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Every Internet Governance Stakeholder Has a Role to Play in the Online Health Debate

Note: This article is part of the preparation for Workshop #116 of the UN's 2020 Internet Governance Forum: "Pandemics & Access to Medicines: A 2020 Assessment”, which will take place in November 16, from 14:00 to 15:30 UTC. Please find more information HERE.

Much has been discussed in relation to the impacts of the COVID-19 pandemic on most aspects of human life, but the dialogue around the long-term repercussions of this event on health online has been rather limited. Telemedicine seems to be the most notable topic to have emerged, skyrocketing in interest in March, but in steady decline thereafter (Google Trends query performed in English, but similar results can also be found in Romance languages), perhaps because it is assumed that, soon enough, healthcare will simply revert to the way it was before.

However, telemedicine is but one of the aspects involved in the wide set of implications that surround this moment in history. The fundamental health structures of most of the world have proven unreliable in the face of the pandemic, and had the effects of the disease been more severe or affected a larger portion of the population, our outcomes could be quite different. Based upon the novel coronavirus experience, nothing guarantees that the world will be ready for a future pandemic.

The reason why a subject such as access to medicines did not become the ultimate global trending topic is that there was no proven cure for COVID-19 available, and treatment methods had to be painstakingly developed by the global medical community. Had there been effective medication from the get-go, the rush to buy it would have been unprecedented. But what would guarantee access to it? Which rules would govern sales? Would people be limited to buying from their own home markets with potentially low supply, or would they be able to import from trusted foreign manufacturers?

If the price gouging of Personal Protective Equipment (PPE) and even hand sanitizer is anything to go by, it can be assumed that the situation would have looked rather chaotic. The question of the upcoming vaccines is also filled with reticence and uncertainty on what is the best approach to take. Matters of health are by and large kept at the local government level, but new challenges demand concerted global efforts on our part. Understanding where we should be going and what we could do has become that much more important.

Looking into the relation between the Internet and health makes a great deal of sense, particularly in the face of the fact that the network has proven as resilient as we hoped it would be. Even though there were initial concerns over how the Internet would perform under significant added stress, through good engineering practices and multistakeholder cooperation, networks around the world mostly thrived with minimal degradation of overall quality. In a health emergency on a large scale, we have observed that the Internet allows people to preserve their health in several different ways.

The need to discuss the subject is real, but which is the correct forum to carry out these discussions? What institutions can be the appropriate conveners? Governments are locked in fierce debates inside and outside arenas such as the World Health Organization (WHO), but the subject of harmonized or at least agreed-upon general rules for health online does not seem to register on their radar. Meanwhile, the Internet Governance community is already steeped in discussions over DNS Abuse related to COVID-19, misinformation campaigns, increase in cyberattacks due to more people working from home, and so forth.

A nascent group of experts has been gathering around the subject at RightsCon and the UN Internet Governance Forum over these last few years. Important steps have been taken, such as the establishment of the Brussels Principles on the Sale of Medicines over the Internet, a set of guidelines that orient what fair access to medications within this context should look like. However, there is a need to take the debate further, get more stakeholders to sit at the same virtual table, and understand what we as a community can do. Here are some ideas of what various stakeholder groups can contribute.

Civil society and NGOs need to look no further than the UN SDGs, in the form of "Goal 3: Ensure healthy lives and promote well-being for all at all ages". Of particular interest to the theme of access to medicines, we have: "3.8 Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all". There is still much to be advanced in the mobilization of actors towards sustainable activism around these matters.

For Academia, there is a wide range of unexplored topics, and data-driven research needed to be performed regarding the integration of health and digital technologies. In fact, this is an area with a perceivable gap in interdisciplinary research that could benefit from greater interaction with other scientific fields. Significant data points are emerging from COVID-related research that need to be studied and understood under the light of the existing Internet Governance literature.

When it comes to Businesses, apart from working directly with the sector, there is a significant ancillary market to that of health online, which involves cybersecurity, certification and authentication technologies, software development, solution development, and a number of other opportunities that might be explored further to the benefit of all. As new strategies are developed to engage local and global markets, these opportunities should be taken into consideration.

Entities that are Contracted parties to ICANN should be particularly aware of the critical role they play in this process, seeing as the DNS Abuse Framework already contains measures targeted at combating the proliferation of illegal opioid sales online. The Framework shows promise in its effort to weed out some of the rogue actors from the network. This is a great first step in generating trust online and ensuring greater safety for consumers, but further actions can be taken.

Indeed, DNS Abuse seems to be the subject in which we have progressed the furthest in dealing with this subject within the Internet Governance ecosystem, having transcended ICANN, entered national and global IGFs, and is starting to coalesce into a reference for future debates. The question moving forward is how to deal with the various actors involved in this space, both good and bad.

As we find ways to punish the bad actors, we should also consider what we could do to create incentives for the good actors, such as is the case of reliable and trusted Internet Pharmacies. How can we shift the equation to make objective sense for actors to behave well, and how can we engage as a community to generate positive outcomes? These are among the many questions that will increase in relevance in the upcoming years, and there is still much to be discussed, hopefully under less strained times.

By Mark Datysgeld, GNSO Councilor at ICANN

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