# Ethical Issues in AI-Enabled Disease Surveillance: Perspectives from Global Health
## 2 Disease Surveillance
\begin{table}
\begin{tabular}{l} \hline \hline
**Global Public Health Intelligence Network (GPHIN)** \\
* GPHIN was established by the Public Health Agency of Canada in the late 1990s.
* GPHIN is an automated surveillance tool, which collects non-structured, event-based, digital data from news feed aggregators and then reports to national and international health agencies, such as the WHO Global Outbreak Alert and Response System (GOARN).
* In 2004, GPHIN detected severe acute respiratory syndrome (SARS) more than two months before the first publications by the WHO [29].
* URL: [[https://gphin.canada.ca/cepr/aboutgphin-rmispenbref.jsp?language=en_CA](https://gphin.canada.ca/cepr/aboutgphin-rmispenbref.jsp?language=en_CA)]([https://gphin.canada.ca/cepr/aboutgphin-rmispenbref.jsp?language=en_CA](https://gphin.canada.ca/cepr/aboutgphin-rmispenbref.jsp?language=en_CA)) (accessed on 1 November 2021) \\ \hline \hline
**HealthMap** \\
* HealthMap was established in 2006.
* HealthMap uses online informal sources, such as ProMed and official-validated outbreak RSS feeds, for disease outbreak monitoring and real-time surveillance of emerging public health threats.
* HealthMap also brings together disparate data sources, including online news aggregators, eyewitness reports, expert-curated discussions, and validated official reports.
* The freely available website 'healthmap.org' and mobile app 'Outbreaks Near Me' deliver real-time intelligence on a broad range of emerging infectious diseases.
* URL: [[https://healthmap.org/en/](https://healthmap.org/en/)]([https://healthmap.org/en/](https://healthmap.org/en/)) (accessed on 1 November 2021) \\ \hline \hline \end{tabular}  
* ProMED is a program of the International Society for Infectious Diseases (ISID).
* ProMED was launched in 1994 as an internet service to identify unusual health events related to emerging and re-emerging infectious diseases and toxins affecting humans, animals, and plants.
* ProMED is one of the largest publicly accessible surveillance systems conducting global reporting of infectious disease outbreaks.
* URL: [[https://promedmail.org/](https://promedmail.org/)]([https://promedmail.org/](https://promedmail.org/)) (accessed on 1 November 2021)  
\end{table} 
Table 1: Disease Surveillance Systems. The IHR has emphasized the importance of both indicator-based and event-based components of epidemic intelligence for the early detection of events [30]. Informal information sources are important in this context, with the WHO reporting that more than 60% of initial disease epidemic reports come from unofficial sources and this percentage continues to increase with the availability of internet-based and social media sources [25]. During the COVID-19 crisis, the frequently changing government platforms used to publicly disseminate data included Facebook and Twitter, as well as government-authorized websites [31]. Common informal sources found on the internet include search queries, news feeds (e.g., Google and Baidu news), blogs, and social media channels [25; 32]. Social media platforms, such as Twitter, are perceived as an increasingly useful form of real-time data with a geolocation resolution that can be systematically mined, aggregated, and analysed by algorithmic applications to inform public health agencies [30; 33; 34]. The increasing number of smartphones worldwide and lower policy barriers in many lower-middle income countries (LMICs) also provide an opportunity for the usage of AI-enabled mobile applications in event-based surveillance [18; 35; 36]. There are also emergent forms of epidemic intelligence [12] which are arising from newly identified microbes through advances in DNA sequencing technology. This primarily relates to genomic epidemiology in which lab-based molecular diagnostics and genotyping methods are being enhanced or replaced by rapid genomics- and AI-based methods to aid epidemiologic investigations of communicable and outbreak diseases [37].