Health and Digital Technologies: Comparison
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Please note this is a comparison between Version 3 by Dean Liu and Version 2 by mohammadreza pourkarim.

New technologies are supported by the global implementation of the internet. These improvements have deeply affected various disciplines of sciences and consequently changed services such as daily business, particularly health sectors. Innovative digital marketing strategies utilize the channels of social media and retrieved user data to analyze and improve relevant services. These multidisciplinary innovations can assist specialists, physicians and researchers in diagnostic, prophylaxis and treatment issues in the health sector.

  • digital marketing
  • viral hepatitis
  • elimination
  • WHO
  • influencers
  • MANAGEMENT
  • campaign

1. Social Media’s Impact on Health Care System

The future of health sectors is deeply linked to the application of advanced technologies. New technologies can lead to a massive change in healthcare practice and its related business sectors in a variety of ways. Companies involved in the food and pharmaceutical industry as well as hospital and producers of laboratory equipment take advantage from new technologies to deliver their products and services to the customers and end users. Furthermore, digital innovations can assist specialists, physicians and researchers in diagnostic, prophylaxis and treatment issues [14,15][1][2]. Compared to recent decades, health decision makers are more accurate and trustful in defining new strategies. Different national and international health organizations use these social media platforms to communicate, design and disseminate their health strategies [16][3]. The World Health Organization (WHO) has already used social media platforms, such as Twitter and other social networks, to communicate and report on health care information [17][4]. This organization calls for social media to be more active in broadcasting health messages to the public, under normal circumstances and during a health crisis [18][5]. Based on data collected from different regions, the WHO anticipates a shortage of human resources in the health care of nearly 12.9 million worldwide by 2035. To counter the shortage of personnel, the WHO is ambitious to apply new technologies for attracting and allocating people with different specialties in healthcare [19,20][6][7]. Additionally, the management of patients has substantially improved, and personalized contact between patients and the healthcare staff is straightforward and more convincing [21][8]. There is an ongoing evolution in communication platforms, and those that have implement these advanced digital technologies in their health system have significantly benefited by attracting larger audiences and consumer groups (Figure 1) [22][9].
Figure 1. Application of digital marketing in program of viral hepatitis elimination. Center of diagram shows the goal of program. This goal is achieved by measurements such as increases in public awareness, screening, treatment and immunization against viral hepatitis (middle zoon). Medical apps, social media influencers and campaigns support and facilitate those medical services through surveillance, reaching target population and access to healthcare services (outer zoon).
In parallel with health service providers, digital technologies are frequently used by ordinary people who search and look for answers on questions about their health on the internet [23,24][10][11]. Surprisingly, monitoring health-seeking queries on the web in different geographical regions and seasons can provide big data, which can be used to analyze real world health associated developments. For instance, it has been shown that the frequency of certain key words in the web correlate with the number of patients with influenza-like illnesses who refer to physicians in some geographical regions [25][12]. This sort of digital-based data analysis can support innovative surveillance systems that can assist epidemiologists in the identification of seasonal influenza epidemics [26][13]. The same approach has been used in the surveillance of Dengue virus [27][14]. Furthermore, in some tropical countries such as India, Indonesia, Singapore, Bolivia and Brazil, web search query data corresponded with the resurgence of Dengue virus [28][15]. Beyond pathogen surveillance, data on web behavior can be utilized as a health indicator of web users and to determine their access to healthcare facilities, including screening tests, vaccine, physicians and therapies (Figure 1) [24][11]. Additionally, the utility of web-based data can be beneficial for the assessment of other health issues such as contraception [29[16][17],30], diabetes [31[18][19],32], obesity [33][20] or cardiovascular diseases [34][21]. However, in the case of communicable diseases, the application of digital technology has extraordinary relevance.
The relevance of digital innovations is highlighted when wresearchers are confronted with human pathogens that cause significant morbidity/mortality, especially during the early days of epidemics. In moments when there is lack of information and few effective therapies (e.g., vaccines and medication), a unified and appropriate response is very critical. Accordingly, it has been demonstrated that access to digitally generated data on platforms of social media can empower an immediate response or/and control the spread of viral diseases such as HIV and Ebola [24,35][11][22]. For instance, during the Ebola epidemics in Africa, a global massive web search was observed. Interestingly, a significant positive correlation was reported between social media behavior (e.g., number of tweets) and an increasing prevalence of HIV, which exemplifies the massive potential of social media’s impact on health status information of users (Figure 1) [36,37][23][24]. The analysis of such geographical location specific data retrieved from web searches helps the health authorities implement appropriate and timely actions. Via social media networking, public health researchers or clinicians have access to a wide/global audience (Figure 1) [38,39][25][26]. This allows the rapid communication of health-related information and might contribute to the improvement of the society’s health status. Several studies have shown that users follow up the advice of messages posted on social media by health advisers [6,40,41,42][27][28][29][30]. Therefore, communicating the implementation of interventions alongside messages to support healthy behavior could have tremendous value and interests. For example, research projects that offered home HIV testing through social media platforms, known as app-based intervention, has been well accepted. [41,43][29][31].
Antimicrobial resistance is another serious health concern that is highlighted in human digital communication. By 2050, 10 million deaths due to antimicrobial resistance are estimated per year, which highlights an eminent threat to human health [44][32]. Recent investigations have demonstrated that misunderstandings and wrong public perceptions underlie antibiotic overconsumption [45,46,47][33][34][35]. Furthermore, self-medication, off-label use (e.g., for curing viral infections) and suboptimal dosing of antibiotics are examples of misconception that occur in both developing and developed countries [48,49][36][37]. Several strategies, such as different assessments or educational programs, have been implemented to increase knowledge concerning antibiotic use and infectious diseases [47][35]. Among a variety of tools, social networking platforms such as Facebook pages, Twitter and YouTube have been efficiently used change public perception (Figure 1) [39,50,51][26][38][39]. The dissemination of an educational program called “antimicrobial stewardship” (ASP) on Facebook and Twitter for students of medicine is a worthy example of the application of social media technologies [50,52][38][40]. Further, to increase students’ awareness, online games about antibiotics have been launched in the UK and USA, which had a positive impact [53][41]. However, the use digital marketing in health system is not always a success story, as has been demonstrated in the case of measles. Despite the availability of an effective vaccine, measles is still a worldwide public health concern, with several measles outbreaks, even in developed countries, in recent years [54][42]. Health policy makers have used social media to promote vaccination programs; however, antivaccine movements have applied similar tools to spread disinformation [55][43]. More so, the activity of the antivaccination (anti-vax) movement on social media seems much higher and more successful compared to the pro-vaccines movement, which contributes to the increased vaccine hesitancy. [56,57][44][45]. A survey showed that activities of the anti-vax movement on Twitter positively correlated with the incidence of measles outbreaks and a drop in vaccine coverage [58][46]. Antivaccine discourses on social media majorly highlight potential vaccine side effects and deaths. Additionally, they try to link the deaths to conspiracy theories and attempt to minimize the effectiveness of vaccines. However, none of them use scientific arguments to support their claims [58][46]. Contrasting the anti-vax movement, communication that reverberate on social media has been able to transmit well-informed information about measles infection sequela and has assisted parents in making the correct decision for vaccination [59][47]. Vaccination against influenza and HPV are experiencing the same scenarios on social media in which misinformation is propagated by antivaccine movements [60,61,62][48][49][50].
Besides monodirectional communication and the dispatch of health messages, social media platforms enable the interactions between stakeholders, such as healthy individuals and patients, patients and specialists and ordinary people who are interested in a healthy lifestyle [63][51]. Nowadays, patients can communicate through social media with health specialists rather than planning visits and speaking in person [64][52]. This can decrease the number of hospital visits [64][52]. In addition to social networking sites, different applications and algorithms offered by authorities of digital markets can be used as blueprints for this bidirectional interaction [65][53]. The term Mobile Health (mHealth) implies the use of different applications (apps) on mobile phones or tablets, which assist in monitoring the personal health of users [66][54]. In such platforms, advice on daily physical or mental behavior, such as diets, activities and treatments, are suggested to the users. Eventually, the daily functioning of the user is monitored, and personalized reports are delivered [67,68,69,70,71][55][56][57][58][59].

2. Current Pandemic and Digital Revolution

From the first days of the SARS-CoV-2 pandemic, which started in December 2019 in China, digital marketing tools (e.g., social media) demonstrated their potential use in times of crisis [72,73][60][61]. Not surprisingly, the first diagnostic report of a suspected pneumonia case with unknown etiology was posted on WeChat by Dr. Li Wenliang, who later died from the same illness. Although the use of social media to disseminate information was adopted in previous epidemics such as Ebola outbreaks [74][62], Zika virus [75][63], Influenza [76][64], Dengue [77][65] and MERS-CoV [78][66], the wide application of digital technology in the SARS-CoV-2 pandemic was beyond previous experiences. The World Health Organization (WHO) noted that “the coronavirus disease 2019 (COVID-19) is the first pandemic in history in which technology and social media are being used on a massive scale.” [79][67]. Accordingly, by applying social media, health information spread quickly and was instantly shared with the public to inform people about the epidemic, prophylactic measures and treatments [80,81,82][68][69][70]. Furthermore, through different channels of social media, bidirectional communication was implemented during phases of lockdown for people with health-related questions and/or to increase their own awareness [82,83][70][71]. This demand was partially linked to the current COVID-19 pandemic, and other needs were related to other illnesses in which patients needed remote care, relevant advice, and medical services (Figure 1) [84,85][72][73].
Access to trustable information is very important, and the spread of fake news has been a major threat for the credibility of social media during the COVID-19 pandemic [86][74]. In the first months of 2020, plenty of disinformation was shared social media that included conspiracy theories, in which bioweapons, the involvement of Bill Gates and the implementation the 5G network were introduced as the main causes or catalyzers of COVID-19 spread [87,88][75][76]. In contrast, following the approval of SARS-CoV-2 vaccines, social media was a crucial platform for the roll-out of vaccines. However, similar to previous vaccination campaigns, individuals used social media channels to spread conspiracy theories and antivaccination disinformation to disturb the immunization program and avoid vaccinations [89,90,91][77][78][79]. Unfortunately, the view rate of vaccine-opposing posts related to SARS-CoV-2 was much higher than the views of pro-vaccine messages [92,93,94,95][80][81][82][83]. Besides vaccine inequity, vaccine hesitancy, which counters public health messages, is now considered a real hurdle for vaccination against SARS-CoV-2 [96,97][84][85].
The current pandemic has been a trigger for users to innovate digital marketing. These initiatives are taken by users to intensify and amplify their activities. Often, people utilize more than one platform of social media. It allows them to disseminate information from one platform to another. This type of activity, which is called cross-platform use [79[67][86],98], is often applied by the antivaccine movement to support tweets with links to YouTube. This nimble strategy tries to boost the dispersal of vaccine-opposing videos by re-tweeting antivaccine contents [99][87]. Unfortunately, this strategy has not been thoroughly used by health authorities so far.
“EpiTweetr” is another innovative tool that was developed by the European Center for Diseases Control (ECDC). This tool allows epidemiologist to track possible emerging threats through searches on different platforms particularly Twitter. This tool automatically monitors, collects and processes data on Twitter and informs experts when the posted material on Twitter is not ordinary. For instance, when an increasing number of Tweets include keywords, such as the name of a pathogen, EpiTweetr automatically informs the end-user. The generated information is the result of massive data collection that has been filtered and validated by the tool. In detail, the signaling of a threat at the early stages is detected in Twitter by EpiTwittr; however, the validation of these data is necessary. Therefore, these signals are checked and approved by public health institutes and international organizations. However, to not miss potential risks, the received signals are rechecked in other platforms of social media as well.
Although EpiTweetr is a free package tool that can be used for any potential threat, the current pandemic helped the ECDC to improve this tool in terms of data collection, processing and visualization for end users. [100][88].
The current pandemic has highlighted the importance of mobile health apps and digital technologies on human health [101,102,103][89][90][91]. To combat the pandemic, huge numbers of mobile applications are available in different countries to share health information and/or trace contacts [104,105][92][93]. These applications can track the health situation of the users and prevent the dispersal of SARS-CoV-2 [106][94]. Eventually, these tools successfully reduced the global costs/health burden COVID-19 [107][95]. Apps such as mHealth have frequently been used during vaccination processes against COVID-19 and are currently used in campaigns for vaccination against HPV and influenza [108,109,110][96][97][98]. Undoubtedly, without digital marketing health tools, the roll-out of mass vaccinations would be more challenging. These tools have been used to contact eligible persons for vaccinations. Furthermore, individuals are regularly invited or reminded by phone message or app notifications to make an appointment and to ensure the completion of the full vaccination program (e.g., the administration of booster vaccines). In addition to the dispersal of vaccines, apps can be used to monitor post-vaccination side effects. After finalizing the vaccination program, a digital immunity certificate or vaccination passport can be issued, which is always presentable by vaccinees [111][99]. This final key service of digital health is online issued evidence, which allows vaccinees to travel and access public places without restrictions. Recent evaluations showed that the digital vaccine passport had a positive impact on re-opening economies [112][100]. Importantly, the usage of mobile applications during the COVID-19 pandemic was confronted with some restrictions that originated from cultural, demographic and political issues in some country [107,113,114][95][101][102]. For instance, using mHealth for contact tracing and the registration of vaccine passports is highly controversial in some regions [115][103].
The COVID-19 pandemic has not only accelerated the digitalization of the health sector but also added new concepts by the introduction of digital vaccination passports, a series of nexuses such as the “Diplomacy for digital health,” “Digital health for diplomacy,” and “Digital health in diplomacy”. These developments have become more widespread on a global scale [114,116,117,118,119][102][104][105][106][107]. Undoubtedly, the COVID-19 pandemic was an important scene for the development and implementation of digital marketing tools, including social media and mobile apps, for health-related issues at a global level. These tools assisted health policymakers to implement a series of efficient responses to pandemic and will certainly be applied in pandemic preparedness programs.

3. Engagement of Influencers in Public Health Issues

For market managers, the power of influencers is worthy [120][108]. Individuals with a large number of followers on social media can efficiently increase the selling rates of a products [121][109]. It has been shown that people like to follow individuals that have created their own follower community and are directly accessible and responsive to the audience. This contrasts with traditional celebrities that have a mass audience and are not tangible for ordinary people. Influencers, or micro-influencers, are trusted by the audience, and compared to known celebrities, their recommendations and advocations are often accepted by their followers [122,123][110][111]. Accordingly, influencers have an impact on decisions makers and can turn/drive the decisions of followers towards some specific products or opinions. There is an increasing body of evidence that social media influencers have a positive impact on public health issues [124,125][112][113] such as reducing smoking [126,127][114][115] and vaccination against HPV or influenza [95,128,129][83][116][117]. The use of influencers in public health is an intervention that can transmit tailored messages and inspire social media users to change their behaviors [95][83]. Furthermore, influencers can collaborate with public health policy makers and support them in the use of social media. Additionally, influencers’ population-targeted engagement has a positive impact on the health improvement of high-risk populations, e.g., immigrants [130,131,132,133,134][118][119][120][121][122].
It seems that all mentioned worthy experiences and knowledge from different disciplines in digital marketing have created a paved path for supporting health programs such as the elimination of widespread pathogens.

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