Ebook: Internet-Based Intelligence in Public Health Emergencies

“Intelligence” results from the evaluation and analysis of collected information. Pragmatically it represents informed, targeted and actionable knowledge, capable of grounding prediction of a probable future. Intelligence can also be described – in ideal terms – as capable of grounding “foreknowledge”. In this latter guise it is less a ground of prediction than of precognition. The present chapter examines these notions of intelligence and proposes two explanatory models: the “Laplacian” model and the “Practical Wisdom” model. Using these models, the chapter analyses “Internet-based intelligence”, which is attaining an increasingly high profile among producers and consumers of intelligence. The variety and volume of Internet-based and open-source information, coupled with increasingly powerful automated analysis techniques, could seem to suggest the possibility that we are moving towards the Laplacian model of intelligence as a ground of foreknowledge. This chapter demonstrates that this cannot be the case – for both practical and theoretical reasons.

The threat of infectious diseases and pathogenic agents appearing among a population is nothing revolutionary and has appeared countless times throughout world history. This Chapter examines the intersection of public health, intelligence and national security, and raises the issue that, unlike in the past, public health should be considered a national security priority and, as such, is deserving of similar priorities and resources. In addition, many of the tools developed to support the field of “intelligence” can be used in the public health arena, and vice versa. The emerging pathogenic threat is not becoming greater so much as society is becoming more vulnerable through ever-increasing technological advances in global travel and continued urbanization; this provides a mechanism for the rapid dissemination of disease across normal population barriers. This threat is compounded by the lack of effective bio-surveillance, threat detection, and multinational mitigation capabilities. The argument concludes that the public health, national security, and intelligence communities must cooperate and that “we,” as a security community, have yet to realize the possibilities, or opportunities, that exist currently in leveraging technological advantages, such as the Internet, and information processes to further our preparedness, prevention, and responsive capabilities.

The latter half of the 20^th century saw a major shift in disease surveillance strategies from reliance upon manually prepared forms sent up the health services pyramid using snail mail to a high tech approach using computer technology and the internet, both for transmission of information between reporting units and as a non-traditional source of information about unusual health events occurring in the community. This chapter walks the reader through the history of the transition from a manually driven disease surveillance paper trail to the digital disease detection era, where the world is wired and wireless, and diseases and information on diseases are travelling at speeds not seen before.

Pandemics occurred worldwide from at least 15.000 years, when a first organized human settlement was created in the Arabic peninsula. From then, systematically, epidemics have occurred periodically intensively shaping human behaviors, but also keeping moderate the population growth. Influenza viruses have been, and still today are, main protagonists of the pandemic recurrence. From thousand years up to day, seasonal flu epidemics have occurred each year all over the world. In a much longer interval completely new influenza viruses provoked massive pandemics leading to millions of deaths. Outbreak communication problems have always been an epidemic side effect: health authorities found themselves inadequate to effectively drive the population behaviors through the correct lines. The last Pandemic flu, 2009-10, also suffered intensively of communication problems, even in the actual era of fast real time communication. But the new web social networks sprouted all around the globe producing massive communication, thousand times more frequent than the Institutional communication. However this did not lead to a coordinated population action to better cope with the epidemic, but more to a wide information chaos that did not help the battle against the virus.

The new media revolution of the last decades, and especially the last few years, has changed the media arena beyond recognition. The access of much of the world's population to digital channels has made the Internet a most important social space. The question I would like to explore in this Chapter is whether the unique character of health crises, namely extreme conditions of stress and uncertainty, makes the Internet and social networks optimal platforms for the health establishment to convey information and directives to the public. The assumption is that during a health crisis many new people join e-patient to check the credibility of the official health establishment's information. In this article I will explore, first of all, how to overcome the gap between the “conservative” establishment world and the dynamic and changing digital world, to try to build an attractive and effective establishment website that can reach diverse populations during a crisis. I will propose the use of multidisciplinary models and approaches: social marketing, risk communication, rhetoric and interactive technologies, to create effective persuasion strategies using the new media. This article reaches a number of main conclusions: the world of the new media presents us with diverse and excellent possibilities for effective communication with the public during crises and emergencies. In order to reach the public, it is important to create a “transparent” website with dialogic and inclusive profiles for various subpopulations, while creating a broad forum of public representatives to help develop online messages during crises. It is important to use inclusive approaches and dynamic strategies of persuasion to build an establishment website, in order to position it in public opinion as a credible, friendly and attractive source of information.

This Chapter is about the use of the Internet and the Web 2.0 media in Italy for the professional and public response to the A/H1N1 virus pandemic. In first place we analyse the role of different surveillance tools, such as the periodic survey Passi or the network of “sentinel” doctors Influnet. All the data collected were immediately communicated to Italian and international professionals and decision makers with existing canals, as the website EpiCentro, or with on line media created on purpose, as the weekly report Flunews. Then we consider the on line formation of doctors and other professionals, implemented specifically for the pandemic emergency, with the course FluFad. Finally, we analyse how the public opinion evolved during the crisis in Italy, with particular attention to the new importance of the Web 2.0 media.

The Chapter examines latest messages on 2011 influenza epidemics in Serbia that were found on 10 February 2011 on the websites of 24 Serbian Public Health Institutes. It adopts four of the STARCC criteria of the Center for Disease Control and Prevention: simplicity, timeliness, relevance and consistency. The variables used for the comparison of messages on influenza epidemics are: word count, the percentage of less known foreign words, last update and the percentage of words on preventive measures. Near half of the analyzed websites (11) had no information on influenza in previous 12 months. High variation coefficients of the investigated variables indicate a low consistency in internet based health communication within the network of Serbian public health institutions. Centralization and coordination in internet public health informing in Serbia is needed, as an effective preparatory measure for pandemics.

The Chapter considers the main threats to information security in health care. The protection of the electronic health information from unauthorized access, use, disclosure, disruption, modification or destruction is discussed. The key concepts examined are: confidentiality – electronic health information must be preserved by authorized restrictions on access and disclosure, not making available or disclosed to unauthorized persons and processes; integrity – electronic health information must be guarded by improper modification or destruction; availability – electronic health information must be accessible and usable upon demand by an authorized person or process. Real life examples are discussed. The information threat scheme and protection mechanisms are represented.

The health, safety, and resilience of internally displaced populations in a disaster or public health emergency can be enhanced by the creation and promotion of a standardized personal health information system, which contains essential data elements necessary for healthcare providers, and local, tribal, and state health departments to identify individuals, meet their immediate health needs, better access critical data, and better obtain surveillance and situational awareness, thereby minimizing morbidity and mortality in at-risk populations. A primary goal is to move the dissemination and utilization of an enhanced personal health information instrument from the clinician-patient model to a population-based model to enable the deployment of the instrument across state-lines, especially for those most vulnerable and at greatest risk in a disaster or public health emergency.

This Chapter examines the controversy within the World Health Organization to establish a Framework for Pandemic Influenza Preparedness. The controversy was over what benefits those who contributed samples could expect in return, in particular in terms of access to pandemic vaccines. Agreement was reached in 2011, although the underlying controversial issues remain unresolved.