This section describes two novel tendencies revealed by the above distinctions: the influx of novel actors that accompany and drive the use of new technologies in pandemic response, and the tendency of new technologies to compound previously distinct activities and workflows within single platforms or single institutional operations.
Influx of novel actors
New informatics introduce a host of actors and intermediaries not traditionally included in pandemic response and coordination. The ways in which this influx interacts with traditional structures for pandemic response can be considered according to a sandwich model, in which interaction is introduced from above and from below. The bottom slice of the sandwich in this metaphor is interaction with affected populations, where novel informatics present at least two types of challenges.
Firstly, social media and big data introduce promising new sources of information on which to base decision-making in pandemic response, but for whose meaningful use humanitarian organizations tend to lack the institutional and technical capacity, and national authorities even more so (Harvard Humanitarian Initiative 2011; Odugleh-Kolev 2014; Smith 2015; Read et al. 2016). Simultaneously, the participatory ethos of new technology encourages humanitarian organizations and government authorities alike to deliberately engage affected communities in the design, implementation and evaluation of humanitarian response (Kaiser 2000; Maxwell et al. 2011; Gillman 2014; Özdamar and Ertem 2015), yet poses a number of non-trivial hurdles to meaningful engagement. Here too, technical capacities tend to be weakest with national governments, necessitating partnership with international organizations to invest in participatory interventions. Infrastructural requirements and issues of access and representativity can also frustrate intentions to utilize participatory technologies. In a humanitarian context, political realities can often be the most meaningful obstacle, even when all issues of capacity, infrastructure, and access are surmountable. For all these reasons, national authorities are rarely in a position to unilaterally dictate the ways in which new technologies are leveraged to interact with affected populations.
Informatic challenges at the top end of the sandwich arise from the (sometimes unsolicited) engagement from novel international actors. Of particular note are V&TCs and digitally native civil society organizations that are small, nimble, and eager to disrupt established practice. These actors present fundamental challenges to humanitarian coordination by their very engagement. Because they do not fit neatly into traditional humanitarian coordination mechanisms, yet tend to demand attention and heighten expectations, novel international actors at the top level of pandemic informatics are a powerful force for asserting knowledge politics in informatics of response. The information flows described by Fast and Waugaman illustrate not only information exchanges in this sense, but fundamental assertions and negotiations about what kind of information is relevant and where and by whom those decisions are made. The moments at which this happens are not regulated by traditional policies of humanitarian coordination or cluster mechanisms, but occur in the practical application of technologies to knowledge and information, what some scholars have termed moments of closure in humanitarian knowledge politics (Burns 2014).
In some instances, international informatics are efficiently structured to serve national authorities. The introduction of data and information clearing houses presents opportunities for national authorities to assert control of national agendas, for example, such as when the Humanitarian Data Exchange enabled Guinean ministries to track training of infection prevention and control training efforts in the country (Fast and Waugaman 2016: 90). This dynamic appears exceptional in a chaotic response environment marked by a “myriad of actors with no clear role or leadership” (Harman and Wenham 2018: 10), however. A pandemic response context where “many of the information collection systems that organizations set up during the response were not linked to national systems or national capacity” (56) necessarily reinforces the capacity and agency of international actors, and often novel actors, at the expense of national authorities’ influence over response processes.
It is also worth noting informatics practices that transcend this two-level model. Most clearly in opposition to the agency of national authorities is the introduction of “hidden actors”, such as application developers, producers of hardware or network managers with de facto influence over humanitarian data during its collection and processing (see Gillman 2014: 7). Equally notable are instances in which international actors bypass engagement with the traditional response environment altogether. In some instances, this appears to occur exclusively at the international register, with little or no contact with any in-country actors. Examples include international networks of scientists collaborating to improve diagnostic tools (Eclipse 2017), or hackathons organized in foreign capitals to develop data models or applications for implementation in pandemic response (Sangokoya 2014; Gordon 2016; Lodato and Di Salvo 2016). Such initiatives raise serious questions about opportunity cost and efficient use of resources.
To summarize, digital communication technologies and information flows introduce a host of novel actors to pandemic response. Traditional humanitarian actors may experience this at the top level through the novel engagement of international actors, or at the bottom level through pressure to engage with affected populations and their data. In each instance, the influx of novel actors carries a risk for decision-making authority and agency to be moved into novel fora, further outside the influence of national authorities.
This may not occur in an absolute sense; indeed, the role of national governments in driving Ebola response strategies has been significant (DuBois et al. 2015: 21). Yet the potential for exclusion merits careful consideration, particularly given the already pronounced tendency for agency of national authorities to be limited by the militarization of humanitarian response (Sandvik 2015) and the increasing prominence of international NGOs in public health service provision (Prince 2014). Such dynamics are particularly vulnerable in the contexts of pandemic and crisis response, and reviews of the Ebola response have also noted how decision-makers’ identities shape response strategies (DuBois et al. 2015: 27).
The application of digital technologies has undoubtedly opened up a host of opportunities for decision-making by novel actors. This may occur in situations where national authorities enjoy a limited role, such as the network communications of global watchdog networks in which NGOs, scientific communities, international health networks and government agencies contribute to multiple digital communications streams and daily webinars to coordinate disease surveillance and response (Ramalingam 2015: 11–13). It may also occur in digital for where there is no direct participation by national authorities, or in situations where national authorities lack the basic technical capacities to engage in a natural coordinating role, such as when “a host of academics, private philanthropists and technology companies” lobbied telecom companies for access to call detail records in order to develop their own response strategies (Sandvik et al. 2017: 16).
Though there are some cases in which novel actors and information practices support a stronger role for national authorities in pandemic response and a greater capacity to exercise agency and decision-making in the design and implementation of that response (Ramalingam 2015: 10-14; Fast and Waugaman 2016: 63-66), but this appears rare and the conditions under which it occurs are unclear. The overwhelming picture is one in which technologically driven informatics exacerbate coordination challenges (Kim 2014), driving the enactment of knowledge politics outside formal structures of humanitarian clusters and beyond the influence of national authorities.
Though the boundaries between diagnostic activities, risk communication, and response coordination were perhaps never entirely clear, these areas have traditionally been institutionally and procedurally distinct. Digital communications’ affordances and functionalities make it increasingly possible to combine activities from these areas in single processes.
This recalls theories of technological convergence, in which the increasing capacity of media tools to integrate multiple functionalities corresponds with broader shifts in markets and genres (Kim 2014). As described by Henry Jenkins (Huerta and Tsimring 2002):
Our cell phones are not simply telecommunications devices; they also allow us to play games, download information from the internet and receive and send photographs or text messages. Any of these functions can also be performed through other media appliances. One can listen to The Dixie Chicks through a DVD player, car radio, walkman, computer MP3 files, a web radio station or a music cable channel. Fueling this technological convergence is a shift in patterns of media ownership. Whereas old Hollywood focused on cinema, the new media conglomerates have controlling interests across the entire entertainment industry (34).
A detailed exploration of how these dynamic maps onto humanitarian technology exceeds the scope of this article, but we feel justified in arguing that there are at least two comparable dynamics. First, we will use the term digital convergence to refer to the ways in which technology enables a concentration of diverse tasks in single platforms and workflows (the same platform conducting a range of tasks). Second, the examples cited in this article consistently exemplify how this type of convergence is coincident with what we term operational convergence, whereby specific types of information and communication management tasks are distributed across novel institutional and organizational groups of actors (same tasks conducted by a range of actors). Below, we briefly describe four examples that demonstrate how this can occur in pandemic response. These examples are not explored in depth, but are meant to illustrate the consistent interplay of convergence with digital media and the injection of novel actors across a variety of humanitarian settings.
The first example is what Ramalingam terms “watchdog and knowledge networks” (2015), understood as networks involved in the “early detection of disease, characterization of the disease, and subsequent reporting and communication directed to decision makers in governments, international bodies and other key audiences” (ibid 9–10). Especially instructive is Ramalingam’s analysis of GOARN, the Global Outbreak Alert and Response Network. As an “operational arm” of the WHO and network of networks that together surveil the outbreak and spread of infectious diseases, GOARN functions as a de facto coordination mechanism for international and national actors engaged in pandemic response. The scope of GOARN’s activity in this regard is impressive, having responded to over 100 outbreaks in over 50 countries between 2000 and 2015, and the network has played a crucial role in the SARS outbreak in 2003 and the avian influenza outbreaks of 2004. Notably, the efficiency and scope of GOARN’s activities is explicitly attributed to the fact that coordination and information exchange occur
across a diverse digital infrastructure that supports text messaging, email, and web-based applications, all of which are employed in tandem to ensure the right knowledge and information get to where they are needed at the right time, and importantly, allows a two-way exchange of information across the network (11).
Notably, the diverse communications between national authorities, WHO staff, NGOs, and scientific institutions are consolidated in a coherent institutional framework and through weekly webinars. This process interoperates diagnostic and coordination, feeding them directly into the establishment of response protocols, including protocols for risk communication, which are in many instances executed by the same actors that provided diagnostic information, by virtue of their capacity for rapid, two-way communication with populations.
Though it is unclear the degree to which this operational convergence of such tasks diminishes the agency of national authorities in a general sense, it is reasonable to expect that the inclusion of multiple actors decreases governments’ scope for top down control. This may often be for the better in terms of effective response, as is likely the case with SARS in 2013, when GOARN’s access to digital communications platforms facilitated the supply on non-governmental diagnostic information, which likely contributed to acknowledgement of the outbreak by the Chinese government.
Assisted Contact Tracing provides a second example. Contact tracing is the epidemiological practice of identifying the individuals who have come into contact with infected individuals, in order to map the spread of a disease (Huerta and Tsimring 2002). In 2014, a private company named Odisi developed a platform for “Assisted Contact Tracing” (ACT), which digitized this process through the use of Integrated Voice Recognition Software. Individuals in Ebola-affected communities were able to report their contacts using mobile phones and then received follow-up messages regarding care and updates on the Ebola response. This digitized approach increased the efficiency of data collection by eliminating the need for human interviewers, and also allowed the integration of other types of data (paper and mobile data), which increased the platform’s diagnostic capacity dramatically. Though the platform was designed and implemented as a diagnostic tool, the affordances offered by digital media quickly presented other opportunities. The automated registry of exposed individuals was quickly adapted for risk communication purposes via SMS follow-up messages, and the digitization of rapid analysis of data promptly positioned the ACT platform to play a coordinating role among parallel diagnostic initiatives. Here, we see a clear digital convergence of diagnostic and risk communication activities on a mobile phone platform, at the discretion of a private company.
A third example is offered by U-Report, a free SMS-based polling tool launched in Uganda in 2011 through a civil society partnership in order to monitor the quality of human rights and governance in the country, with a focus on polls related to human rights. In early 2012, platform users noted early signs of the outbreak that would later come to be known as “nodding sickness” and would claim over 3000 lives in the following months. U-report did not have a health mandate and did not solicit these early epidemic reports, but received them because the communication platform was already in place and integrated into the communication habits of users. In this sense, the presence of a digital media infrastructure very much conditioned the implementation of a diagnostic tool, which promptly provided a site for national coordination, as U-Report collaborated with the Ministry of Health and the WHO to develop and implement a 4-stage communications and mobilization plan. Here again we see the digital and operational convergence of diagnostic activities and risk communication activities by national authorities with the support of international organizations. Notably, while national authorities are directly engaged in both sending and receiving content, they do not have direct control of the operational and financial processes that support the initiative.
Fourth and lastly, the Humanitarian Data Exchange (HDX) was established by the UN Office of Coordination for Humanitarian Affairs in 2014, in an effort to improve and coordinate access to humanitarian data. The Ebola Crises Page collected 62 data sets from UN, governmental, civil society, and private sector data sources and invited users to contribute their own data to the site. The page also featured maps and visualizations developed in collaboration with private charitable foundations and private businesses. As such, the site represents a near seamless integration of all the components of pandemic informatics. It directly served the needs of independent diagnostic efforts by providing access to quality humanitarian data; it performed a coordinating function by establishing standards and expectations for the use and production of humanitarian data, and visualizations and graphics created by the community were incorporated into the HDX gallery for download and use in independent risk communication efforts. Here, we see convergence between digitally enabled coordination efforts, deeply rooted in multilateral humanitarian institutions, and the diagnostic processes that they enable. Unlike the examples above, the question of who engages with the HDX and how is not significantly pre-determined. The platform is designed to be open, and to the extent that contributors are invited and approved by OCHA, it is reasonable to expect that it is open to national authorities. To the extent that technological capacity still limits national authorities from engaging with the platform, convergence of diagnostic and coordination activities nonetheless consolidates what we can call informatic discretion outside their spheres of influence.
What is striking about these examples is not necessarily the fact that activities related to different informatic components interact; that has to some degree perhaps always been the case. What is striking is the degree to which they do so automatically, as conditioned by digital media, and within the purview of the actor driving the technological and informatic innovation. This is almost never national authorities, due to capacity issues described above. To the extent that reliance on technology and the introduction of novel actors drive informatic discretion beyond the influence of national authorities, this phenomenon is likely to be exacerbated by instances of technological and operational convergence.