vaccine trackers and tools, among others.

Accounts of ‘vaccine characteristics’ include details of ‘vaccinated groups’ across countries, revealing, for instance, the prioritisation and principles of vaccination (also politics?) in different nations. The marker for India, for instance, reads ‘all adults’ under the rubric ‘vaccinated groups’ under the ‘national immunization program’. But Hungary’s reads ‘Healthcare workers & elderly & adults with comorbidities & essential workers’ and Guatemala’s as ‘Healthcare workers & elderly & adults with comorbidities’. In the case of Libya, it says simply ‘N/A’ (not applicable), leaving us to speculate on exactly how the ‘national immunization program’ is being operationalised when there are no identified ‘vaccinated groups’.

Flagging Social Issues  

The Covid-19 dashboard lays a great deal of emphasis on the bioethical aspects of the pandemic’s progress, consequences and its treatment. It insists, for instance, on transparency and the ‘responsible use of digital public health technologies’. Under VIEW-Hub of the International Vaccine Access Center (IVAC), it provides visualised data on vaccine use and impact, including the most studies per country for the factor, ‘Economic Burden of Disease’ for various diseases, computing costs per household, of having to deal with specific illnesses.

Far more interesting is the linkage of biomedical data with key social issues, indicative of a massive emphasis on the socio-cultural and economic undercurrents that determine how Covid-19 affects the world. Under the rubric ‘Immunization Equity’, this same VIEW-Hub’s data from the GAVI Alliance – which includes UNICEF, Bill & Melinda Gates Foundation, World Bank and a large number of civil society organisations around the world – for the equitable distribution of vaccines, informs us that as of 2019, the number of children in India with no access to vaccination stands at 19,192,018, higher than many other nations from the Global ‘South’. The number should tell us something about the prospects for a Covid vaccination campaign and its possible inequities. These numbers for various countries also point to the problems in public health policies in these nations.

Disposable People

The Covid-19 Dashboard is significant for its clear-sighted view of the social histories of disease and medicine, a field popularised by the historian Roy Porter in his mammoth The Greatest Benefit to Mankind, and which now has excellent work on biocapital, the social politics of Artificial Reproductive Technologies and surrogacy, the economics of stem cells, gene lines, etc.

Under its ‘equity’ rubric, the Dashboard has an interesting set of points from Jeffrey Kahn and colleagues of the Berman Institute of Bioethics (Johns Hopkins) and the Center for Health Security at Johns Hopkins Bloomberg School of Public Health. Cautioning against exacerbating existing inequalities, the note says:

  • Digital public health technologies should be deployed in a manner that does not propagate pre-existing patterns of unfair disadvantage or further distribute harms and risks unfairly throughout the population.
  • To the extent possible, digital public health technologies should be designed to rectify existing inequities.
  • Oversight mechanisms must be in place to ensure that the improved public health outcomes are equitable, and to detect and correct any unforeseen resultant injustices attributable to the technology or that can be addressed using the technology.
  • Incentives and disincentives for adopting new technology must be equitable, not exploitative, and aligned with effective use of the technology.
  • Disparity-driven technology gaps should be explicitly recognised. To the extent possible, provisions should be made to address the digital divide.

Acknowledging racial and class-based inequalities across the USA, the above write-up is salutary in pointing to the potential for further unequal measures in the light of the pandemic, which has, as several commentators have noted, produced more ‘disposable people’.

Vaccine Hesitancy

There is another fascinating report summary, prepared by Rupali Limaye, Director of Behavioral and Implementation Science at the International Vaccine Access Center in the Johns Hopkins Bloomberg School of Public Health, on ‘vaccine hesitancy’. The report is an eye-opener on how social histories of medicine are shaping perceptions, evaluations and processes around Covid-19. It opens thus:

 “Among the 41% of US citizens who told researchers last year that they would not receive a COVID-19 vaccine as soon as it was available, African Americans were the least willing. A history of formal medical exploitation and decades of institutional and cultural racism have entrenched that mistrust and fear…”

Directly pointing to the systematic injustice to and exploitation of specific races and ethnic groups in US health policies and medical experimentation, the Report is a history itself. The Report goes on to speak of the politicisation of vaccination before bringing up the ‘number one question’ Limaye was asked: ‘Are the vaccines safe for Black people?’ She also records:

“Many also ask how many African Americans participated in the vaccine trials. How many African Americans who were in the trials have comorbidities like diabetes and high blood pressure, so that they can truly trust the claims of the efficacy and safety.”

Noting a similar vaccine hesitancy in Africa and India, Limaye appeals for a responsible role of the social media in the battle against Covid.

The Covid Dashboard is evidently not just algorithms or biomedical trials. It is a site that locates contemporary biomedicine in the language of a particular history of biomedicine that was racialised, iniquitous and exploitative. The Johns Hopkins initiative alerts us to the social dimensions of Covid even through an aggregation of data.

From within this data emerges the bioethical imagination.

(The author is Professor, Department of English, University of Hyderabad)

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