WHO and ECDC launch indicator framework to evaluate the public health effectiveness of digital proximity tracing solutions
WHO issues first global report on Artificial Intelligence (AI) in health and six guiding principles for its design and use
Artificial Intelligence (AI) holds great promise for improving the delivery of healthcare and medicine worldwide, but only if ethics and human rights are put at the heart of its design, deployment, and use, according to new WHO guidance published today.
The report, Ethics and governance of artificial intelligence for health, is the result of 2 years of consultations held by a panel of international experts appointed by WHO.
“Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology it can also be misused and cause harm,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This important new report provides a valuable guide for countries on how to maximize the benefits of AI, while minimizing its risks and avoiding its pitfalls.”
Artificial intelligence can be, and in some wealthy countries is already being used to improve the speed and accuracy of diagnosis and screening for diseases; to assist with clinical care; strengthen health research and drug development, and support diverse public health interventions, such as disease surveillance, outbreak response, and health systems management.
AI could also empower patients to take greater control of their own health care and better understand their evolving needs. It could also enable resource-poor countries and rural communities, where patients often have restricted access to health-care workers or medical professionals, to bridge gaps in access to health services.
However, WHO’s new report cautions against overestimating the benefits of AI for health, especially when this occurs at the expense of core investments and strategies required to achieve universal health coverage.
It also points out that opportunities are linked to challenges and risks, including unethical collection and use of health data; biases encoded in algorithms, and risks of AI to patient safety, cybersecurity, and the environment.
For example, while private and public sector investment in the development and deployment of AI is critical, the unregulated use of AI could subordinate the rights and interests of patients and communities to the powerful commercial interests of technology companies or the interests of governments in surveillance and social control.
The report also emphasizes that systems trained primarily on data collected from individuals in high-income countries may not perform well for individuals in low- and middle-income settings.
AI systems should therefore be carefully designed to reflect the diversity of socio-economic and health-care settings. They should be accompanied by training in digital skills, community engagement and awareness-raising, especially for millions of healthcare workers who will require digital literacy or retraining if their roles and functions are automated, and who must contend with machines that could challenge the decision-making and autonomy of providers and patients.
Ultimately, guided by existing laws and human rights obligations, and new laws and policies that enshrine ethical principles, governments, providers, and designers must work together to address ethics and human rights concerns at every stage of an AI technology’s design, development, and deployment.
Six principles to ensure AI works for the public interest in all countries
To limit the risks and maximize the opportunities intrinsic to the use of AI for health, WHO provides the following principles as the basis for AI regulation and governance:
Protecting human autonomy: In the context of health care, this means that humans should remain in control of health-care systems and medical decisions; privacy and confidentiality should be protected, and patients must give valid informed consent through appropriate legal frameworks for data protection.
Promoting human well-being and safety and the public interest. The designers of AI technologies should satisfy regulatory requirements for safety, accuracy and efficacy for well-defined use cases or indications. Measures of quality control in practice and quality improvement in the use of AI must be available.
Ensuring transparency, explainability and intelligibility. Transparency requires that sufficient information be published or documented before the design or deployment of an AI technology. Such information must be easily accessible and facilitate meaningful public consultation and debate on how the technology is designed and how it should or should not be used.
Fostering responsibility and accountability. Although AI technologies perform specific tasks, it is the responsibility of stakeholders to ensure that they are used under appropriate conditions and by appropriately trained people. Effective mechanisms should be available for questioning and for redress for individuals and groups that are adversely affected by decisions based on algorithms.
Ensuring inclusiveness and equity. Inclusiveness requires that AI for health be designed to encourage the widest possible equitable use and access, irrespective of age, sex, gender, income, race, ethnicity, sexual orientation, ability or other characteristics protected under human rights codes.
Promoting AI that is responsive and sustainable. Designers, developers and users should continuously and transparently assess AI applications during actual use to determine whether AI responds adequately and appropriately to expectations and requirements. AI systems should also be designed to minimize their environmental consequences and increase energy efficiency. Governments and companies should address anticipated disruptions in the workplace, including training for health-care workers to adapt to the use of AI systems, and potential job losses due to use of automated systems.
These principles will guide future WHO work to support efforts to ensure that the full potential of AI for healthcare and public health will be used for the benefits of all.
At Local Production Forum, WHO and partners highlight key steps to improve access to health technologies
The first WHO World Local Production Forum ended today after five days of discussions centered on promoting quality and sustainable local production to improve access to medicines and other health technologies.
- Delegates from over 100 countries, international partners, civil society groups, industry associations, and major investors joined WHO, WTO, UNIDO, UNICEF and UNCTAD to highlight the challenges facing local production and the steps required to address them, as well as the range of opportunities for the sector.
Looking ahead, the Forum will provide a platform to drive forward efforts to support and enhance local production of health products in low- and middle-income countries.Forum conclusions, recommendations and next steps
Increasing manufacturing capacity for global security - The COVID-19 pandemic has highlighted the importance of local manufacturing as a key component of pandemic response by reducing reliance on global markets and imported products.
Vaccine production was a central theme at the Forum, as were the role of new technologies and generation of flexible manufacturing strategies to develop sustained production capacity in low- and middle-income countries.
Technology transfer and licensing were seen as key to scaling up production. Sharing intellectual property and know-how will be essential, along with facilitation of voluntary licensing and effective technology transfer. It will also be vital to create a favourable environment for technology transfer. Key elements will include good governance; a skilled workforce; good access to market information and careful assessment of local capacity to receive and absorb the transferred technology.
Governments’ role is key in creating an enabling political environment and a supportive business eco-system. Such efforts must be coordinated with relevant stakeholders at national, regional and global levels.
National regulators and local manufacturers can drive quality-compliant local production and facilitate faster access to health technologies during pandemics and beyond. To do that, they need continued training, support and resources.
Low access to capital is a key limiting factor for local manufacturers in low- and middle-income countries. The greater interest expressed by key development banks and other financial institutions towards investing in the sector indicates improvement in this area, whilst the need to develop strong investment cases, including demonstration of a long term economically viable business case, were highlighted as key components of successful manufacturing projects.
A mechanism to stimulate industry engagement was recommended for strengthened collaboration with and among industry bodies with the aim of transferring priority technologies to low- and middle-income countries.
A strategic advisory group should be established by WHO in collaboration with Member States and partners to address current and future global challenges and trends in local production and technology transfer.
The next Forum will be held in The Netherlands as announced by Deputy Prime Minister and Minister of Health, Welfare and Sport, Hugo De Jonge. The Local Production Forum is now established as a long-term mechanism to promote dialogue and decision-making to strengthen local manufacturing capacity and move towards the shared goal of universal access to health technologies.
Following a 70-year effort, China has been awarded a malaria-free certification from WHO – a notable feat for a country that reported 30 million cases of the disease annually in the 1940s.
“Today we congratulate the people of China on ridding the country of malaria,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Their success was hard-earned and came only after decades of targeted and sustained action. With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal.”
China is the first country in the WHO Western Pacific Region to be awarded a malaria-free certification in more than 3 decades. Other countries in the region that have achieved this status include Australia (1981), Singapore (1982) and Brunei Darussalam (1987).
“Congratulations to China on eliminating malaria,” said Dr Takeshi Kasai, Regional Director, WHO Western Pacific Regional Office. “China’s tireless effort to achieve this important milestone demonstrates how strong political commitment and strengthening national health systems can result in eliminating a disease that once was a major public health problem. China’s achievement takes us one step closer towards the vision of a malaria-free Western Pacific Region.”
Globally, 40 countries and territories have been granted a malaria-free certification from WHO – including, most recently, El Salvador (2021), Algeria (2019), Argentina (2019), Paraguay (2018) and Uzbekistan (2018).China’s elimination journey
Beginning in the 1950s, health authorities in China worked to locate and stop the spread of malaria by providing preventive antimalarial medicines for people at risk of the disease as well as treatment for those who had fallen ill. The country also made a major effort to reduce mosquito breeding grounds and stepped up the use of insecticide spraying in homes in some areas.
In 1967, the Chinese Government launched the “523 Project” – a nation-wide research programme aimed at finding new treatments for malaria. This effort, involving more than 500 scientists from 60 institutions, led to the discovery in the 1970s of artemisinin – the core compound of artemisinin-based combination therapies (ACTs), the most effective antimalarial drugs available today.
“Over many decades, China’s ability to think outside the box served the country well in its own response to malaria, and also had a significant ripple effect globally,” notes Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “The Government and its people were always searching for new and innovative ways to accelerate the pace of progress towards elimination.”
In the 1980s, China was one of the first countries in the world to extensively test the use of insecticide-treated nets (ITNs) for the prevention of malaria, well before nets were recommended by WHO for malaria control. By 1988, more than 2.4 million nets had been distributed nation-wide. The use of such nets led to substantial reductions in malaria incidence in the areas where they were deployed.
By the end of 1990, the number of malaria cases in China had plummeted to 117 000, and deaths were reduced by 95%. With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, beginning in 2003, China stepped up training, staffing, laboratory equipment, medicines and mosquito control, an effort that led to a further reduction in cases; within 10 years, the number of cases had fallen to about 5000 annually.
In 2020, after reporting 4 consecutive years of zero indigenous cases, China applied for an official WHO certification of malaria elimination. Members of the independent Malaria Elimination Certification Panel travelled to China in May 2021 to verify
the country’s malaria-free status as well as its programme to prevent re-establishment of the disease.
China provides a basic public health service package for its residents free of charge. As part of this package, all people in China have access to affordable services for the diagnosis and treatment of malaria, regardless of legal or financial status.
Effective multi-sector collaboration was also key to success. In 2010, 13 ministries in China – including those representing health, education, finance, research and science, development, public security, the army, police, commerce, industry and information technology, customs, media and tourism – joined forces to end malaria nationwide.
In recent years, the country further reduced its malaria caseload through a strict adherence to the timelines of the “1-3-7” strategy. The “1” signifies the one-day deadline for health facilities to report a malaria diagnosis; by the end of day 3, health authorities are required to confirm a case and determine the risk of spread; and, within 7 days, appropriate measures must be taken to prevent further spread of the disease.Keeping malaria at bay
The risk of imported cases of malaria remains a key concern, particularly in southern Yunnan Province, which borders 3 malaria-endemic countries: Lao People’s Democratic Republic, Myanmar and Viet Nam. China also faces the challenge of imported cases among Chinese nationals returning from sub-Saharan Africa and other malaria-endemic regions.
To prevent re-establishment of the disease, the country has stepped up its malaria surveillance in at-risk zones and has engaged actively in regional malaria control initiatives. Throughout the COVID-19 pandemic, China has maintained trainings for health providers through an online platform and held virtual meetings for the exchange of information on malaria case investigations, among other topics.
-----------------------------------------------------------------------Note to the editorWHO malaria-free certification
Certification of malaria elimination is the official recognition by WHO of a country’s malaria-free status. WHO grants the certification when a country has demonstrated –with rigorous, credible evidence – that the chain of indigenous malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least the past three consecutive years. A country must also demonstrate the capacity to prevent the re-establishment of transmission.
The final decision on awarding a malaria-free certification rests with the WHO Director-General, based on a recommendation by the independent Malaria Elimination Certification Panel (MECP). For more on WHO’s malaria-free certification process, visit this link.Virtual forum: “From 30 million cases to zero: China creates a malaria-free future”
On 2 July, representatives from China’s National Health Commission and frontline health workers will join malaria programme managers from other regions, WHO experts and global partners in a virtual forum to share reflections and perspectives on China’s malaria elimination journey. Discussions will be in English with simultaneous interpretation provided in Chinese, French and Spanish. To register for the webinar, visit this link.