As I write this, we are now just over three months into the COVID-19 pandemic which has changed everyone’s lives significantly. While lockdown conditions are starting to ease, there is now talk of a second wave in many countries. With a vaccine is still a few months away it seems at the earliest, one of the intriguing questions to come out of this human tragedy is the future for space-based healthcare, and how the healthcare and space sectors can potentially work together. In a major departure from our usual features, we talk exclusively to a number of healthcare professionals about all things space, satellite, and healthcare.
Dr. Beth Healey has worked in Geneva and the United Kingdom, and has also worked in Antarctica at Concordia Station, a French-Italian base, as a research MD. She has worked for the European Space Agency (ESA), researching the effects of physical and psychological isolation on a group of people. I talked to her at the height of the pandemic in the U.K. as she was working in the intensive care unit in a hospital in Bath in the UK, dealing with the impact of COVID-19.
Healey’s insights into how satellite might be used in the future are fascinating, and she believes things have changed forever as a result of the pandemic. Healey believes space tech will become a fundamental part of healthcare systems going forward.
“[Satellite] was a technology that was coming. There was always an emphasis to use satellite technology, and now that we have been using it, I would be very surprised if we don’t continue too, as it has been really useful. It allows that communication between different countries and healthcare systems. But, also within hospital community, it allows teaching and learning a lot more accessible. Satellite technology is a lot more practical for telemedicine. It is important to have mix. You still need face to face, but also it provides a really useful technology that will continue to be used as we put the infrastructure in place,” she says.
Healey calls satellite a really exciting technology for developing healthcare systems, where the access isn’t there. She believes satellite and space technology will help equalize access to health care. “It will stop people from delaying and seeking medical advice. I think we have all been guilty of having busy lives and not being able to go to the doctor. By making more healthcare more accessible and easier to access, this will help. I think it is less stressful having a teleconsultation,” she says.
Satellite technology is also vital to track the spread of infection. “If you look at the John Hopkins map, it was interesting to see where the virus was and correlating the risk to the area you were working in. Especially in Switzerland, our criteria for swabbing and doing the tests was based on where people had been travelling. By looking at that map, you were able to have a real-time update on how the disease was progressing and what populations could be at increased risk. You could see that progression of how the disease was developing,” Healey says.
Healey shares a practical example of satellite and healthcare working closely together, the GoodSAM App, developed by Mark Wilson, a consultant neurosurgeon and a professor at Imperial College London. Healey describes the app, which connects people in cardiac arrest with nearby healthcare workers, like an Uber for healthcare.
“As a healthcare professional, I have signed up for this, and if someone next door was having a cardiac arrest, I could be notified through the app, and come and help until an ambulance. It can also tell you where the nearest defibrillator is,” she says. “Now, they are starting to do video calls between the ambulance and people doing CPR. So, they can look at a relative and they can put a smartphone on their chest and sensors in a smartphone can work out how people are breathing.”
The app is even looking into drones with defibrillators. Healey says administering CPR quickly is key for a positive neurological outcome, and this app which is a direct satellite application wil improve cardiac outcomes. “People like Mark are trying to develop that dialogue between the satellite industry and medicine and see what we can do with satellite to improve patient care,” she says.
Healey is also part of a working group at the United Nations that was doing predictive modelling of Malaria. She points to the fact that the European Commission developed an online tool to show the surface water of all of these different countries with satellite technology. “Someone used satellite technology to look at the climate, in terms of heat and conditions. So, they looked at it together, and know how much water there is, and how much water there is going to be, and what the temperatures are, we can try and predict where the mosquitoes are and where they will infect people with malaria, and then we can work out where to put medical centers. So, you can predict where the likely outbreaks will be as a result of these climate prediction modelling. So, surveillance through satellite technology could really make a difference here.”
New healthcare structures will emerge as a result of the pandemic, and the way we liaise with medical professionals will likely change. Healey thinks the use of Artificial Intelligence (AI) and satellite technology is going to explode within the healthcare sector, and she believes there are so many ways it can be used.
“We already know of some ways it can be used but it didn’t have the funding, or even the dialogue between the satellite industry and healthcare to implement those changes. I think coronavirus has bought an awareness of what can be done and I think it will bring an emphasis to it. Often, you will see healthcare improve after a war or a big event. We have seen a development of our medical systems in a positive way and the majority of that has been through satellite applications,” she says.
Healey gives the example of digital passports. As a doctor in the accident and emergency department, she is unable to access a patient’s medical notes and medication because of cybersecurity issues, and it would be useful if patients had digital passports with that information on their phones. “I think it is crazy you can’t have access to that information. It is starting to change, so people have that information on their phone. It is still not there. But, something like that in an emergency setting could be really useful,” she says.
Dr. Loubna Bouarfa, CEO of Okra Technologies, founded the company in 2015 with a vision of moving the healthcare industry toward a future of personalized medicine powered by explainable AI. “If you look at the data we use, we look at different sources. For example, if it is about conditions like coughs and colds, you need data about humidity, pollution, movements of people, etc. So, the concentration of population. You need to use this to identify the right treatments for the right people. You need to communicate to countries about this. This is a high level of hierarchy. Getting all that data, whether from satellite, IoT [Internet of Things], or historical communications, and then informing the right stakeholders why they need that treatment. We always start bottom-up. What is the problem and how can we solve it?” she says.
Bouarfa says when you look at the COVID-19 pandemic and satellite, the first level is getting governments and medical professionals data that can answers those questions and manage social distancing, and inform decision-makers on a national or global level what strategies they need to maximize the response.
“The second level is when talking about different maps. You have different territory levels. You need to bridge the communication gap between life science companies, doctors with specialist investigators. You really want to speed up the process of communication. When there is a new drug on the market, a doctor that finished their study 20 years ago, it will be difficult for them to prescribe that. You need to get doctors on board with new treatments and support the evolution of a drug and report its performance. You need to get data on new treatments and how the treatments in rural and urban areas so wherever patients live they can get access to the same treatment. Everybody should be able to get access to new drugs,” she says.
The third level is the patient level, where medical professionals need more remote communication to prescribe the right treatments. “Monitoring technologies need to be more and more available so there can be early detection to help inform the decision. That is another area of telemedicine. We need technology and data to tell us the best treatment. This is what Okra is about. Some of this is environmental data so this could be important, and satellites could help here,” she says.
So, what will the future look like for this technology powered healthcare system? “The big dream is to get to preventative medicine. Something we tried centuries ago, but we went to clinical and specialized medicine. With the increase of chronic diseases, we need to change that. It needs a big change. The pandemic was an earthquake to move there faster. Before we got there, you have the sprint jump. You need to reach a first point before you go to personalized, preventative medicine. This sprint jump is what I call a more strong, responsive ecosystem. We need doctor, regulator, patient acting stronger together and reacting faster. I see the first goal is how we can make that interaction effective and efficient with all the data possible. So, we want to avoid it taking 20 years to get a drug in the market from studies. If there are drugs that can benefit patients, they should be able to get it fast, whether based in rural or urban settings. We need to democratize healthcare. You shouldn’t have to worry if your kids are living in rural areas. It is this move to preventative, personalized medicine,” she says.
Vanessa Candeias is a global health expert and systems thinker, a former head of global health and healthcare, member of the Executive Committee at the World Economic Forum. She is another influencer who is looking at the relationship between satellites and healthcare. She thinks satellite and space-based technology will have important roles to play in advancing public health. She says we have already seen examples how robotics technologies have been adapted from use in space to healthcare. “What we need are bridges and open channels of communication across the two fields so that information can easily flow from one to the other,” she says.
She thinks technologies that use satellite will be in high demand, and uses the example of drone delivery of lifesaving product and solutions. She talks about a company called Zipline that delivers critical and lifesaving products precisely where and when they are needed, safely and reliably. Zipline uses a combination of technologies including 3D satellite mapping to bring for example blood or vaccines to remote areas where their delivery would otherwise take hours or even days. They are an American company operating in Rwanda and Ghana, but Candeias believes their model of delivery and operations could be increasingly used in other countries and when it does start to operate this can have a significant impact in the healthcare supply chain, both for healthcare providers and for individual users.
Candeias is hopeful that we will see more partnerships involving satellite and healthcare going forward. She doesn’t think healthcare systems will be able to find all the solutions for all the problems if they are working in silos or isolation. “We absolutely need collaboration across IT, satellite, communications, AI, robotics, health, consumer, retailers, education, agriculture, etc., and we also need very strong cooperation between public sector and private sector. If businesses and governments are working each one on its own lane without actively seeking to collaborate then solutions that benefit us all as individuals and families using the healthcare systems will be harder to find and harder to scale up at sustainable costs,” she says.
This vision of space and technology-based healthcare is a compelling one. Candeias adds, “My hope is that the ecosystem of players in the health and healthcare space becomes ever more inclusive and works closely with high tech companies as well as companies from several other sectors to always find the solutions that benefit the patient while improving the efficiency and costs in the health delivery system.”
ReaMedica, a company based in Kenya, is looking to use technology to improve the lives of people in Kenya. COVID-19 cases have been increasing rapidly in Africa, and with healthcare systems that don’t necessarily have the financial resources of other parts of the world, dealing with a pandemic becomes even more problematic.
Michael Seo, CEO of ReaMedica says COVID-19 has pushed the acceleration of looking at the space-based health solutions because of physical distancing, and the fact that COVID-19 is highly contagious. He believes this has pushed the interest into telehealth to the forefront of the discussion.
“It is not to say it is easyily implementable. In Africa, the discussion about this type of technology and consultation has been much more prevalent around mental health. In terms of the actual application, it has been around in situations that require complex knowledge. Up to this point, it has been used in surgical training, surgical simulation. That makes sense. In the very complicated, tertiary type of care such as heart surgery, it has predominantly been used in this way. But, now you are seeing it much more used especially in the mental health case as well as basic consultations in terms of primary care. It has pushed the conversation to an accelerated pace,” he says.
The implementation of digital technologies in countries such as Kenya is vital to have effective healthcare across the country. However, there are disconnects. Seo says when you talk about a reset in healthcare, you can’t avoid a proper use of technology in your plan. There are some interesting challenges.
“Kenya is considered one of the more digitally connected countries [in Africa]. They have a rate of 112% mobile coverage. People have multiple SIM cards for their phones. You have the question of affordability. People do a lot of stuff here on WhatsApp. It can be used to share ultrasound images, for example. The disconnect is when you try to do that with the hospital. All the forms will be electronically challenged. The reality is the hospital does not have an internet connection outside of the urban areas. There is a really big implementation challenge. You need to integrate those solutions into operating processes and management. It is a herculean task,” he says.
When he looks at the technology part, Seo says the big issue is that there are not the inter-connected digital platforms that allow a system to function quickly and efficiently, especially with data gathering. “You have platforms that the public hospitals use. There may be electronic health systems that the private healthcare systems use. You then have a tremendous amount of paper-based documentation which maybe redundant, because you have it digitally,” he says. “If you think about COVID, there has to be a lot more thought about the funding and reintroduction of technology. But, one of the key aspects is will these services under national health schemes be reimbursed. Who is going to pay for all of this technology?”
There are many obstacles to space-based healthcare. “A difficult thing with space-based healthcare, is that you are in many ways location-less. You can have someone in Oxford helping someone in Bangladesh for example, but you can have very restrictive data regulation. In some countries you have to have physical data that is in the server in the country. There are data access legislation issues are going to have to be sorted out for these services to be widely adopted and legal.”
Over the last few months, many have wondered how a vaccine to protect against COVID-19 could be developed, and more importantly how it can be distributed quickly and effectively. Gavi, the Vaccine Alliance believes satellite technology is increasingly being used to support the delivery of primary health services in domains such as communication and the production of geospatial data.
Gavi is a public-private partnership that helps vaccinate close to half the world’s children against some of the world’s deadliest diseases. Since its inception in 2000, Gavi has helped to immunize a whole generation – over 760 million children – and prevented more than 13 million deaths, helping to halve child mortality in over 70 low-income countries.
According to Gavi, geospatial satellites have the potential to bring specific support to immunization programming by supporting health resource mapping, population estimation, immunization microplanning of services, modeling geographic accessibility to health services, disease surveillance, campaign monitoring and modeling vaccination coverage.
Li Zhang, director of Strategic Innovation and New Investors Hub, points to fact that Gavi supports innovative projects which have the potential to increase vaccine uptake and coverage: from drones to deliver vaccines in Ghana and Rwanda, to sophisticated demand-side programes in India and Africa; from digital solutions in data and registration with telecoms and financial services companies in Côte d’Ivoire and Mauritania and use of satellite imageries and modeling in the Democratic Republic of Congo (DRC), to logistical supply chain solutions in Senegal and Uganda. “In the midst of this disruption, the pandemic could also bring a silver lining. Driven by a need to find new ways of delivering healthcare, it is possible that COVID-19 could accelerate the adoption of digital technologies in the provision of immunization services. For instance, we are seeing how existing innovations are being adapted and deployed by our partners to support COVID19 response,” Zhang says.
Hope Johnson, director of Monitoring & Evaluation, says Gavi is currently finalizing in partnership with HealthEnabled and UNICEF a landscape analysis on “Improving immunization coverage and equity through the effective use of geospatial technologies,” by Sarah Cunard and Patricia Mechael, which will be published soon.
“This report will showcase various case studies in Gavi-supported countries which demonstrate how the visualization of geospatial data, spatial analysis and geostatistical modeling can help service delivery teams identify communities where children have not been fully immunized, therefore improving service delivery and vaccine coverage,” she says.
Gavi has been exploring in collaboration with UNICEF the potential of geospatial and satellites technologies in various countries including Myanmar, Chad and Mozambique to improve equity of immunizations coverage. Furthermore, through its INFUSE program, Gavi is currently working with WorldPop/Flowminder and the Center for International Earth Science Information Network (CIESIN) to support the Government of the Democratic Republic of Government in mapping settlements, health facilities, health areas and produce population estimates through satellite image analysis. This builds on the work Flowminder and CIESIN had already been doing in the DRC, namely as part of the BMGF-DFID-UNFPA-funded GRID3 program. “This work should help to improve immunization micro-plans to reach zero-dose and under-vaccinated children,” says Zhang. VS