# Trust, but Verify: Informed Consent, AI Technologies, and Public Health Emergencies
## 5 Scenarios  
Notwithstanding any legal obligations under clinical practice and data protection regulations, to evaluate the concept of trust-based research consent, this section considers three different scenarios with specific relevance to the COVID-19 pandemic and beyond. Throughout the discussion above, I have used contract tracing as a starting point. Identifying the transmission paths of contagious diseases with such technology has been around as a concept for some time [98]. However, this has potential implications for privacy including the inadvertent and unconsented disclosure of third parties from a consent perspective. It has been noted that human rights instruments make provision for when community imperatives supersede individual rights (Art. 8 SS2, [14]); and trust in government has had implications for the acceptance and success of tracing applications, for instance [76; 99]. For  
Figure 3: A Schematic Representation of Trust Behaviours. representative research behaviours, therefore, it is important to consider the implications of current informed consent procedures in research ethics as well as from the perspective of trust-based consent introduced above. * _Contact tracing:_ During the COVID-19 pandemic, there has been some discussion about the technical implementation [100] and how tracing fits within a larger socio-technical context [101]. Introduction of such applications is not without controversy in socio-political terms [76; 102]. At the same time, there is a balance to be struck between individual rights and the public good [103]; in the case of the COVID-19 pandemic, the social implications of the disease are almost as important as its impact on public and individual health [104]. Major challenges include:
* Public Opinion;
* Inadvertent disclosure of third party data;
* Public/Individual responses to alerts. * _Big Data Analytics_: this includes exploiting the vast amounts of data available typically via the Internet to attempt to understand behavioural and other patterns [105; 106]. Such approaches have already shown much promise in healthcare [107], and with varying degrees of success for tracing the COVID-19 pandemic [108]. There are, however, some concerns about the impact of big data on individuals and society [109; 110]. Major challenges include:
* Identification of key actors;
* Mutual understanding between those actors;
* Influence of those actors on processing (and results). * _Public Health Emergency Research_: multidisciplinary efforts to understand, inform and ultimately control the transmission and proliferation of disease (see for instance [111]) as well as social impacts [99; 104], and to consider the long-term implications of the COVID-19 pandemic and other PHEs [112]. Major challenges include:
* Changes in research focus;
* Changes introduced as research outcomes become available;
* Respect for all potential groups;
* Balancing individual and community rights;
* Unpredicted benefits of research data and outcomes (e.g., in future). Table 11 in Appendix A summarises perspectives relating to _informed consent_ and _trust-based consent_ relating to the three related activities: contact tracing, big data and issues pertinent to research during a PHE as described above. Each of these scenarios needs to be contextualised within different perspectives: the broader socio-political context, the wider delivery ecosystem, and historical and community-benefit aspects, respectively. Traditional informed consent for research would be problematic for different reasons in each case as summarised. If run in connection with or as part of data protection informed consent, any risk of research participants stopping their participation may result in withdrawal of research data unless a different legal basis for processing can be found. In all three cases, it is apparent that a simple exchange between researcher and research participant is not possible. There are other contextual factors which must be taken into account and which may well introduce additional stakeholders.