JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic has raised the importance of the deployment of digital detection surveillance systems to support early warning and monitoring of infectious diseases (ID). These opportunities create a “double-edge sword” as the ethical governance of such approaches often lag behind technological achievements.

Objective:

The aim was to explore the intersection of individuals’ autonomy and healthcare rights with those of common good for population-based public health outcomes specific to ID control and prevention.

Methods:

We searched relevant articles in a number of databases that addressed ethical issues of using artificial intelligence, digital surveillance systems, early warning systems and/or big data analytics technology for detecting, monitoring, or tracing ID according to PRISMA guidelines, and further identified and analysed them with a theoretical framework.

Results:

This systematic review identified 29 articles presented in six major themes clustered under individual, organisational and societal levels, including: awareness of implementing digital surveillance, digital integrity, trust, privacy and confidentiality, civil rights, and governance. Whilst these measures were understandable during a pandemic, the public were concerned about receiving inadequate information, unclear governance frameworks, and lack of privacy protection, data integrity and autonomy when utilizing ID digital surveillance. The barriers to engagement could widen existing healthcare disparities or digital divides by underrepresenting vulnerable and at-risk populations, and expose patients’ highly sensitive data such as their movements and contacts to outside sources, impinging significantly upon basic human and civil rights.

Conclusions:

Our findings inform ethical considerations for service delivery models for medical practitioners and policymakers implicated in the use of digital surveillance for ID spread and a basis for the global governance structure.