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An explainer on digital therapeutics and their relevance to ending the pandemic.
Just months ago, few knew that SARS-COV-2 existed, and now the virus has spread globally to almost every country, infecting nearly 5.5 million people and causing more than 345,000 deaths. Not only has COVID-19 exposed the fragilities of healthcare systems in dealing with infectious diseases, but it has also revealed the vulnerabilities of human behavior during times of crisis.
As scientists endeavor to build new biological vaccines for COVID-19, there is increasing recognition that societies must look beyond biological methods alone, and include digital interventions called “digital therapeutics,” in order to change human behavior and build societal resilience.
In order to successfully combat the virus, we must complement biological vaccines with digital vaccines, a subcategory of digital therapeutics, to inform and educate the population and reinforce behavior related to health hygiene best practices.
Digital vaccines are envisioned as evidence-based prevention approaches that are delivered via smart phones and tablets for nudging positive behavior. They are gamified, digital interventions that draw on principles of neuroscience, psychology, Artificial Intelligence (AI) and behavioral economics to provide safe and low risk mechanisms for influencing significant behavior change. The goal is to provide fun, immersive and motivational features within a mobile app to encourage non-addictive, interactive, game-playing experiences and induce desired changes in behaviors. This idea of digital health technologies is supported by the U.S. Food and Drug Administration:
“In the context of the COVID-19 public health emergency, the use of digital health technologies…has the potential to facilitate social distancing by reducing patient contact with, and proximity to, health care providers, and can ease the burden on hospitals, other health care facilities and health care professionals that are experiencing increased demand due to the COVID-19 public health emergency.”
Digital vaccines can leverageproven neurocognitive training to change behaviors, reach a broad audience, and be deployed widely, quickly and updated frequently.
Using these training methods and mobile technologies, digital vaccines are showing promising evidence of changing behavior in pilot randomized controlled studies. Highly interactive video games with animation activities train the brain to improve processing, understanding and memory by stimulating both the neurological functioning and the cognitive ability of individuals.
Digital vaccines that are enabled via gamified, mobile applications can be culturally sensitive and customizable to specific regions and contexts. They can entail deep levels of personalization to ensure that vaccines meet the requirements of target audiences from all geographical, social and cultural realms. For example, to develop a COVID-19 digital vaccine that promotes hand-hygiene in a specific region in India, researchers are examining the sociological, environmental and regional norms to adapt an existing game for hand-hygiene literacy to include local preferences, which may include instructions in the regional language, game avatars resembling local appearances, recognizable icons in the game interfaces, and so on.
This technology would allow rapid deployment of the digital vaccine, which can learn and adapt based on live and forecasted data. In the case of a rapidly changing virus, we need to approach containment and immunization with agility and precision that exceeds the vectors of infection. AI-driven approaches provide a system of automated learning frameworks, moderated through human intervention and feedback loops, that can stay ahead of an epidemic – and be based on data.
A pediatric digital vaccine using a gamified learning platform to improve dietary choices, physical activity and nutrition literacy has already shown promise in multiple clinical trials. It is currently being evaluated for managing chronic disease-related risks in children via a large-scale randomized experiment.
Adapting and re-purposing this platform for containment of infectious diseases could lead to a digital vaccine candidate for the COVID-19 pandemic that will need to subsequently undergo extensive evaluation.
We are currently in the process of adapting and scaling an existing digital vaccine, conducting randomized field trials and ongoing research and development to gather and analyze evidence of positive behavioral and physiological outcomes. We are working to design, implement and deploy the technology at scale within populations that are at high risk. The key outcomes will be tracking incidence of COVID-19, time factors and transmission rates as well as uptake of health-hygiene practices.
If the trial is successful, this evidence-based digital vaccine candidate for infectious diseases could be made available for global adoption to help alleviate health challenges caused not only by COVID-19 but also address future infectious diseases to come.
Rema Padman is Trustees Professor of Management Science and Healthcare Informatics in the Heinz College of Information Systems and Public Policy at Carnegie Mellon University in Pittsburgh. She is also Thrust Leader of Healthcare Informatics Research at iLab and Research Area Director for Operations and Informatics at the Center for Health Analytics at the Heinz College, and Adjunct Professor in the Department of Biomedical Informatics at the University of Pittsburgh School of Medicine.