Live Longer with AI

By Tina Woods
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About this book

Live Longer with AI examines how the latest cutting-edge developments are helping us to live longer, healthier and better too. It compels us to stop thinking that health is about treating disease and start regarding it as our greatest personal and societal asset to protect.

The book discusses the impact that AI has on understanding the cellular basis of aging and how our genes are influenced by our environment – with the pandemic highlighting the interconnectedness of human and planetary health.

Author Tina Woods, founder and CEO of Collider Health and Collider Science, and the co-founder of Longevity International, has curated a panel of deeply insightful interviews with some of today’s brightest and most innovative thought leaders at the crossroads of health, technology and society.

Read what leading experts in health and technology are saying about the book:

"This is a handbook for the revolution!"

—Sir Muir Gray, Director, Optimal Ageing

"You can live longer and be happier if you make some changes – that is

the theme of this book. Well-written and compelling."

—Ben Page, CEO, Ipsos Mori

"Tina's book is a must-read for those who want to discover the future of health."

—José Luis Cordeiro, Fellow, World Academy of Art & Science;

Director, The Millennium Project; Vice Chair, Humanity Plus; Co-

Author of The Death of Death

About the consultant editor

Melissa Ream is a leading health and care strategist in the UK, leveraging user-driven design and artificial intelligence to design systems and support people to live healthier, longer lives.

Publication date:
September 2020
Publisher
Packt
Pages
602
ISBN
9781838646158

 

Introduction

The search for the secret of eternal youth and the quest for immortality have endured since humans life began—some would say this is part of our intrinsic survival instinct and is hardwired into our genetic code, which has evolved since life on earth began, about 3.6 billion years ago.

How did life begin? Where do we come from? Where do we get this insatiable curiosity that drives us, making us want to live longer, and for some of us, even forever?

These are questions I have been fascinated with ever since I was a little girl. I used to draw a lot, which helped me work out my ideas and process my obsessive curiosity about life. My drawings were everything from religious images depicting Jesus and Mary to anatomical drawings from textbooks on obstetrics showing the birth process. I thought I was destined to be a doctor, but then fell into a very different path after studying genetics.

Years later, with three sons born, through complete serendipity, I saw Sir Ken Robinson's wonderful TED Talk "Schools Kill Creativity." Seeing this 20-minute talk resulted in an epiphany moment—I suddenly realized what was "holding back" my middle son in school (hyperactivity, it turns out, which is a gift in so many ways, but not necessarily at school when you have to sit still at a desk for hours!). Compelled to read Robinson's book The Element, I realized for myself what was holding me back and what I was really interested in too.

Fundamentally, it is what drives people, and how they can either be blocked (though archaic educational systems, stultifying workplaces, or slow-moving institutions, for example) or be released, enabling them to achieve big things from seemingly small and inauspicious places when they find their purpose and their passion.

Just look at Greta Thunberg! Most people know her as the climate change activist that she is—most recently named by Time Magazine as the "Person of the Year." But did you know that she has Aspergers, was very depressed, and had no interest in eating, until she found her cause?

Will and purpose are what drive us to want to live longer. And I am not sure this is hardwired into our genes, like the survival instinct clearly is.

For me, I re-discovered my purpose when I hit "middle age" by going back to my entrepreneurial proclivities and becoming a sort of social entrepreneur. I started a social enterprise to inspire young people in science and technology; two years later, I started an innovation business in health, and then a year later I co-founded another venture in longevity.

A lot of what I do is about making connections with ideas and with people to drive change. Some of the stories from the extraordinary people I have met are in this book. I talked to scientists, entrepreneurs, corporate leaders, politicians, activists, and even the world's strongest man.

We all have our own exquisitely unique way of figuring out the path we take in our lives—and our personalities shape whether we follow, create, or destroy these paths in this most intricate map of life.

So back to the first question: how was life first created? Let's turn to the science.

 

Life's beginning

Theories still abound. The leading contender, detailed in the BBC's wonderful program The Secret of How Life on Earth Began[1], explains that it all started in hydrothermal events in the deep sea.

The water was tepid enough, and alkaline enough, for precursor organisms to form in the porous sections of the rock, which in effect acted like "cells." These cells contained essential chemicals, and when a natural proton gradient developed, so that the proton concentration was higher outside the inner membrane than inside the membrane, it enabled cells to store and release energy (protons are subatomic particles occurring in all atomic nuclei, with a positive electric charge equal in magnitude to that of an electron). These cells were the ideal place for metabolism to begin and for the first molecules, like ribonucleic acid (RNA), to form by harnessing the energy created by the gradient, which also created the conditions for a cell membrane to emerge.

Many scientists have been involved in solving the mystery of life. Most people have heard of Charles Darwin, who developed the theory of evolution, and he, together with other lesser known figures like the Russian Alexander Oparin, proposed various versions of theories that life started with chemicals that began to form microscopic structures in a "warm little pond."

In 1953, one of the greatest scientific discoveries of the 20th century, that of the double helix structure of the DNA code by Watson and Crick, redirected the search for the origin of life by revealing the extraordinary structure inside living cells.

All living things are made of cells, which contain DNA, the instructions that tell a cell what it will become. Most forms of life are made up of just one cell. Bacteria are the most well-known group and are ubiquitous, included in almost all the branches of the "tree of life," as published in Nature[2] in 2016. An analysis of the tree suggests every living thing—including humans—descended from a bacterium.

More recent research[3] by Gustavo Caetano-Anollés shows that viruses emerged before bacteria, supporting the idea that viruses stemmed from the cellular domain, which may shape the ongoing debate over when viruses first existed. Caetano-Anollés came up with this theory by exploring protein folding and the origins of transfer RNA (tRNA), which is central to every task a cell performs and thus essential to all life. He discovered that tRNAs of each of the super kingdoms diverged from the overall tree, allowing him to determine the order in which viruses and each of the super kingdoms diverged.

Caetano-Anollés also studied how viruses swap genes with a variety of cellular organisms[4]. His findings suggest that viruses share genes with organisms across the tree of life.

Driven by such exponential developments in understanding the biological assets codified in life on the planet, scientists are now racing to put together what they call the "book of life[5],"the genetic sequences of all complex species on the planet and the relationships between them. So far, they have only decoded 0.28 percent of the relevant DNA, but with DNA sequencing seeing a million-fold decrease in costs since 2003 (when human DNA was first mapped), this has made it viable for Juan Carlos Castilla-Rubio, chairman of SpaceTime Ventures, to launch the Earth BioGenome Project. This project aims to fully sequence everything on the planet, on land and in the oceans, that has cells with nuclei, over the next 10 years. When it reaches full sequencing capacity, the project will be generating about 1,000 to 2,000 times more data than that produced by Twitter and YouTube combined.

Significant advances in AI and causal machine learning will be needed to decode the many complex networks at work in this most extraordinary book of life, which will provide a new foundation for biological discovery and innovation at an unprecedented scale.

Castilla-Rubio's aim is to create a new inclusive bioeconomy that can help solve the majority of humanity's problems in energy, water, food, materials, healthcare, and transport in a rapidly changing climate. Preserving life on the planet is not only critical to our own survival as a species, but also to preserving nature's vast biological intelligence, which has been codified in the book of life over the past 3.5 billion years of evolution.

Today, biology has become fully digital, so DNA information can effectively be coded as ones and zeros and can thus be programmed to unleash a powerful nature-inspired innovation engine. In Castilla-Rubio's view, biology will be the most valuable enterprise in the 21st century, and far more valuable than monetizing people's data, but it depends on sharing the value of the assets fairly between and across nations. This is the dual mission of the Earth Bank of Codes[6] that the Earth BioGenome Project launched in partnership[7] with the World Economic Forum.

What is AI?

AI is generally defined as the ability of a machine to show intelligent behavior. It is often confused with "machine learning," which is the ability of an AI system to analyze raw data and from that learn how to make predictions from new data.

Deep learning combines AI with machine learning and was inspired by how the human brain works, with its system of neural networks. An artificial neural network is literally a computer program or algorithm that organizes millions or billions of transistors in a similar way to how a brain's neurons interconnect to transmit nerve impulses.

Deep learning is being used widely in consumer technology and increasingly in health and medical applications.

Castilla-Rubio makes the crucial point that to maximize the societal value and public benefit from decoding the book of life, we need to engineer governance on data access, data sharing, and the use of protocols[8] to avoid the vast concentration of wealth and power in a few companies, and to proactively identify and manage the risks and the many unintended consequences that the book of life will certainly unleash. Engineering longevity is a case in point, and we will explore the ethical considerations and social and economic disruptions that it may bring to society at large in this book.

 

Living forever

All this talk of life assets being reduced to ones and zeros would have been heresy before the 1800s, when most people believed in "vitalism"—the notion that living things were endowed with a magical property that distinguished them from inanimate objects. In religion, vitalism was thought to be responsible for animating the first humans, and also perpetuating the immortal soul.

This vitality—energy of life—is still the subject of so much research today. Scientists are busy trying to understand this life force of cells, and how to unlock the elixir that could keep us going, potentially forever.

Ever since becoming "human," we have sought to understand how we can become immortal—how to bottle up vitality. This is the stuff of ancient myths, Greek legends, and modern literature.

The "Epic of Gilgamesh" is an ancient Mesopotamian poem that tells the story of Gilgamesh, king of the city Uruk, who tragically loses his beloved friend Enkidu—this compels him to find the solution to prevent or overcome old age and death. On his journey, Gilgamesh discovers a flower that can achieve rejuvenation, but in the end doesn't use it. The moral of the story is that the king becomes wiser as a result of his journey and achieves a different kind of peace.

Gilgamesh has survived the ages and is enshrined as a character in popular culture too—as one of the Marvel Avengers with eternal powers including virtual indestructibility, limitless stamina, superhuman strength, and, of course, extreme longevity. But there are many other stories throughout the ages: Herodotus' Fountain of Youth, Rowling's philosopher's stone, Barrie's Neverland, and Ovid's Cumaean Sibyl. The list goes on in the search for eternal youth.

Fast forward to the present day and eternal youth may soon move out of the realms of myth[9] and into reality thanks to developing technologies. Three main technological shifts are driving the innovation in biology and longevity (according to Alex Zhavoronkov, a pioneer in AI and CEO of Insilico Medicine, who I interview in this book):

  1. DNA sequencing and synthesis: The cost of genetic sequencing has come down to $100 per person (compared to $24,000 only a few years ago[10]), so decoding our DNA is becoming accessible to the masses.
  2. AI, machine vision, and machine learning is rapidly developing.
  3. Biological data collection and manipulation in the lab is increasingly automated.

Combining these three applications presents a very powerful tool for AI, which can be categorized in the following ways according to Zhavoronkov[11]:

  • Machine learning refers to algorithms that can learn from and make predictions on data.
  • Deep learning is a subset of machine learning and is based on neural networks.
  • Reinforcement learning (RL) is a method of directing unsupervised machine learning through rewards and penalties.
  • Generative adversarial networks (GANs) are structured, probabilistic models for generating data and consist of two entities—the generator and the denominator. The denominator checks the authenticity of the data produced by the generator, whereas the generator tries to trick the denominator—it's kind of like learning to lie without getting caught.
  • Transfer learning is a machine learning method where the set of learned features of a model for a specific task is reused, or repurposed.

The applications of these tools within the field of aging research[12] offer tremendous opportunities.

 

AI and understanding health and aging

Aging is an almost universally unifying feature possessed by all living organisms, tissues, and cells, which I will describe in the next section.

Insilico Medicine uses GANs and RL to research "biomarkers of aging" and to deploy novel methods for analyzing the most important features underlying the aging process.

These techniques can also produce diverse synthetic molecular and patient data, and help to identify novel biological targets and molecular compounds with desired properties in much less time than traditional methods used by pharmaceutical companies.

In fact, using these techniques, Insilico Medicine managed to generate and validate a novel small molecule in just 46 days, designing the drug from scratch—compared to in two to three years by pharmaceutical companies following "accepted" practice. This was considered the "AlphaGo" moment in health and was published in Nature Biotechnology on September 2nd, 2019[13].

Insilico's work shows that AI can reduce the 99% preclinical failure rate in pharmaceutical and expedite the time it takes to go from R&D in drug discovery to real treatments. Not surprisingly, these developments are all of high interest to pharmaceutical companies that are threatened themselves by technological disruption, especially as AI talent is being siphoned by tech companies.

Modern AI will continue to drive the longevity[14] biotechnology industry, and contribute to the convergence[15] of countless areas of research across the course of a human life. Better use of public data, combined with digital tools and an understanding of the wider determinants of health, will give us the ability to better identify risks and help the people most in need before they become patients, which is a big focus of this book.

At the moment, AI devices work independently of one another, with data flowing through each device. The true power of AI can be unleashed when these devices are connected and algorithms can analyze datasets across these devices. The datasets collected from multiple sources can be described as "multimodal datasets." When these multimodal datasets are consolidated into one model, and algorithms can generate completely novel insights, spotting the patterns that would otherwise not be spotted in individual datasets, this is called "multimodal learning."

The two main benefits of multimodal learning lie in more robust predictions (since multiple sensors analyzing the same information can act as a double-check and make predictions more precise) and new pattern recognition (by combining multiple sensors).

The potential of multimodal learning to develop predictive and preventative health strategies is colossal. Insights from genetics, biological, behavioral, environmental, and financial data are currently under-utilized and there are significant opportunities to use AI and multimodal learning to predict disease and incentivize healthier living through harnessing such "life" data.

The opportunity for tech developers is getting these devices to learn, think, and work together to produce novel insights. This is the basis of research in aging biomarkers, for example, which could lead to the development of strategies to minimize the risk of dementia, or, indeed, cure it.

There are billions of petabytes of data flowing through AI devices every day and the volume will only increase in the years to come, which is why edge and quantum computing are so important. "Edge computing" is a distributed computing model that brings computation and data storage closer to the location where it is needed, such as devices and sensors. This dramatically increases processing times and will help with managing the proliferation of data that will only increase in years to come.

Indeed, 2020 marks the start of what's been called "our trillion-sensor world[16]" and data is quite clearly fueling the economy—healthcare, finance, insurance, education, and beyond. Big Tech knows this, which is why companies are investing so heavily in health.

 

The Big Tech takeover of our health

Leading tech futurist Peter Diamandis[17] predicts Apple and Amazon will come up with a service where a person pays a company to keep them healthy, rather than to cover the cost of illness, based on their health history and daily activities. This approach makes so much sense. This is where China and other Asian countries are ahead of the game: the basic philosophy of Chinese medicine that has been practiced for over 3,000 years is that prevention of disease and maintenance of health is the main priority of doctors. The doctor is paid a retainer to keep their patients healthy.

But do we want Big Tech to "take over" our health? As the use of technology in our lives becomes more widespread, social, legal, and ethical issues will grow in importance[18].

Amy Webb, professor of strategic foresight[47] at New York University's Stern School of Business, warns of scenarios in the future when Amazon, Google, and Apple could run our households, as well as our health. One day, smart refrigerators, for example, could be calling you out for snacking between meals and smart garages could start telling you to walk to work on a sunny day!

Amazon has big plans in healthcare with Alexa, which is already helping people with dementia in their homes to live independently for longer. The company has also launched its own health clinic[19] for employees, a program called Amazon Care that provides virtual and in-person urgent care, preventative care, and medication delivery for Amazon employees enrolled in its Amazon insurance plan. Amazon is also working on a health project with JP Morgan and Berkshire Hathaway called Haven[20].

Amazon has also been active in its response to the pandemic, from prioritizing delivery for high-need items to launching a $20 million AWS Diagnostics initiative. Amazon Care also announced a partnership with the Gates Foundation-sponsored Seattle Coronavirus Assessment Network to deliver home testing kits for coronavirus in Seattle.

Just recently, Amazon announced it is getting into the health gadget market with a new fitness band and subscription service called Halo[48]. Unlike the Apple Watch or basic Fitbits, the Halo Band doesn’t have a screen but comes with an app with standard fitness tracking functionality but also two novel (some would say disturbing) features: creating 3D scans of your body fat and listening to the emotion in your voice.

Google is active in health and healthcare through the Alphabet company Verily[21] and its Google Fit ecosystem for wearables[22]. One of its most notable commercial activities has been the recent $2.1 billion acquisition of Fitbit.

Google's core expertise in search is being applied to make it easier for doctors to search medical records, and to improve the quality of health-related search results for consumers across Google and YouTube.

On the technological side, some of Google's innovations are mind-blowing. DeepMind recently announced a new deep learning tool called AlphaFold[23], which can predict the innumerable ways in which various proteins fold by analyzing their amino acid sequences. The ability to predict a protein's shape is useful to scientists because it is fundamental to understanding its role within the body, as well as diagnosing and treating diseases believed to be caused by misfolded proteins, such as Alzheimer's[24], Parkinson's[25], Huntington's[26], and cystic fibrosis[27]. Understanding protein folding using tools like AlphaFold will aid drug discovery to fight today's most intractable diseases, including COVID-19.

Apple is getting into healthcare through its on-site employee medical clinics, Apple HealthKit, and Apple Watch. It is putting its efforts into harnessing the value of lifestyle data to help understand what keeps us healthy and develop the technologies to keep us well.

Some interesting Big Tech partnerships have formed in response to COVID-19. For example, Apple and Google announced in April 2020 that they are partnering to develop and deploy an automatic, anonymous, Bluetooth-based contact tracing technology for COVID-19, which is now being used in many countries, including the US and parts of Europe.

Big Tech companies can easily build risk profiles based on all the metadata they have. Apple and Amazon can already see what we buy, how active we are, and what we eat via Apple Pay, Apple Watch, Amazon Fresh, and Whole Foods. But Big Tech still can't really learn the same way humans learn. Our intelligence is still greater than theirs, but maybe not for long.

In July 2019, Microsoft invested $1 billion[28] in the Elon Musk-founded AI venture OpenAI, helping toward its efforts to build artificial general intelligence (AGI) that can rival and surpass the cognitive capabilities of humans. OpenAI's mission is to ensure that AGI—which they mean as, highly autonomous systems that outperform humans at most economically valuable work—benefits all of humanity. In its charter, the venture states that it will actively cooperate with other research and policy institutions to create a global community working together to address AGI's global challenges. In an open letter, it said: "We cannot predict what we might achieve when this intelligence is magnified by the tools AI may provide, but the eradication of disease and poverty are not unfathomable."

Once AI can learn and solve problems in similar ways to humans, it throws up more questions than answers in fundamental areas, and especially ethics.

In his book Superintelligence, Professor Nick Bostrom, director of the Future of Humanity Institute at the University of Oxford, analyzes the steps needed to develop superintelligence, and the ways in which humanity may or may not be able to control what emerges, along with the kind of ethical thinking that is needed. Bostrom suggests[29] that creating AI to understand human values is essential to ensuring we will be safe. But inputting individual lines of code to teach a superintelligent robot what humans care about would be a nearly impossible task due to the complexity of human emotions and cultural differences.

Cultural differences are at the heart of how AI is being developed around the world, and the starkest differences are between China and the US, which are both on a quest to lead the world in AI.

 

China winning the global AI race

So far, China is winning. The rise of China as a leading player in AI research has been revealed by new figures showing how quickly the country is gaining on the US[30]. The 2019 AI Index Report, put together by US academics and researchers, found that Chinese companies are on average receiving millions of dollars more in investment than their Western counterparts.

Why and how is China becoming so powerful here? For a start, China has developed a completely different version of the internet than the one the Westernized world is using. And it is all based on phone technology using WeChat, a messaging platform that is very much like WhatsApp. WeChat was developed by Tencent, a social media giant, and it has quite literally exploded, becoming ubiquitous in Chinese business, culture, and society. WeChat has become completely integrated into people's lives simply because all transactions can be accomplished using a tool in the palm of your hand.

Its rise has been quick and is accelerating. WeChat now has more than a billion monthly active users (1.17 billion as of Q1 2020[31]) and a significant portion of all Chinese data traffic. It is the "app for everything," acting as a social network, a payment system, a communication medium, and, perhaps most ambitiously, the infrastructure for business transactions through its "mini programs," which resemble Facebook pages.

The number of these mini programs is fast rising—it includes big companies like McDonald's as well as the many tiny businesses run in local communities—and on last count is equal to half the number of iOS apps available in Apple's App Store[32]. Because the mini programs run inside WeChat, business customers don't have to sign up, log in, or add their credit card numbers, so it is easy and seamless. It is supremely clever.

In 2017, the Chinese Government published its ambitious national plan to become a global leader in AI research by 2030, with healthcare listed as one of four core research areas during the first wave of the plan. WeChat will be a core part of this plan, with the majority of China's 38,000 medical institutions registered on the platform, enabling patients to engage digitally.

WeChat is now used to self-diagnose, look up drug information, search medical information, schedule doctor appointments, and process healthcare payments.

Not surprisingly, WeChat gave China a significant advantage in managing the COVID-19 pandemic too. This includes its "Health Check" app, which takes self-reported data about places visited and symptoms to generate an identifying QR code that is displayed in green, orange, or red, corresponding to free movement and 7-day and 14-day quarantines.

In parallel with the explosion of WeChat, the Chinese Government is building a so-called "social credit system[33]" that aims to collect and analyze information on its 1.4 billion citizens and rate millions of corporations, both domestic and foreign. Its goal is to keep local governments, businesses, and people in compliance with national directives.

Many Western commentators talk of social credit policy only in very negative terms, through its potential to abuse human rights and control citizens' behavior too heavily. This, of course, is a valid, justified position in many respects.

However, on the technological front, it is clever as a gigantic data sharing platform, with a universal "national API" allowing data from over 1 billion citizens to be accessed, shared, and leveraged. Adding in the magic dust of multimodal learning and edge computing, you can easily understand why China is leading the race in AI.

Through its social credit policy, China guides its citizens' behavior in ingenious ways—just like Big Tech does, but in the context of a completely different cultural, political, and ethical framework.

Businesses are imaginatively nudged to behave as model companies. Using AI, the system can rate firms for "credibility" or "sincerity." The higher the score, the more benefits companies have access to, but it goes the other way too—with blacklisted companies potentially being denied access to cheap loans or facing higher import and export taxes. For international businesses, the system looks at business contracts, social responsibility, regulatory compliance, and how many Communist Party members they employ to give a score.

In the West, China's Government is typically seen as a "citizen controller," but in China, they see the Government through a different cultural lens—as a record keeper, whose central job is to consolidate Government files. Keeping a central database of social credit records means that important information can be accessed by state agencies, city governments, banks, industry associations, and the general public, and data on individuals and companies can inform their own evaluations.

While China's Government does not issue social credit scores to every individual (as of September 2019, it has not issued a social credit score to any Chinese citizen), what it is doing is encouraging local governments to use social credit data to develop their own scoring systems for local residents.

Several cities in China have already rolled out such systems on a trial basis, and many more are gearing up. "My Nanjing" is a good example, tying together city transportation, environmental data, hospitals, utility providers, civil affairs bureaus, courts, schools, local financial institutions, and charitable organizations into a one-stop shop for citizen services. Once logged in, citizens are able to view certain aspects of their social credit files, including records of any state-issued awards and honors, unpaid bills, traffic violations, and any legal violations and administrative penalties received.

While My Nanjing doesn't issue social credit scores (yet), it does include a points system that nudges and rewards people for behavior that protects the environment, while improving their health. "Green points" are assigned to users based on their public transportation choices, with points earned for walking, biking, taking the bus, or riding the subway. Citizens can earn double points for not driving on heavily polluted days.

Doesn't this sound like something the West should have in place?

 

The EU as a leader in "ethical AI"

Indeed, the features on the My Nanjing app look remarkably similar to what Estonians are able to access via their e-Estonia program. Estonian citizens can access all their records, including health records, and choose to share them with anyone they wish.

Note the words "citizen" and "choose"—this is the point of difference between how China and the European Union (EU) deal with data. It is the citizen's choice in the EU—enshrined by the General Data Protection Regulation (GDPR)—that stipulates that citizens are the custodians of their data and can choose how and with whom to share it.

While the EU is rarely considered a leading player in the development of AI, certain EU countries like Estonia and Finland are pioneering ethical ways of accessing and sharing data in a social contract between the citizen and state that is very different to that in the US and China.

I visited Estonia and Finland in April 2019 as part of a study tour with Melissa Ream (an AI expert in health and adviser for this book). We organized the study tour for senior health stakeholders as part of the National Academic Health Science Network AI Program in 2019 to see what we could learn and take back into the UK scenario.

We learned a lot, but, most important of all, we learned how important trust is before data sharing can generate true rewards for people and society. The extraordinary potential of data lies in its value as a tradable public asset or societal good for the benefit of all.

Estonia is a digitally enabled society through its e-Estonia program. Nearly every one of Estonia's 1.3 million citizens has an ID card, which is much more than simply a legal photo ID. Technically, it is a mandatory national card with a chip that carries embedded files, and using 2048-bit public key encryption, it can function as definitive proof of ID in an electronic environment.

Citizens have unparalleled access to a range of digital services through a trusted data exchange (called the "X-Road"), built on an open and secure data architecture. Citizens can lock and unlock access to a range of services and see which professionals have logged in (after granting access).

Estonia was the first nation in history to offer internet voting in a nationwide election in 2005. The i-Voting system allows citizens to vote from any internet-connected computer anywhere in the world. In health, over 95% of the data generated by hospitals and doctors has been digitized, and blockchain technology is used to assure the integrity of stored electronic medical records, as well as system access logs.

Finland is piloting the use of Estonia's X-Road to adopt as its trusted data exchange, enabling it to collaborate beyond borders (why have borders in a digital utopia, right?). It also passed a law in April 2019 allowing for secondary use of data, which will significantly accelerate innovation, particularly with AI.

SITRA, the Finnish innovation agency, is pioneering an ethical open data ecosystem through its work on the IHAN (International Human Account Network)[34], a "human-driven data economy" involving the creation of a method for data exchange and a set of European-level rules and guidelines for the ethical use of data.

The IHAN standard is the "human" equivalent of the IBAN banking standard. Finland has a strong well-being culture, empowered through access to data; citizens take far more personal responsibility for their health than most other developed nations as a result.

Overall, these data models all highlight how culture will influence the use of AI in our lives and the role of the citizen versus the role of the state in issues linked to privacy, security, fairness, justice, liberty, and human rights. There is something to learn from all of them.

Countries are paying increasing attention to the ethics of AI. For example, the UK set up the Centre for Data Ethics and Innovation[35] in 2018. Singapore is establishing an advisory council on the ethical use of AI and data[36]. Australia's chief scientist has called for more regulation of AI[37], and the National Institution for Transforming India, an Indian Government think tank, has proposed a consortium of ethics councils[38].

In March 2019, the Leverhulme Centre for the Future of Intelligence published a survey of the EU's AI ecosystem[39], which highlighted the key differences between the EU, US, and China. The report revealed how the EU is more focused on ethics compared to the US and China, but also flagged how its leadership in AI is being hampered through less Venture Capitalist (VC) investment and startup funding. The EU is beginning to address the funding challenges through such initiatives as the VentureEU fund and the European Fund for Strategic Investment, which may also ease the "brain drain" of talented researchers and developers going to other continents that are able to afford higher salaries through better-funded ventures.

It is clear that brain drain, skills, and jobs will all be impacted by the AI revolution. According to Yuval Noah Harari[40], poorer countries will suffer as there will be less demand for the unskilled labor they've typically provided and the more developed countries will be able to invest in the specialized skills to meet higher demand for jobs in the digital era.

More than a decade ago, Thomas Friedman[41] argued that the force of technology is the key driver in flattening the world. However, according to futurist Azeem Azhar[42], far from flattening the world, technologies have fractalized it, and location matters. Indeed, there are complex geostrategic maneuvers at work between China and America in a world where existing institutions, such as the G7 or United Nations, have less impact.

After months of slogging it out against the US trade sanctions, some of China's most profitable tech companies are looking to reduce their exposure to the US[43]. Recently, the US succeeded in changing Britain's decision to include Huawei as one of its core partners to bring in 5G technology—much to the anger of China. The COVID-19 pandemic is significantly exacerbating these tensions.

 

The move from global to local

Azhar predicts that national governments will increasingly insist on adhering to local laws and standards. Indeed, "localism" seems to be in vogue. For example, India is insisting that critical data relating to its businesses and citizens reside within India[44]. In the UK, there are interesting local initiatives being developed through the Connected Health Cities program, which uses a data sharing "consent wireframe" devised and overseen by local citizens, who decide how their data might be shared for anonymized, pseudonymized, and identifiable purposes. The level of transparency enabled through an audit feedback loop (which confirms when personal data was used and what it was used for) has been central to developing and maintaining trust in the system.

Will such examples of "localism" swing the pendulum away from "globalism"? Could we ever create global open standards? Would nations adhere to them?

These are important questions as nations build their capabilities in data and AI to solve the world's problems.

The experience of COVID-19 has also thrown up big questions on state authoritarianism versus citizen empowerment—and privacy is a big concern for many. But the issue at the heart of everything is trust—people need to trust science, business, the government, and the media. People need to trust those institutions that hold such power and influence over their lives.

Taiwan's response to the pandemic is a shining example of how tech can build trust, accountability, and democracy by harnessing citizen action[45]. In the earliest stages of the crisis, a month before the World Health Organization (WHO) declared COVID-19 a global pandemic, Howard Wu, a clever "citizen coder," developed a crowdsourcing app using Google Maps where people could input stocks of masks in pharmacies to help people find them. As the app went viral, an equally clever government digital minister, Audrey Tang, spotted the opportunity to extend the availability of masks by distributing them through pharmacies affiliated with Taiwan's National Health Insurance (NIH) system, keeping track of them in real time. Tang then created an open-source portal for mask data to be open to the general public and invited other tech activists, in addition to Wu, to contribute too. Taiwan's collectivist approach to dealing with the pandemic is being recognized globally as a leading exemplar showing what open data, open governance, and collaboration between citizens and government can achieve.

 

Professor Baron Peter Piot

World expert in global health; Director of the London School of Hygiene and Tropical Medicine; Handa professor of global health

I met Peter at the National Academy of Medicine Healthy Longevity Global event that took place on 3-4 February, 2020, in Singapore. I had been asked to speak about the work we were doing with the APPG for Longevity, 10 days before we were due to launch The Health of the Nation Strategy, and I met Peter in one of the breaks.

COVID-19 was definitely "in the air," so to speak, and on people's minds—we had to use sanitizer before entering the conference suite and I remember feeling distinctly uneasy when someone started coughing in the row in front of me at one of the sessions.

Back from Singapore, I followed up with Peter to arrange a coffee in London, and a date was set for 23rd March to meet at his office. This, of course, was a week after the first day of the official UK lockdown on 16th March. Unsurprisingly, Peter was getting immersed in the UK Government's response to COVID-19, and his office asked to reschedule the meeting.

I followed up in April and was told that Peter was unwell, but I did not realize that at the time he was battling the COVID-19 infection himself, suffering terribly from "the revenge of the virus" as he described it when he had recovered.

He wrote about his experience very movingly in Science in an article headlined "Finally, a virus got me." He was compelled to publish the piece by a desire to communicate that COVID-19 is about people first and foremost, not just about the statistics that dominated the headlines. He also wanted to highlight that it is potentially far more serious than flu, with chronic morbidity and other long-term sequelae for some.

It turns out that Peter started suffering from the symptoms of COVID-19, including fever and a sharp headache, on 19th March (he had started working from home on the 16th). He tested positive in a private clinic on the 25th March, as he had suspected. Peter initially thought the infection would pass in a straightforward manner, being fit and healthy, with his age (71) being the only risk factor. He continued his work for a while as a special adviser to the European Commission President, Ursula von der Leyen.

But the fever persisted, and complete exhaustion set in and was getting progressively worse. On the recommendation of a doctor friend, Peter went to get examined on 1st April, and discovered he had severe oxygen deficiency and severe pneumonia typical of COVID-19, as well as bacterial pneumonia.

He was hospitalized but tested negative for the virus at that time (this is also typical: the virus disappears, but its consequences linger for weeks).

Peter says this in his personal account: "I shared a room with a homeless person, a Colombian cleaner, and a man from Bangladesh—all three diabetics, incidentally, which is consistent with the known picture of the disease. The days and nights were lonely because no one had the energy to talk…but I always had that question going around in my head: how will I be when I get out of this?….after fighting viruses all over the world for more than 40 years, I have become an expert in infections…they got me, I sometimes thought. I have devoted my life to fighting viruses and finally, they get their revenge."

My interview with Peter was on the 29th June. By then, he had been interviewed by many newspapers and broadcasters around the world, including the New York Times and the BBC, on his personal experience and what the pandemic is teaching the world. I was obviously very grateful to Peter that he kept our appointment!

Peter has an extraordinary background. His official biography is rich with the numerous prestigious posts he has held over his 40 years as an expert, but what stands out is his pursuit of access to health for all.

Peter co-discovered the Ebola virus in Zaire in 1976 while working at the Institute of Tropical Medicine in Antwerp. He was one of the leading critics of the UK, UN, and WHO's response to the Ebola outbreak in West Africa in 2014, which he thought was too slow. In 2014, he was named "TIME Person of the Year" ("The Ebola Fighters").

He also led research on HIV/AIDS, sexually transmitted diseases, and women's health, mostly in sub-Saharan Africa. He was the founding executive director of UNAIDS and Under-Secretary-General of the UN from 1995 to 2008, and an associate director of the Global Program on AIDS of WHO.

Under his leadership, UNAIDS became the chief advocate for worldwide action against AIDS, also spearheading UN reform by bringing together 10 UN system organizations.

Peter is the first chair of Her Majesty's Government's Strategic Coherence of ODA-funded Research (SCOR) board and is also a special advisor to the president of the European Commission on research and innovation for COVID-19. He is a member of the board for the Coalition for Epidemic Preparedness Innovations (CEPI).

Peter has published over 600 scientific articles and 17 books, including his memoir No Time to Lose in 2012 and AIDS Between Science and Politics in 2015.

Tina Woods: You've been in the field of virology for so many years. You've seen viruses grip communities and nations, and then suddenly you caught COVID-19 yourself; what surprised you about the experience? Did your experience as a patient match up to what you would have expected as a professional?

Peter Piot: Good question; I actually never expected I would get ill! I've never been ill in my whole life, or seriously sick, so I've been lucky at 71. I never thought about it. I didn't assume I was invincible or immune to COVID-19, but getting sick was just not on my radar screen. When I got it, I thought—as I believe the majority of people thought, as the consensus was then—that I'd be OK. I thought that with COVID-19, either you're asymptomatic or it's a bit like the flu, or sometimes a bad flu; 1% of those infected die, and they're older people anyway, and they have pre-existing conditions.

We were primed to think of it as if those deaths don't count. The more I thought about it afterward, I got really angry at some points. It's a very eugenic discourse and that's reflected in how in many countries—including the UK—care homes were treated seriously, or not. That's actually one of the reasons I came out of the shadows to talk about this.

I told the world that there is a lot in between. This disease is much more nuanced, and there's a lot of chronic sequelae—chronic conditions that could be with you forever that hang around as a result of this disease.

On the other hand, once I was admitted to the hospital, I became a patient 100%. I didn't try to be the doctor. I've said before that I'm not the type of person who tells a taxi driver which route to take.

Tina Woods: Yeah! You let them look after you, then?

Peter Piot: I let them do their job, yes.

I was also so exhausted, and actually quite confused, so I was not capable of thinking clearly. I think, retrospectively, it was a good experience. I mean, it was a terrifying experience, yes, but it was good to feel the virus inside, and not just look at it and try to defeat it, in some way or another, from the outside.

My mother tongue is Dutch, and we have this term "ervaringsdeskundige," which means "experience expert." It comes from the social side of government, from social policy-making. You wouldn't dream of developing policies for, let's say, the elderly, by only speaking to experts and not by involving people who are old. I come from the AIDS movement, and people living with HIV have been involved from really quite early on as part of our reaction to HIV/AIDS.

I think what getting infected has also done for me is make it clear that the official communication on COVID-19 has not been about people; it's been about flattening the curve. Certainly, the UK was probably an extreme example; you had ministers, even the Prime Minister, giving lectures about the reproductive rate (R0) and flattening the curve. It was about saving the NHS, and so on; and then, as an afterthought, it was about saving lives.

That's why I think there was so much interest in my story. I gave the first interview to a Flemish weekly magazine, because I'm very well known in Belgium, and that was to help raise awareness. Then, when the interview was taken up by Science, it got millions of views. That was very interesting to me; it showed that there was a gap in the whole communication strategy and the storytelling.

Tina Woods: Where do you think, internationally, the public health messages were right? I know we certainly have got it wrong in the UK on a number of fronts, but what do you think the message should have been?

Peter Piot: Well, of course, the benefit of hindsight is always there. I'm probably a bit milder than many other people about all the mistakes we've collectively made, but the most important message is that the severity of this epidemic is unprecedented. I think that the communication of that message wasn't very well done.

I gave some talks about this with non-health experts in Singapore, but I don't think people internalize how contagious it is. Because of that, acting early is one of the most important things. That's one lesson that's particularly true for anything that's contagious; if you can nip it in the bud, you basically prevent not only the next generation of infections but the nth generation. In essence, by preventing transmission in the beginning, you can prevent the whole chain that comes afterward.

COVID-19 also illustrates how important it is to prevent the development of obesity, diabetes, and cardiovascular disease through healthy lifestyles. I probably was lucky because I am not ill; I have no underlying conditions.

On the other hand, I got some messages from friends saying, "You'll be fine; you're a strong person."

In the hospital, I'm there thinking, "Well, there are certain things that your body does that are not under your control." You can't do anything at that moment of crisis, but you can make yourself more resilient as an individual or as a society.

The most important lesson for a government is to act early and at a scale that makes a difference, and an accompanying issue is maintaining enough trust in the government to do that. That's a big difference in what we've been seeing in Eastern Asia compared to Europe. There's one thing they had in Singapore, in Hong Kong, in Taiwan, and in South Korea: the SARS experience.

Tina Woods: Of course, they learned a lot from that.

Peter Piot: Yes, but we've also had lots of events to learn from. Afterward, we always say, "No, never ever again," and so on, and then we start again as if it were erased. Where SARS hit, those people learned from it, but more importantly, they set up a system to be ready when the next thing happened. It's not enough to learn and to say that we'll remember; you need to institutionalize that.

Internalizing the necessary changes, and making them part of the culture, is another essential element in making these changes stick. For example, in Japan, since the Spanish flu, people wear face masks even when they have a stupid cold to avoid infecting others. It's become part of the collective consciousness, and part of what's considered good behavior for the community.

Tina Woods: The masks are worn in a sense of collectivism, for the public good, then?

Peter Piot: Yes, the collective good. When in Japan, or in Singapore, people wear a face mask or a mouth mask, but it's not to protect themselves: it's to avoid infecting others. It took me a while to understand that; I've been going to Japan and East Asia for a long, long time, and at first, I thought, "These are people who are scared of others." I was completely wrong.

I've had a very hard time understanding the resistance to face masks and mouth masks. It's there in individuals as well as governments. I think in the UK, they still haven't said that it's compulsory [this advice has partially changed since this interview] and you can even hear resistance from scientists who say that the evidence is weak, and so on and so forth.

But they're cheap, there are no side effects, you can even make it yourself, and it can be sexy!

Tina Woods: I have seen some sexy face masks and some real creativity there! I think, if nothing else, it's a reminder of the fact that this is serious. That's what I found when I put the face mask on; initially, I found it very odd, but it's a very good reminder.

Peter Piot: I wear it as a reminder, too. I'm not contagious to anybody, and I assume I can't be infected because I have immunity.

Tina Woods: Is that true, though? Do we know for sure how long the immunity lasts?

Peter Piot: There's a lot we don't know, but frankly, if that's not the case, then a vaccine is impossible. In any case, I wear my mask whenever I go into a cubicle or an inside space in a shop because we go every morning to buy bread and vegetables, and what have you. I also always wear it on public transport, just as a way to let people know that hey, this change is coming.

Tina Woods: I think the key messages in what you've said are that governments and individuals need to act early, and that prevention, by remaining in good health, is important. Is there anything else you want to add to that?

Peter Piot: We need to be ready, meaning that we have a combination of systems in place: real-time intelligence on what is going on, cultural attitudes, and mental preparation. I think that these are the key issues. As a general reflection, you can assume that societies that are more cohesive are more resilient and are therefore better prepared for shocks like this.

Tina Woods: The sheer level of infections and deaths in care homes was a bit shocking, wasn't it? What do you think it told us about our values as a society?

Peter Piot: It was very shocking. As I've said, my work on HIV and epidemics has revealed how they exacerbate the fault lines in society, and make inequalities worse.

With COVID-19, the fault line that worsened the most in my opinion was how we treat our elderly; on the other hand, it revealed once again the higher vulnerability of ethnic minorities. Although we haven't totally understood why that's the case, in the US, a big part of that vulnerability is due to limited access to care. In the UK, that factor's a bit less important because we've got the NHS, but there are still maybe some genetic factors, as well as social discrimination and other social factors that are relevant. However, we've seen the higher vulnerability of ethnic minorities being exacerbated by different epidemics before.

The way the elderly have been affected by COVID-19, though, is something new. I mean that in the sense that I can't think of anything else that has revealed just how badly we are dealing with our elderly citizens. I've been in elderly care homes, though I'm not familiar with the British system. I know the Belgian system, because my parents were part of that before they died. My mother died in September, but she died with dignity, at a moment that she had chosen to die, which is something that's been possible in Belgium since '96. The economic situation and the housing situation mean that for most people, it's no longer possible to have, say, three generations in one home as used to be the case. So, what do we do when you're no longer productive, or when you become a bit of a nuisance for everybody? We park you in a pre-mortuary type of institution.

If you've got the money, then you can have even a butler and all that. There is an enormous class dimension in the quality of these institutions. But if you seriously think about it, this is how your old age is going to be; how comfortable you are in it depends on whether you have the money to affect it. Plus, of course, it depends whether you're abandoned by your family, and so on. Another revealer of this problem we have with how we treat our elderly citizens was the heatwaves in France in 2019. I read articles about old people who died during those heatwaves on their own, and it took two or three weeks to find out they were dead. It's so sad, this loneliness.

I think that it's interesting in the UK that the Department of Health changed its name to the Department of Health and Social Care in 2018. I never got a sense that social care was taken seriously budgetary-wise, and I'm a bit surprised when you look at it politically because older people are first in politics. They vote the most; they put pressure on their MPs; and they're well organized in many countries. Despite that, social care has been absent from the agenda of the politically active older generation. I never understood that. It may be completely unfair what I'm saying because it's a field I'm only viewing from the outside. I don't know for sure, but I've never seen a campaign in the media, or people testifying to how bad it is.

Tina Woods: All the data shows it's the most vulnerable who are hardest hit by COVID-19: those in deprived areas, the elderly, and the already unwell. Do you think there are any long-lasting changes that will come out of this pandemic?

Peter Piot: Well, I always have hope, I'm an optimist. Experience shows that it's not always the case. That's why it's important, I think, to understand that today we're in the midst of a crisis. It's not over. With this pandemic, we're only at the beginning; we're right in the midst of it. That means it's definitely worthwhile to take stock now and learn for the next wave. We need to put in place now, or start a discussion about, what we need not only for this next wave but also for the next epidemic, in 5 years' or 10 years' time. We need to start now, and not wait until it's all over, and when it no longer has any use.

Tina Woods: There's been a rise in nationalism and putting one's own country first during the pandemic, but there's a culture of openness that we need in terms of data sharing to help stop future pandemics. What do you think nations, and the global community of nations, need to do moving forward?

Peter Piot: First of all, we need to take a good and hard look at what happened. That's not about who's to blame—I don't think that's very useful—but about what the lessons are that we can learn.

We need to consider the immediate future, and the next outbreaks and waves. Next, we can start thinking in the longer term. For example, take Germany in Europe. I think Germany and Denmark probably had and have the best responses, and that's reflected in the lowest death rates and the lowest infection rates.

Part of that might be the backgrounds of the leaders—the German leader is a physicist. I'm not saying that people with a medical or scientific background make better politicians, but I do think there is an immediate understanding there of what needs doing; there is far more resolute leadership early on. There's been an interesting combination of strong national leadership and local implementation in the individual Länder, the federal areas of Germany. The central leadership gave a lot of resources and authority to local authorities.

In the UK—I knew this, but I hadn't understood how bad it is—it's a hyper-centralized country. No wonder Public Health England wanted to control everything to do with testing, and no wonder they were unable to do it, particularly since it was a home-based test. They weren't working with businesses, or with private firms, or with universities and labs. It's all about logistics, organization, and coordination when dealing with pandemics; it's all about communication. Government test stats show that these are not strengths of governments in general. Letting go is essential. By that, I mean that the UK Government needs to provide the resources, have the policies, take the decisions, and then let people do things. That's what's happened in other countries.

Tina Woods: That's something that we're also exploring in the All-Party Parliamentary Group that we're doing with the Health of the Nation: building up resilience for the next epidemic, with this concept we're calling decentralized health resilience. It's about health in our communities, starting individually with taking care of ourselves and building up from there and mobilizing local and regional networks to act quickly. There's a role for central leadership, but the implementation is very much driven from the ground up. Which countries are effective models that we could look to for inspiration, moving forward?

Peter Piot: National leadership is the easier one in a sense, because countries that have done well have seen strong leadership at the top. That's why when people say this is a public health crisis, I say no, this is a societal crisis, which requires the leadership of whoever is in charge in the country—prime minister, president, or whatever. We've seen it in Singapore, in Thailand, in South Korea, and in Vietnam.

There's another interesting lesson in the transition to the second part: Vietnam is a hyper-centralized society and politically controlled, yet the response has been very locally driven. Rather than to go for a nationwide lockdown, they did it sometimes as locally as by neighborhood, by company, by factory, or by schools. Rather than go for the bulldozer approach, which we've been using in Europe, they went for a more granular, more targeted or tailor-made approach. That's, I think, where we are now. This consensus is what we need to cope with the second wave and with particular local outbreaks. You used the term "localized resilience," is that correct?

Tina Woods: Decentralized health resilience. It's an approach where you're building from the bottom upward; it's this notion of decentralized networks.

Peter Piot: I like that a lot. I mean, it's nice to have the NHS, but it's also problematic to have the NHS as it is now with the hyper-centralized system. When you go to procurement and action, it's too slow and it's too heavy. And I never understood why one of the strengths of the NHS, primary care and GPs, who are much more connected to the community than hospitals, were excluded from the response.

Tina Woods: What key legacy points, moving forward, do you think we need to take on board as a country?

Peter Piot: I think we need to mobilize resources, not just money, to invest in new systems. In the UK, we can see that Public Health England is not fully equipped to the task. Frankly, its budget—the budget for public health and for the prevention of disease—has been cut. (Since this interview, the decision was taken in August 2020 to disband Public Health England; in its place will be the formation of National Institute for Health Protection (NIHP) that will absorb the pandemic response unit of PHE and combine it with the NHS Test and Trace service and the Joint Biosecurity Centre.) This is not recent. This has been going on, I think, from even when Labor was in power. I think it's been going down every year, because there's pressure to put money into the NHS into curative things, rather than prevention (since 2014, it is estimated that £850 million has been cut from public health budgets in England[46]). That's also why care for the elderly and for others has been left out. Then, we spend all that money when someone from a care home has to be hospitalized, at enormous cost.

It doesn't make sense. Working out how to fix that, in political terms, is massively important.

Tina Woods: Is it fair to say that one of the key takeaways from the pandemic is that we need to focus more on prevention?

Peter Piot: Absolutely. But then, you see the rhetoric again; the UK Prime Minister, Boris Johnson, said, "We are going to build 100 new hospitals." I'm not sure that we need that, but that's very concrete. Compare that to saying, "We are going to cut obesity and diabetes and so on, by doing this and that." They're not very popular measures, but would contribute far more to the health of the nation than 100 hospitals. I am pleased to see that the PM and the Government are now going to tackle obesity.

Tina Woods: Do you think viruses sometimes get overlooked when we talk about planetary health and respecting the environment?

Peter Piot: Of course. I'm biased because I've spent much of my professional life dealing with viruses, but they do, it's true.

I remember when I was in my last year in medical school in Ghent in Belgium, and I did some of what today would be called career counseling; I don't think that term existed in '73! I said I wanted to study infectious diseases, and I wanted to specialize in that. All my professors said, "No, no, no! There's no future in infectious diseases. We've got antibiotics. We've got hygiene and vaccines." I still went for it, being a bit stubborn and thinking that you need to follow your passion.

There are cancers caused by viruses. When you think of liver cancer, you should think of hepatitis C; cervical cancer is caused by human papillomavirus. We have a cancer that's preventable through a vaccine, and really, isn't that wonderful? Looking at the take-up of the HPV vaccine in some countries, Britain is doing very well on that one.

I think we will see that more and more things are linked to viruses, and not only viruses but the whole microbiome (this is the aggregate of microbes—bacteria, fungi, and viruses—and potentially harmful ones, but mostly helpful ones). It's not just that an evil virus is attacking us—we need to understand it in the context of the wider microbiome. There is a kind of harmony of microbes in our guts—and there are more and more indications that something like that harmony exists with viruses as well.

Tina Woods: When it comes to the human impact on biodiversity, what do you think is the most important thing to understand from the general citizen's perspective?

Peter Piot: One extreme perspective is that these epidemics, these emerging infections, come from animals. In large part they come about because of risky interactions between animals and people, and sometimes extremely risky ones in poorer parts of the world. That's true in Central Africa, where everywhere people eat the proteins that are surrounding them, but also in China with the consumption of even threatened species. There's that, plus the whole modern food industry.

I'm not a vegetarian, but when you think about it, the way that food is produced and sold in the modern era is a very high-risk business. In the old days, when a small farmer had a few chickens dying from a microbe, that was bad for him and for the chickens. Today, you have literally a million chickens in one farm and they're sent all over the world. Industrial farming increases our risk of exposure, and the potential for novel viruses. That's one aspect.

On the other hand, we live in a completely obesogenic environment. That's certainly the case in Western countries, but also, increasingly, elsewhere. Think of the fact that even in Africa now—in South Africa—the percentage of women who are obese is as high as in the US.

All that together, plus the ever-looming threat of climate change, means that we really need to question, fundamentally, how we live and what we do and don't do. This is where planetary health is becoming very important as a concept. The question is how to translate that into action in the environment.

Tina Woods: So, if you had to pick one core message that you would want to say to the average punter about planetary health, what would you say?

Peter Piot: In order to have a better future for everybody, we need to not only work on our own health but also respect the health of the planet. That means thinking about biodiversity, how we consume food, how we produce it, and respecting the environment. I learned a lot about that from the Navajo and Hopi, and it had a big impact on me, particularly since they are so poor. I think that the core message is moving away from thinking we're the masters of the universe and everything around us. We need to stop thinking the universe is at our disposal and we can do whatever we want with it.

Tina Woods: Going back to health resilience: we've seen how huge a risk poor health is, on its own but also with the epidemic. Do you think we need a risk management framework for health like we have for climate change? Health is where the climate change agenda was 10 years ago—shouldn't we be guiding investment and innovation decisions by ESG mandates, like we do for climate change, and applying them to health?

Peter Piot: This seems essential. In terms of risk management for COVID-19, I think that there's some serious cognitive dissonance around it; there's this idea that we're going to end this epidemic, eliminate it, wipe it out with a vaccine, and so on. I don't think it's realistic. We need to see, as a society, that it's about harm reduction and about risk management. I think that's true for everything because I'm also realistic enough to know that we need jobs and employment. People need to move around. It's something I'd like to read more about.

Tina Woods: One final question: how have you changed your lifestyle since getting ill, and what is your secret for a healthy, long life now that you've gone through what you have?

Peter Piot: I think I'm looking for a better work-life balance—although I've not been very successful! Right now, frankly, I'm still in recovery. I'm rebuilding strength. There's no qualitative difference in my lifestyle yet, but I'm trying to do more exercise. I'm paying more attention to all kinds of things. I lost seven kilos with COVID, which is more than I ever succeeded in doing with exercise and diet, so I will try to keep it that way. I think that's a question to ask me again at the end of the year, to see whether I actually followed up on my intentions!

 

Final thoughts

Citizens have a crucial role to play ahead in shaping the "new normal" and choosing between nationalist isolation or global solidarity. The epidemic itself and the resulting economic chaos are a global problem that can only be addressed through collaboration—and we should take stock of how more "collectivist" countries are weathering the pandemic storm far better than the more "individualist" countries are to date.

In order to beat COVID-19 and minimize future viral threats, we need to share information globally. But we also need to act locally to harness trust from our citizens, building individual and community resilience—and from there national health resilience. The concept of decentralized, or distributed, health resilience is something we will explore in this book.

Scientific cooperation has exploded in the quest to understand what puts people at risk of infection, why some suffer more than others, and what treatments and vaccines might be able to prevent further deaths. The next chapter will lay the groundwork on the science of aging, including the role of genomics and regenerative medicine, as well as more ethereal considerations on what gives us the "will to live."

 

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About the Author

  • Tina Woods

    Tina Woods is a social entrepreneur and pioneer in health innovation – connecting science, government, business and academia to align thinking and take action – solving real world problems and capitalizing on new opportunities amidst uncertainty and change. She is the Founder and CEO of Collider Health and Collider Science and Co-Founder and CEO of Longevity International that runs the All Party Parliamentary Group for Longevity.

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