As many different countries choose many different approaches in order to fight the virus, it still remains a huge task, even for the majority of countries in the developed world. As countries with a functioning health care system like France or even Germany struggle to contain the outbreak of the virus.
If the Covid-19 epidemic has shown one thing, it might well be that despite our belief we cannot control any and every disease. While somehow most Western countries might come through this pandemic relatively unharmed, it has still shown us that we have a lot to learn about our approach to a functioning medical system.
One country that frequently eclipses the rest of the World when it comes to medical expertise and a functioning heath care system is Cuba. While many are aware that Cuban doctors are sent to a lot of different countries, especially poorer ones, the proportions of this aid and cooperation system are less known.
However, if this system of health cooperation is functioning so well, why don’t any of the major countries in the World aspire to imitate some of its aspects in order to improve their own health diplomacy? Is the capitalist world too stubborn to adopt good ideas from other systems?
While Cuba is a relatively poor country compared to most of the Western World, this has never been an excuse for not providing medical aid and medical assistance to those most in need in any part of the World. For example, as Hurricane George devastated Haiti in 1998, Cuba immediately sent a force of 200 medical staff to help the local population. But the Cuban model doesn’t stop at immediate medical relief. This is actually only the beginning. After the initial damage is more or less under control, Cuban doctors and medical staff usually stay there and begin to train and treat the patients in the devastated country so as to provide development assistance to the local health authorities. This includes the process of transmitting knowledge to the local population by either training staff on the ground, or, more importantly even, by providing local students with the chance to acquire a medical degree in Cuba. This allows fully trained medical personnel to come back and be able to help the local population where it is most needed.
This feat is even more impressive if you consider that every single step of the way is free of charge. This is seen by some as a true act of solidarity to the ones that are most in need. This is particularly astonishing as Cuba didn’t have a lot of support and of trading partners after the Soviet Union collapsed. In the early 1990s, male body weight in Cuba fell by 20-25 pound on average and public transportation was cut by 80%. Still, even in these difficult times for the country, its foreign policy regarding health remained the same, and Cuba continued assisting others where and when they needed it. 
So why is it that Western countries are neither discussing nor adopting the Cuban model to some extent?
The two parts of this question might well be closely linked to each other, as the West and in particular the United States have always had a hard time accepting Cuba’s existence in the first place. Since Cuba has a socialist government, it was always viewed as a possible threat in Washington, which imposed a trade embargo on the country, already in 1958. Writing this in 2021, when the Soviet Union is long gone, and an East West divide is not so visible anymore, it is astonishing that this embargo remains in place.
This might be one reason why Western media and policy-makers remain reluctant to fully acknowledge the real role Cuba plays when it comes to global medical relief. This whole situation really is an indictment on most powerful Western governments, as they remain unable to even acknowledge that their way of thinking might not be the best or even the only way.
As the Covid-19 pandemic rages on stronger than ever (especially in the United States, the one country that will not in any case acknowledge Cuba’s know-how or accept its existence), the Cuban situation compared to the rest of the World remains under control for the moment and Cuba is only waiting for the opportunity to help its neighbours.
It remains difficult to see a change of course for the United States, when it comes to its relationship with Cuba and its reluctance to accept any kind of help or advice coming from this country, but maybe if the rest of the World starts implementing some Cuban medical policies, the US eventually could follow the same path.
 John M. Kirk, “Cuban Medical Internationalism and Its Role in Cuban Foreign Policy,” Diplomacy & Statecraft 20, no. 2 (August 5, 2009): 275–90.
In this blog post I want to talk about the plight the Uyghurs face in China since the beginning of the pandemic. A crisis like this puts the socially vulnerable in a more vulnerable spot, especially in a country with a sizable amount of its population living in poverty, and has no social welfare system like China. During the various lockdowns in 2020 worldwide, most people were confined to home, many people lost their job or livelihood, with no employment payment, no income or savings, and many struggled to pull through. The Uyghurs and other ethnic minorities in Xinjiang suffered way more than that. The Uyghur communities in southern Xinjiang have much higher poverty rates than the Han communities, as a result of long-term discrimination policies against their Muslim identity. In recent years, their culture, language and religion have been further suppressed by the regime in the name of national security, many fell victim to the “re-education” camps or forced employment schemes.
Xinjiang is a vast region located in the northwest of China, home to over 13 million Uyghurs and over 1 million Kazakhs, who are the ethnic and cultural minorities. News reports and investigations showed that since 2015, numerous ‘re-education camps’ were being built all around Xinjiang, and it is estimated that over 1 million Uyghurs and Kazakhs are being detained in such camps, facing brainwash, mental and physical abuse day by day.
In the beginning of the pandemic, many migrant workers were eager to return to big cities for work, but were forced by the lockdown to stay home for more than two months. As a result, thousands of Uyghurs were being sent across the country, to fill up the vacuum of labour following the first lockdown. Many were forced to wear GPS bracelets to track their whereabouts. According to a report by the Australian Strategic Policy Institute, Chinese government sent approximately 80,000 Uyghurs to other regions of China to work in factories, including for many international brands like Nike, Apple, BMW and Volkswagen. In July 2020, a New York Times visual investigation found that Uyghurs were also included in a government-sponsored forced labour program to produce face masks, in order to satisfy the skyrocketed global demand of P.P.E.. Much of the mask production was for export. Besides all of this, hundreds of thousands of Uyghurs and other minorities were forced to undertake hard and manual labour in Xinjiang’s vast cotton fields and the garment factories, where 20% of the world’s cotton is from.
Another report by China Tribunal also reveals that the detainees in the “re-education camps” are victims of organ harvesting, a practice that is not at all uncommon in Chinese prisons. China has one of the lowest voluntary organ donor rates in the world, with the spreading of Covid-19, there were concerns that the Uyghurs were being “killed-on-demand” for Chinese Covid-19 patients, as China announced its first double-lung-transplant for a Covid-19 patient, who waited only five days for a “consenting” donor to provide a perfectly matching set of lungs.
There were two major lockdowns in Xinjiang in 2020, the first one was from mid-July to early September, when the rest of China reported almost no new cases every day. The same measurements like those in Wuhan were imposed there, people were not allowed to leave their home, some building gates were sealed with iron bars, and residents were forced to take unknown medicine every day. Around this time it was also reported that a mass female sterilization campaign was being carried out among the Uyghur population, similar to the one carried out nationwide in the 1980s and 90s, as a result of the one-child policy.
Being the most heavily policed area of the world, “covered by a pervasive network of surveillance, including police, checkpoints, and cameras that scan everything from number plates to individual faces”, most people could never move freely before the pandemic. Many questioned the scale of the outbreak in the cities, and expressed their concern of possible outbreaks inside of the ‘re-education camps’. Given that ‘[t]hose camps are especially vulnerable to contagious disease due to the cramped cells, lack of medical resources and generally dire conditions.’
The second lockdown in Xinjian was carried out from late October to late November in the area of Kashgar, where most Uyghur communities and ‘re-education camps’ are located, harsh measurements were imposed on its residents again. According to the news reports and studies, the human rights violations in China continue to deteriorate during the pandemic. In January 2021, the U.S. government declared that the Chinese government has committed genocide on Uyghurs and other ethnic minorities of Xinjiang,’, it was by far the strongest condemnation by any government against the Xinjiang crisis, hopefully more countries will take part in the joint effort to end such atrocities against humanity.
Epidemiological surveillance is defined as the ongoing systematic collection, analysis, and interpretation of health data that is essential to the planning, implementation, and evaluation of public health practice. The aim is to observe, study and analyze any given infectious disease in order to get a better understanding of its spreading and its impacts on a given population.
It is the foundation for immediate action as well as long-term strategies in order to keep a disease at bay. Epidemiological surveillance falls under the competence of national authorities. However, international agencies and organisations such as the World Health Organization (WHO) play an increasingly important role ever since the SARS breakout in 2003 and even more so in the light of recent events and the outbreak of the Covid-19 pandemic. A rapid communication on an international level, the collection of background data as well as data interpretation of climatic variations are important tools in controlling and predicting the outbreak of diseases including zoonoses. Satellite surveillance of vegetation growth, for instance, is used as an indicator of rising vector numbers, thus enables the prediction of vector-borne diseases. There are different strategies for monitoring diseases, such as passive and active surveillance.
Active surveillance vs. passive surveillance
In order to collect data the different surveillance strategies draw their information directly from the source, notably health care workers. Passive surveillance is the most commonly used surveillance strategy and relies on surveillance forms filled out by health care personnel, which are periodically collected from health care facilities. The aim is to draw an approximate picture in order to assess current trends. However, it is a very shallow method as it is based on minimal data and does not offer many incentives to health care providers to actively engage in the process of data collection. It is common for health care workers to only partially fill out those forms, to neglect certain aspects or to stay vague in the description of symptoms.
One example that illustrates this problem is vaccines. Vaccines are known for being very cost-effective. In other words: the benefits outweigh the risks by far. However, clinical trials for vaccines are very costly, which is why post-licensure evaluations (for vaccines or drugs that are already licensed and allowed on the market) are often based on the results of passive surveillance in order to detect and monitor adverse events. Unfortunately, the results drawn from passive surveillance are often unreliable due to an insufficient proof of causality between the vaccine or drug in question and specific symptoms. However, passive surveillance is still used for the evaluation of contraindications to diphtheria-tetanus-pertussis (DTP) vaccine and also for evaluating the risks of combined or simultaneous vaccinations. In essence, in the case of vaccine adverse events, unwanted symptoms or side-effects of a vaccination, there appears to be a significant trend of underreporting coupled with adverse event reports that lack precision and specification.
In contrast, active surveillance institutions such as healthcare providers, work places, laboratories, nursing homes, or schools etc. are directly contacted by state authorities in order to obtain more detailed information. Both strategies have their advantages as well as their drawbacks. On the upside, passive surveillance can effortlessly be conducted on an on-going basis and reaches a broader population pool. On the downside, passive surveillance is known to provide incomplete data due to underreporting and is therefore suited for routine surveillance tasks. Active surveillance has the benefit that data is collected in a more inquisitive way and therefore requires a more intense mobilization of resources. It therefore provides more accurate data and is primarily used to investigate serious diseases, which display a potential risk to public health.
Other surveillance methods also exist, such as behavioral risk factor surveillance, outbreak surveillance, sentinel surveillance and syndromic surveillance but to name a few. Behavioral risk factor surveillance is based on an ongoing and systematic surveillance of data in order to identify possible risk factors for the outbreak of a disease, whereas outbreak surveillance is used to find the source of the outbreak via active surveillance methods. Sentinel surveillance focuses on identifying disease trends and which groups of a population are at a greater risk of contracting a disease. The aim of syndromic surveillance is to identify illness clusters in their early stages in order to limit a potential outbreak.
Alternative surveillance modi
On top of the classic surveillance methods, countries such as China are using modern technology in the battle against disease. For example, the China Infectious Diseases Automated-Alert and Response System (CIDARS) is an early warning model and a new epidemiological surveillance method. CIDARS is based on a mobile phone network which has a list of all relevant phone numbers of the epidemic staff on all levels from the national level down to the provincial level in order to inform the key personnel involved by SMS providing any given health facility reports a case.
Another big data pool or complementary channel of information is social media. An increasing number of organizations including scientific institutions seek to use data from social media platforms. However, regulations relating to the protection of personal data are at the source of major challenges in this field – which calls upon legal and ethical guidelines establishing a threshold that should not be overstepped.  Putting modern technology at use for epidemiological surveillance appears a pertinent path in the future, although there are a few more practical and ethical obstacles to overcome in order to replace present day surveillance tools.
The WHO – a global response to a global threat
The World Health Organization (WHO) plays a crucial role in epidemiological surveillance and disease prevention worldwide. Its principles for the implementation of mass vaccinations as well as the WHO’s guidelines in the case of a pandemic are an important basis for the prevention and control of illness on an international level. Ever since the outbreak of the covid-19 pandemic, the recommendations of the WHO have gained unprecedented importance, notably in terms of surveillance strategies as well as strategies in combatting the new virus. As the topic of mass vaccinations has turned into an issue of major controversy, the organization recommends carrying out a risk assessment in order to evaluate whether the potential benefits of a mass vaccination outweigh the risks (risk-benefit criteria). Furthermore, the WHO proceeds with recommendations related to the coordination and planning of such mass vaccination campaigns.
More generally, the WHO plays an important role in shaping the actions of major decision-makers, such as governments, independent laboratories, health care institutions or pharmaceutical companies in surveillance. However, the type of disease surveillance used to detect an illness or the type of remedy deployed in order to eradicate a disease are at the discretion of national actors. Public health policies are still a national matter and, even if international organizations play a role in shaping those policies, state sovereignty cannot be violated. The WHO plays a central role in coordinating global health threats – yet its capacities are purely advisory and it has no enforcement power. 
It should also be emphasized that there is a major asymmetry when comparing the scope of action of developed countries to the possibilities of developing and underdeveloped nations. While global surveillance initiatives as well as WHO recommendations may be efficient in developed countries, developing countries struggle from the additional pressure put on their already fragile health systems. It may lead to an undue shift of resources and commitment from already highly prevalent and preexisting diseases, which should however not be left unattended.
The aim of this blog post was to create a better understanding of the existing mechanisms in the field of disease prevention by presenting its central tools and most important actors, such as different types of epidemiological surveillance and the modus operandi of the WHO. Nevertheless, it is also important to outline the limits of the above-mentioned strategies as well as to show new potential analytical tools that are on the rise. To conclude, it is crucial to create awareness of the difficulties developing countries might have in following the WHO’s recommendations when combatting an infectious disease and that many countries lack the trained personnel as well as the medical equipment to meet international health standards.
 Richard J. Wolitski et al., “The Public Health Response to the HIV Epidemic in the U.S.,” in Aids and Other Manifestations of HIV Infection, ed. Gary P. Wormser, 4th ed (Amsterdam: Academic Press, 2004), 983–1000.
 S Rosenthal and R Chen, “The Reporting Sensitivities of Two Passive Surveillance Systems for Vaccine Adverse Events.,” American Journal of Public Health 85, no. 12 (1995): 1706–9.
 Weizhong Yang et al., “Chapter 7 – China Infectious Diseases Automated-Alert and Response System (CIDARS),” in Early Warning for Infectious Disease Outbreak, ed. Weizhong Yang (Amsterdam: Academic Press, 2017), 133–61.
 M. A. Mayer, L. Fernández-Luque, and A. Leis, “Chapter 5 – Big Data For Health Through Social Media,” in Participatory Health Through Social Media, ed. Shabbir Syed-Abdul, Elia Gabarron, and Annie Y. S. Lau (Academic Press, 2016), 67–82.
 Eduardo Lazcano-Ponce, Betania Allen, and Carlos Conde González, “The Contribution of International Agencies to the Control of Communicable Diseases,” Archives of Medical Research 36, no. 6 (November 2005): 731–38.
The current crisis triggered by the COVID-19-pandemic can be described as many things, including as a giant magnifying glass that sheds light on the injustices and the systematic political and social malfunctions of the world. For many of us, it might be the first time experiencing such a pandemic. Nevertheless, it is not the first time in history that a health crisis unleashes profound changes that not only affect the sanitary domain, but also economics, politics and, more broadly, development itself by generating fears, inequalities, but also a sense of hope for a better world. There are different ways in which individuals deal with the threat posed by a disease, including art, an activity that constitutes a pivotal component of the social world. This blog post focuses on how the US-American artist Keith Haring used art as a means of social activism in order to raise awareness about AIDS and help people to make sense of the disease in emotional and cognitive terms.
Why art matters in times of crisis
Artists have always played a crucial role in communicating the injustices of the world, nurturing hopes through their work, acting as spokespersons for those who do not have the means or the power to raise their voices and being a motor of social activism. Especially in times of crisis, art has proven itself to be a tool that allows mankind to process experiences, to find a source of strength and comfort, to feel connected to a holistic experience, to understand each other on a deeper level and to see ourselves within a larger society. While it could never save lives in the way that science may be able to, art can nevertheless deliver a strong message – as American artists Keith Haring once said, “Art should be something that liberates your soul, provokes the imagination and encourages people to go further.”
When AIDS hit the world
This ideology of delivering a message through art was particularly prevalent during the AIDS pandemic that had its outbreak in the early 1980s. The illness is caused by the human immunodeficiency virus, or HIV, that is transmitted through bodily fluids and that attacks the body’s immune system. According to the World Health Organization, HIV is still one of the world’s most serious public health challenges. For the Centre for Disease Control and Prevention, the virus originated in Central Africa and may have jumped from chimpanzees to humans in the late 1800s. At that time, it spread slowly across Africa and into other parts of the world, and eventually also arrived in the United States around 1970, even if it did not come to the public’s attention until the early 1980s. In that decade, one American city was hit especially hard by the crisis: New York City.
There‘s a new guy in town
The AIDS pandemic led many artists and activists in New York City to identify new forms of supporting social causes by using art as a mean of resistance. Among those artists was Keith Haring, an openly gay advocate for safe sex. Haring grew up in Pennsylvania and moved to New York City in 1978 where he enrolled in the School of Visual Arts and dived into the art and social scene of the East Village. There he found an alternative art community outside of galleries and museums. He started experimenting with chalk graffiti over unused advertising spaces in subway stations. Little did he know that with a piece of chalk and a combination of pop art and graffiti, he was setting the scene to changing the world. Throughout his career, Haring devoted his time to public works that often-carried powerful social messages. Especially during the last years of his life, Haring generated activism and awareness about AIDS during a time where little was known about a virus that not only was a taboo topic, but particularly affected the gay community.
A social construction of reality
In his work, Haring created attention and awareness of HIV and AIDS by breaking with taboos and using explicit sexual iconography to inspire the general public for a more open conversation about the virus and its prevention. He promoted safe sex campaigns and constructed a social reality, in which he portrayed the virus not as a biological entity, but as an enemy – the devil of the people. Since the pioneer work of sociologists Peter Berger and Thomas Luckmann, scholars have studied how social reality is constructed in intersubjective exchanges and interactions. As a constitutive domain of the public sphere of a society – including the global –, art is a major field for the construction of reality. By representing AIDS though black shapes that somehow resemble a devil with horns, Haring loaded the disease with specific negative connotations, which help raise awareness about the dangers it poses to human beings. Even if this was not Haring’s only approach to deal with the disease from an artistic perspective, it showcases clearly how he intended to provoke discussions about AIDS by depicting the disease itself as a threat to humanity and by employing resources that are easily linked by the audience as evil.
Why Keith Haring’s work still matters
Haring was diagnosed HIV positive in 1988 and died of AIDS related complications in 1990 at the young age of 31. But his art has never been forgotten. Even though he might be dead for more than three decades, his work keeps inspiring people, organizations and movements all over the world. If he were still alive, public spaces would probably already be painted with coronavirus-images, depicting it as an “evil enemy” or a “social monster“, bringing it to life by means of representations that are beyond the scientific domain to educate people about the illness rather than live in fear of it. Just like Haring created a sort of visual identity for AIDS, he would have probably also created one for the coronavirus, accompanied by words like “Ignorance = Fear, Silence = Death” in order to enact social change and bring conversations into the mainstream. There is no better way to summarize Keith Haring’s intention than with his own words: “I don’t think art is propaganda; it should be something that liberates the soul, provokes the imagination and encourages people to go further. It celebrates humanity instead of manipulating it.”
 Berger, P. & Luckmann, T. (1966). The Social Construction of Reality: A Treatise in the Sociology of Knowledge, Garden City, NY: Anchor Books.
The following thoughts on contact tracing apps try to give a new perspective on their purpose. They question the trend in society not wanting to share private information with the government while sharing it at the same time publicly through social media.
The majority of people criticising contact tracing apps do not want to share private information, or in concrete words do not want to share their location and by consequence their daily routines or habits.
This is understandable in a way: location or spatial data provides really delicate information and various types of knowledge can be derived from one’s location. From movements, we know where a person works, lives, shops, and visits friends. We are able to learn a lot about a person but also about communities by “just” having knowledge about their location.
If you now think: “Well, I will never gonna get this tracing app on my phone”, I invite you to remember what other sources of information as delicate as spatial data within a tracing app is publicly accessible of you. Maybe you have a Facebook-, Instagram-, Google Mail- or WhatsApp- or LinkedIn-Account. Social Media and so many other sources are publicly providing a mass of spatial-, and other types of data from the majority of people.
If it is not from social media, there are still other ways to find aggregated information such as official statistical data from governments, data from insurance companies, or data from news media.
These channels of data often do not provide personalized information about people. But we should not forget the bigger picture of data analysis. The objective of data analysis is finding meaning and correlation in incredibly huge amounts of data. Findings derived from so called big data are not about that one certain person, it is about finding patterns in an aggregate of “digitalized reality” concerning activities, opinions, circumstances, and habits of people. I am not saying that personalized data is not playing a huge role in data analysis, but this is mostly the case when an analysis has the purpose to explain a company what advertisement best fits for a certain person. To make it more concrete: personalized information is mostly used from companies for the purpose of marketing.
Let us also remember that what is now called data is digitalized information. Information has always been important for societies and will always be. The main difference between then and now is the capacities of storage, the amount of data and the speed in which data can be processed. Of course, these differences bring up new consequences for society, which should be considered, but still the principles of the impact of information and knowledge on society is as important as it has always been. As Francis Bacon once said: knowledge is power.
But back to the criticism of contact tracing Apps: not wanting to share spatial data, even if it is for the purpose of public health, illustrates that it is important for our society that personal data is not used without consent even if it is for a society’s own good.
Why is there a tendency to think that data will be used against us? And why do we fear this on the one hand, but on the other proudly share family photos on various social media platforms? This matter seems irrational for me and brings me to the conclusion that our global society is in need for an open discourse regarding the subject of data collection, analysis, and use. We need to inform ourselves, so that we do not start sticking to irrational fear, when it comes to the matter of data. But I also call upon institutions, NGOs, governments, organizations, and companies to speak openly about this subject and share aims and objectives concerning the matter of data analysis in a transparent and explicable manner.
If this will not soon be the case, stories like failed attempts to introduce a contact tracing app in order to tackle the COVID-19 pandemic will repeat over and over. We need to be clear about both sides of the coin: There are negative impacts in every innovation, in every new trend. But there are also good intentions, good reasons, and eventually good outcome from innovations if we are just able and ready to use it right. The good side of the coin cannot be realized, however, if we live in the bewildering situation of on the one hand sharing loads of data on social media and on the other being afraid of sharing data within an app that would help us to tackle the pandemic.
This blog-post does not only want to question the view on data related matters in our society. It also wants to take an effort in informing about the potential of contact tracing apps for the solution of this crisis in line with this recent statement by the WHO:
“COVID-19 has heavily emphasized how contact tracing is crucial for managing outbreaks, and as part of the strategy for adjusting, and eventually lifting, lockdowns and other stringent public health and social measures. As the pandemic develops further, it will be a core measure to manage further waves of infection”
The sources below contain further articles about functioning, purpose, objectives, outcome of contact tracing apps and about the on-going debate. I hope this blog post is providing an incentive to read and think further about data analysis in relation to contact tracing apps, but also in terms of other topics.
Budd, J., Miller, B.S., Manning, E.M. et al. Digital technologies in the public-health response to COVID19. Nat Med 26, 1183–1192 (2020). https://doi.org/10.1038/s41591-020-1011-4
Ienca, M., Vayena, E. On the responsible use of digital data to tackle the COVID-19 pandemic. Nat Med 26, 463–464 (2020). https://doi.org/10.1038/s41591-020-0832-5
World Health Organization. Public health surveillance for COVID-19 Interim guidance (2020)
World Health Organization. Online global consultation on contact tracing for COVID-19 (2020). COVID-19: Surveilllance, case investigation and epidemiological protocols
Siffels, L.E. Beyond privacy vs. health: a justification analysis of the contact-tracing apps debate in the Netherlands. Ethics Inf Technol (2020). https://doi.org/10.1007/s10676-020-09555-x