Global Crowdsourcing Can Help the U.S. Beat the Pandemic
To fight Covid-19 the U.S. must be open to ideas from everywhere, including developing countries. Sometimes, less-wealthy countries can offer simple, low-tech solutions that are highly effective at containing infectious diseases. A team at Northeastern University spent two months scouring the Internet for other ideas that less wealthy countries have used to address the pandemic in areas including prevention, testing, isolation, quarantining, treatment, and reopening and have organized more than 50 ideas across these categories on a website, Reverse Innovation to Fight Covid-19,
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To fight Covid-19, the United States must be open to ideas from everywhere, including developing countries. Sometimes less-wealthy countries can offer simple, low-tech solutions that are highly effective at containing infectious diseases.
In an earlier article, I discussed how U.S. health care organizations are borrowing lessons from Asia and Africa to fight Covid-19. Looking further, a team at Northeastern University’s Center for Emerging Markets spent two months scouring the internet for other ideas that less-wealthy countries have used to address the pandemic in areas including prevention, testing, isolation, quarantining, treatment, and reopening. We’ve organized more than 50 ideas across these categories on a website maintained by Jorja Kahn: Reverse Innovation to Fight Covid-19. We invite health care leaders and policy makers to adapt these ideas and contribute to them. Global crowdsourcing could help all countries fight the pandemic more effectively.
Here are three takeaways from our explorations.
1. The United States needs a comprehensive strategy.
Places including Hong Kong, Rwanda, Singapore, South Korea, Taiwan, Thailand, and Vietnam rapidly developed nationally coordinated strategies for fighting Covid-19. Their goal, almost from the outset, was to crush the pandemic, not merely “flatten the curve” to a medically manageable level. Many of these countries created high-level command centers to develop and implement their strategies. They’ve used everything in the toolbox — not just lockdowns and treatments. They moved quickly, sometimes preemptively, knowing that delays could be costly when an infection can spread exponentially. For the same reason, they didn’t wait for flare-ups to reach serious levels before responding. Poor countries such as Ethiopia, Rwanda, and Vietnam that have a paucity of medical staff and facilities were especially under pressure to nip the infection in the bud. By comparison, the initial U.S. response was slow and disjointed. With experience, several U.S. states are developing more-comprehensive strategies, but more can be done, particularly at the federal level. For examples of poorer countries’ effective national strategies, look at the cases of Vietnam, Rwanda, and Taiwan
2. Simple solutions can make a difference.
Many ideas that other countries have used to fight Covid-19 are simple and low-tech, but they have worked. The classic example is masks, which studies have shown are an inexpensive way to slow the spread of infection and allow economies to reopen. Several countries have created public campaigns that encourage mask wearing, social distancing, and handwashing. Their national leaders often set an example and made the pitch themselves, in televised and online addresses. A Taiwanese team instructed citizens on the proper way to make, wear, and dispose of masks. A catchy infection-prevention video collaboration between musicians and Vietnam’s health ministry went viral in the country. In China and elsewhere, temperatures are checked regularly in public places. Singapore’s government has hired laid-off airline employees as “ambassadors” to disseminate information on Covid-19 and encourage safe practices.
Countries have sometimes augmented these simple practices with additional technologies. Some have used drones and robots to monitor public places and blare messages if people were getting too close to one another, or to disinfect offices and malls. Singapore, South Korea, and Taiwan complement human contact tracing with digital contact tracing. Hong Kong and Taiwan are using “electronic fencing” to ensure compliance with quarantining and isolation requirements. Some countries have produced Covid-19 maps locating hotspots and dashboards showing how many ICU beds and ventilators are available in various hospitals. China initially used artificial intelligence to support nonintrusive thermal scanning of crowds in public venues, but with the number of new cases now down in the teens, it continues to do so primarily at international airports and border control points.
These countries have also used vintage practices that have atrophied from disuse in the United States. A case in point is pooled testing: combining samples from several people into a single test and then testing those people individually only if the pooled result is positive. The United States once used the technique to monitor syphilis, and it is still widely used in poor countries, where tests are in short supply and cost is paramount. Manoj Jain, a Memphis-based infectious disease physician and epidemiologist, learned about pooled testing used for tuberculosis screening in India (Jain was a World Health Organization consultant) and wondered why the United States wasn’t doing the same for Covid-19. “Having seen it work well in India gave me the confidence to push for it in the United States,” he says. Working with his city’s mayor, Jain helped Memphis become one of the first cities to get FDA approval for pooled testing in private labs. As Covid-19 persists and millions need to be tested in schools and workplaces, pooled testing is getting a second look in the United States. “The FDA should mandate it nationally,” Jain says.
Home isolation of Covid-19 patients is another practice that countries including India have used effectively. In China and Vietnam, anyone testing positive is isolated in an institutional facility, away from family. Delhi has shown that home-based isolation of mild or even moderate cases, with proper medical screening and supervision, can be safe and cheap and can reduce the strain on hospitals. It is strongly preferred by citizens, who fear being whisked away from their families by the authorities. Delhi’s approach, supported by instructional videos, public health protocols, and an all-in-one telemedicine and contact-tracing app, has become a model for the rest of India. While government-mandated quarantine in an institutional facility would probably meet resistance in most democracies, home-based isolation is now being considered in the United States even for advanced cases, and it may help when hospitals are packed or hard to get to, as in remote rural areas.
3. Learn from global experiments.
All countries, including the United States, can learn from the innovative responses to Covid-19 around the globe. (See, for instance, this site on Covid-19-related innovations in Latin America). Recently, convalescent plasma therapy made headlines in the United States, but it had been tried with Ebola patients and has been used by countries including Argentina and India to treat Covid-19 patients. Dr. Nimmi Rastogi, an adviser to the Delhi government, notes that “it doesn’t require fancy equipment and is a cost-effective treatment.” She adds that although it’s not always effective, the risk of serious side effects is low.
Developing countries also have some advantages in new product development, such as lower costs, significant talent pools, large patient populations, and fewer regulatory barriers to innovation. In countries including South Africa, local organizations have rushed to produce ultra-low-cost ventilators to meet Covid-19 needs. India’s InnAccel has developed an FDA-approved device to reduce ventilator-associated pneumonia that is also safer for caregivers and a helmet-based noninvasive oxygen therapy for which it has sought FDA emergency-use authorization. Similarly, U.S. efforts to develop rapid tests for Covid-19 are being complemented by projects overseas. The Institute of Genomics and Integrative Biology in New Delhi has developed a highly reliable paper-based Covid-19 test that can provide results in an hour and costs less than U.S. $7 per use. Paul Davis, who invented the home pregnancy test, is involved with the 120-year old L’Institut Pasteur de Dakar in Senegal in developing a Covid-19 rapid-test that is expected to cost a dollar per test.
Vaccine development is another important front for international partnership, because countries can benefit by collaborating in the research, clinical testing, and manufacturing of Covid-19 vaccines at a global scale. Chinese vaccines are being tested in Brazil, Pakistan, and the United Arab Emirates. Russian vaccines will be manufactured in China. The Oxford/AstraZeneca vaccine will be bulk-produced in India — and so on. Yet Russia and the United States are not part of COVAX, the 184-nation alliance that aims to produce and distribute vaccines quickly and equitably, and China joined only this month. Vaccine nationalism, the head of the WHO warns, “will not end the crisis but perpetuate it.”
The Promise of Crowdsourcing
Given the high stakes, the nations of the world must cooperate to fight Covid-19. The United States must turn outward, not inward, and embrace ideas from everywhere, including developing countries. Our center’s Covid-19 website is a small step in that direction. Looking beyond Covid-19, the same innovation crowdsourcing approach could help improve U.S. health care generally. When faced with a health care problem, U.S. providers tend to go for expensive, high-tech solutions. But crowdsourcing ideas from developing nations could point us toward simple, low-tech, inexpensive solutions that might be just what the doctor ordered.
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Global Crowdsourcing Can Help the U.S. Beat the Pandemic
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