Satellite Technologies’ Role in Healthcare

By Malak Trabelsi Loeb

Introduction

Space technologies as Remote Observation and civil space-based Earth Observation and its applications capabilities have become indispensable. Their crucial role in improving humankind’s daily life could be evidenced in its importance to connect people via telecommunication satellites and to support their commercial transactions. In practice space technologies have been used by state and non-state actors to address various global matters and that could be manifested in the reliance on these means to achieve the 2030 “United Nations Sustainable Development Goals” (SDGs). Space technologies’ crucial role in achieving the 2030 SDGs may be pinned in the 2030 “Sustainable Development Agenda”, through the importance of the Earth Observation technologies (EO) and Geolocation satellite services (GSS)[1]. However, space-based technologies use to support the achievement of the SDGs is not limited to the EO and GSS; it includes more means like human and space flight and microgravity research and satellite communication technologies. The witnessed paradigm shift in space exploration gave rise to infinite possibilities led humankind to master the space harnessing for unprecedented socio-economic development. Consequently, the benefits of these technologies have been maximized to preserve the environment[2] response to disasters, protect biodiversity, enable education, manage the weather, provide Telemedicine services and manage agricultural activities[3]. Nonetheless, healthcare remains one of the most crucial subjects to be addressed due to its role in ensuring healthy communities and its impact due to its interconnection to all other spheres of humankind’s life. Thus, amid the current Covid-19 (Coronavirus) outbreak, the compelling situation has put forward the crucial role of the space technologies, highlighting their use in disaster management, international cooperation and Telemedicine, which will be addressed in this article.

1. Satellite Technologies and Disaster Management

The use of satellite technologies in disaster management has been critical in timely allocating, assessing containing and mitigating the risk. The first international framework on the application of satellite remote sensing in the management of disasters was agreed upon in 2000 under the “International Charter on Space and Major Disasters” (the Charter). The latter is an agreement under which international humanitarian collaboration is established to enable the free use of satellite data to rapidly respond to disasters[4].  The Charter is activated by an authorized user who is a competent authority acting on behalf of a country, which its space agency a member to the Charter. Authorized users are eligible to activate the Charter to manage a disaster within their countries or non-member countries. However, in order to ensure a timely action to manage the disaster, United Nations Office For Outer Space Affairs (UNOOSA), United Nations Institute for Training and Research’s UNOSAT are authorized on behalf of the United Nations Agencies, and Sentinel Asia’s users, to the activate the Charter upon large-scale disasters. Furthermore, since 2012, the Charter has adopted the international principle of Universal Access and consequently, the Charter was opened to any disaster management authority to become a member[5]. It is of importance to mention that the Charter can be activated only if the conditions are met. First, the disaster must be of a natural or technological origin, second the request must be made within ten days from the occurrence of the disaster. Thus, the compelling sudden event or situation, which may have a significant impact and consequences to the environment, lives and infrastructure is the primary condition of the Charter activation. Nevertheless, the temporal scope of the Charter is limited due to its mandate limitation, which dictates that the support under the Charter lasts from one to four weeks[6].
Satellite technologies use under the Charter to mitigate disasters’ risks hinges on efficient and rapid responsive support. Once the request is notified, the Emergency team analyzes the situation to decide upon its eligibility for the action under the Charter. Whereas the request falls under the scope of the Charter, an immediate acquisition plan is made to process the satellite imagery and notify the harvested information from the satellite imagery to the disaster responders. Following the observation planning, users take the adequate satellite command and surveillance to monitor the disaster’s evolution in order to record the data and transmit it to the ground for analysis and quick report response. The members of the Charter may intervene to analyze the images to assist in the risk assessment[7]. The mechanism of disaster response to mitigate the risks that fall under the Charter may be summarized in the following chart.

Since the efficiency of the Charter lies in the timely response to disasters, it is critical to identify the time frame to react under the designed process. As per Voigt et al. (2016), the average of overall satellite Emergency response time (from mobilization to the first product from 2000 to 2014) was reduced from 4.5 days in 2006 to 2.5 days in 2014[8]. The efficiency and rapid response of a space agency’s satellite application to a disastrous situation may be demonstrated through JAXA satellites’ capabilities as an example. The JAXA’s “ALOS-2”, also known as “ALOS-2 Rapid Response” approval to an emergency observation request may be granted within the hour before the “command uplink”. Once the approval is granted, automated data analysis is made within the next two hours, and the provision of the information on the area of the disaster may be provided within five hours. ALOS-2 capabilities also encompass night observation rendering the emergency response more efficient since it is useful to manage the next day report[9]. Nonetheless, it is of importance to mention that the “International Charter on Space and Major Disasters” scope is not only covering environmental disasters as large scale oil spills and massive wildfires. Pandemic diseases management also falls under the scope of the Charter as it will be analyzed next.

2. Satellite Technologies and Telemedicine

The second most important application of space use through satellite technologies to have a crucial social impact is Telemedicine. The latter is deployed to provide medical services to rural and remote hospitals through the integration of medical science with Information Communication Technologies (ICT)[10]. Technically, Telemedicine services consist of employing multimedia software, computer network systems and telecommunication technologies, whereby parties do not have physical contact. The application of space technologies enabled more accessible healthcare services, thanks to the use of cost-effective ICT that enabled the implementation of different systems in different areas within the health sector such as medical R&D transfer, health planning, expertise exchange, and health education[11]. However, the most crucial application of Telemedicine in the healthcare sector is the substitution of the traditional healthcare means to provide services in isolated and geographically challenging areas as well as culturally challenging regions (like regions where another woman healthcare provider could only treat the woman). Telemedicine is also crucial to serve people and ameliorate their health in places with healthcare facilities deficit due to different factors, mainly due to the lack of infrastructure and the scarcity of technical and human resources and thus, the “infrastructure” was substituted by “infostructure”[12]. Due to its fundamental social impact, Telemedicine application in remote areas and limited resources’ countries may be considered a form of a non-financial return on investment on space programs, which may contribute to countries national social welfare. Such a benefit could be illustrated, through the pilot project developed by the “Microgravity Centre” at the “Faculty of Engineering at Pontificia University Catholic of Rio Sul” and implemented in 2007, within the Amazon Region. The project highlights the impact of satellites technologies, specifically ICT role in providing specialized medical assistance within this remote area to detect skin cancer cases and other dermatological issues. The succeeded first mission in the Amazon Region was followed in 2008 by a second Telemedicine campaign within the same region. The mission that involved ICT services combined with biomedical engineering, which involved remote opinions by specialists, has succeeded to detect many patients with skin disorders. Out of the total 176 consultations, 21,2% were inclusive cases, which required the remote specialist to conduct further medical investigations to make the pathological analysis of the biopsies to identify cancerous cases[13]. The cited practical example proves the efficiency of satellite technologies’ applications to design and implement Telemedicine mechanisms to overcome health matters in socially, geographically and economically challenged communities. An extensive literature review conducted by Siddequee et al. (2019) on Telemedicine projects in Nepal demonstrated that Telemedicine services could fill the existing gaps in traditional healthcare. The authors emphasized the role of Telemedicine to overcome the impeding factors for people from accessing quality health, as low-income level, scarcity of health workforce and facilities and the geographical disadvantage. The same research paper stressed on the crucial Telemedicine services’ benefits – if deployed on a large-scale in these countries[14]. Nonetheless, Writing this paper amid the Covid-19 (Coronavirus) outbreak, It is crucial to highlight the role of Telemedicine services in managing pandemics disasters.

3. Satellite Technologies and Pandemic Management

Pandemic as defined by the “World Health Organization” (WHO), is “the worldwide spread of a new disease”[15]. History shows that pandemic outbreaks cause economic, political and social disorders with significant mortality and morbidity on the human side. Since 2005, the WHO have reformed the International  Health Regulations (IHR), which entered into force on June 15, 2007, as a response to the 2003 Severe Acute Respiratory Syndrome (SARS) pandemic failure in early reporting the outbreak. The amended international instrument binding 194 countries impose a framework aiming to maintain a global public health security. The IHR established rules and procedures compels states’ parties to uphold global disease management standards to detect, report and respond to outbreaks. The pandemic outbreaks in the years that followed have induced more stakeholders to step in and invest in more sophisticated disease preparedness tools, cooperation means and risk mitigation to contain the pandemics[16]. The use of Satellite technologies by the international community presents an integral part in the management of pandemics, which was evidenced in the case of the Ebola Virus Disease spread in West Africa between 2013 and 2015. The “US Geological Survey”, on behalf of the “US National Geospatial-Intelligence Agency” activated in 2014  the “International Charter on Space and Major Disasters” to enable the use of satellite technologies for the monitoring and rapid response to mitigate the risk of the Ebola outbreak in “Sierra Leone”. Consequently, a pandemic outbreak was categorized as a disaster under the Charter for the first time[17]. The international instrument enabled a worldwide collaboration through, which countries availed themselves free access to satellites output in response to pandemic outbreaks. After the West Africa Ebola’s outbreak, the international community has witnessed the emergence of new trends of cooperation to contain the pandemic spread, which was catalyzed by the rise of “New Space”. The technological progress, space financial funding growth, globalization, and digitalization have led to the emergence of “New Space”[18]. The latter gave birth to “New Space” firms which consist of (1) “Space access” firms specialized in payload launch into space (cargo and human), (2) “Remote Sensing” firms, (3) “Satellite Data and Analytics” firms, (4) “Habitats and Space Station” firms, (5) “Low Earth Orbit Tourism”, and (6) “Beyond Low Earth Orbit” firms and “Research” and Investment” Firms[19]. Thus, the emerging new trends in the space industry marked an unprecedented development led by private actors. The global space sector, in the last five years, has undergone remarkable growth in the launch service and ground equipment activities,[20] which was catalyzed by the private actors’ entry into the global space economy[21]. “New Space” induced private actors to develop breakthrough technologies to reduce satellites’ manufacturing and launching costs, evidenced in the bourgeoning SmallSats and constellations business. The witnessed shift within the satellite industry amidst the “New Space” rise, led national and international agencies to partner with commercial space firms to use their satellite capabilities like remote sensing capacities to access high-resolution satellite imagery. Such a partnership was critical in enabling stakeholders’ use of satellite technologies during the previously discussed Ebola outbreak for more effective mapping as the available maps of that region were made since the colonial era[22]. For example, the known commercial company for its humanitarian mapping services, “Mapbox” has enabled responders like “Doctors without borders” a “crowdsourced tracing” capabilities to access helpful data information filling the “two generations-old” map gaps[23]. The Ebola outbreak has marked a shift in the reliance on satellite imagery mapping to manage risks from being in the hands of states actors to be shared with private actors. Consequently, the involvement of private actors helped in the capacity building as well as the allocation of maximum resources under the management and control of both the competent authorities and international stakeholders. Furthermore, Satellites’ Global Positioning System (GPS) services helped healthcare professional during the Ebola outbreak to keep track of the exact outbreak zones and to find their way around in unfamiliar areas[24]. Schootman et al. emphasized the strategic role of unmanned aerial vehicles, location-based social media platforms and other GPS applications in the surveillance, monitoring, and mitigating public health risks[25]. As for Telemedicine services deployment in the Ebola case, it has offered real-time results, which enabled those who are fearful of entering into “Ebola” military-alike facilities to be tested home[26].

In the case of Covid-19 outbreak in China, the country has witnessed an unprecedented rush to use Telemedicine services provided by the private health sector. As per the Economist (2020), there was a shift in the consumer behavior toward the use of Telemedicine, which catalyzed the development rate of the private “online healthcare market” that would have taken five years without the pandemic outbreak. Taking the example of “JD Health” the private online healthcare firm, its founder “Xin Lijun” claimed that his monthly services have tenfold increased since the outbreak. Notwithstanding the private Telemedicine assistance during the pick of the outbreak, private health providers are challenged due to medicine deliveries issues and to the Chinese health authorities’ restrictions like limiting the permission for online practitioners to only prescribe repeated medications as well as follow up consultations[27]. Furthermore, the Chinese health authorities, with the cooperation of the “China Aerospace Science and Industry Corporation” have utilized Telemedicine services into remote areas in Wuhan and Shantou. “Telemedicine Vehicles” and remote technicians were connected to local hospitals through ICT to conduct the needed tests on the residents who received remote medical assistance in case of a positive result to Covid-19. Telemedicine services played an important role to facilitate the collaboration between healthcare centres to deliver adequate and timely response whereby real-time imagery of patients is collected, transmitted through a satellite moderator and processed to the communication satellite platform, which is sent back to the control centre[28]. The use of satellite technologies, in this case, allowed healthcare providers to remotely follow up with the patients as well as provide training, mentorship and supervision to other healthcare employees. Most importantly, these remote services enabled healthcare employees to conduct their missions with minimum contact with potentially infected patients. Nevertheless, due to the high number of the infected patients who needed hospitalization, the Chinese authority sought to expend the healthcare facilities by building two hospitals “Huoshenshan” (25,000 square meters) and “Leishenshan” (30,000 square meters) in Wuhan, which were both completed in ten days. Such an accomplishment could be made possible, in a pandemic zone, only through robust monitoring from the stakeholders via the high-resolution observation ”GaoFen” satellites constellation. The healthcare facilities’ project was achieved under Wuhan University who relied on satellite services for the mapping, surveillance,  and remote sensing to complete the mission[29]. China has deployed the satellite capabilities with complex, disruptive technologies to mitigate its distressed healthcare system and contain the dissemination of the virus. Robots and Internet of Things (IoT) devices, which consist of any device that includes a sensor used to transmit data via the internet, served to reduce the contact between health service providers and contaminated patients in Wuhan. For example, the latter’s “Hongshan  Sports Centre” was turned into a smart field hospital accepting patients. The smart hospital was handled under the collaborative efforts between “China Mobile” Company, “Wuhan Wuchang Hospital” and “CloudMinds” the cloud-based systems for robotics maker. Thanks to the IoT devices and robots, the exhausted healthcare providers were relieved from working around the clock. They were kept safe from potential contamination and thus, the infection did not spread to the medical teams who are considered to be the most valuable asset during a pandemic. Furthermore, for efficient monitoring from a distance, a specific protocol was designed relying on satellite technologies. The smart hospital was monitored at a distance, starting with the “triage” through initial screening of the patient by 5G thermometers to detect signs of fever, followed by monitoring his vital signs through a worn ring or bracelet connected with the “CloudMinds” Artificial intelligence platform[30]. The abovementioned non-exhaustive means, supported by satellite technologies,  have been crucial for China to contain the fast-spreading Covid-19. Thus, the combination of Telemedicine, which primarily hinges on the deployment of satellite technologies’ use, Artificial Intelligence and other exponential technologies made a great contribution to the Chinese healthcare provision during this public health crisis. Nonetheless, these tools and methods could not be as efficient without taking timely measures by the competent authorities to contain the pandemic and prevent its spread outside of the outbreak areas. The scale of the applied measures was boldly rising in accordance with the spread of the virus. It was escalating from imposing schools and workplace closure to mandatory quarantine and total lockdown in Wuhan and other affected cities. The Chinese authority used surveillance technologies to implement its strict public policies for the general interest. It deployed all its surveillance resources as drones and location-based social media applications to track people’s movements. After weeks of struggle against the virus, China has considerably reduced the rate of transmission of infection[31]. The example of China could be a model (which could always be improved) on how to ensure the achievement of the obtained results to be applied for the future. However, the application of the Chinese model may be possible only if the country had adequate human capacities as well as robust technological, infrastructural, financial and timely preparedness capabilities and strong law enforcement mechanisms. These capabilities may be considered to be essential and indivisible determinants to contain rapid virus dissemination successfully. Having said that, one would imagine the challenging situation if the pandemic outbreak occurred in low resource developing countries, which lacked trained healthcare providers to manage pandemics as well as the technological, financial and infrastructural capabilities. One would question the reliance on the international community aid and cooperation to cover larger-scale outbreak. In such a situation, the international community would be challenged to face a global health crisis with an overwhelming call for action in different regions across the world. However, the situation is compelling even in the case of a developed country, taking the example of Italy who is currently driving its fierce battle against Covid-19, the latter’s healthcare system is near a collapsing stage. The situation in Italy has exposed many gaps in its healthcare system. The shortage of healthcare providers, which was aggravated by the spread of the virus among doctors and nurses, as well as the shortage of Intensive Care Units and medical equipment, have caused major distress within the system. As a consequence to the stated facts, the death toll in Italy has considerably jumped as one of the nurses from “Bergamo” Italy claimed: “I have never seen so many people die together before my eyes,” said a nurse from one of the main hospitals in Bergamo, a city in northern Italy”[32].
The difference between the Chinese and Italian healthcare capabilities reflects the respective outputs putting forward the hypothesis that a similar reliance on the Chinese deployed resources and the taken actions to manage the pandemic would have made a difference in Italy. Nonetheless, the hypothesis cannot be ascertained due to lack of facts and reliable information, mainly concerning the Italian case. However, based on the Chinese experience with Covid-19, the key to address and manage the outbreak hinges on abiding by the International Health Regulations, timely detecting the infection before it spreads at a large-scale, mobilizing the needed resources, appointing trained healthcare providers to carry on the field and Telemedicine services, tracing infected patients contacts, quarantining and isolating, preparedness measures including mandatory lockdowns and international coordination.

Conclusion

The satellite industry has bourgeoned giving rise to a new era for satellite capabilities, which enabled a high social return in different areas of humankind life. Satellite technologies are critical in ensuring healthy lives, promoting wellbeing and managing public health risks.  Firstly, and most importantly, satellites’ role in disaster management, particularly in the management of pandemic risks is fundamental. Telemedicine can be critical too to support the public authority mitigating the public health risk. However, to maximize the benefit of satellite technologies in containing pandemics, countries have to act in accordance with the international norms to ensure a timely preparedness against the public health risk, capacity building, transparency and collaboration. Secondly, these technologies form a critical tool to ensure global access to healthcare and achieve universal healthcare coverage at a lower price. Telemedicine is the future of healthcare services, and thus, public health authorities across the world shall reduce their legal barrier to allow private actors’ entry into the promising Telemedicine business. Public health authorities shall also partner with private health professionals, institutions and universities to form qualified remote technicians, ICT services and other related inputs to build adequate Telemedicine systems. Finally, The key enabling people’s access to  adequate and cost-effective healthcare is to integrate Telemedicine in large scales, especially in low- and middle-income countries in order to achieve a sustainable efficiency gain.

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Malak Trabelsi Loeb

ABOUT THE AUTHOR
Malak Trabelsi Loeb is the TAFFD’s Ambassador to Dubai – UAE.  She is a Senior Legal Consultant specialized in International Business Law and International Space Law, as well as an Adjudicator in the International Court for Dispute Resolution, International Commercial Arbitrator at the International Arbitration Organization. Her practice focuses on complex International Business transactions, Due Diligence, International contracts, Commercial legal matters, Alternative Dispute Resolution, Corporate Governance, Company Law, Space Insurance, New Space Legal Challenges and Space policies. Mrs. Loeb is advocating for Sustainable Space For Humanity addressing the complex outer space socioeconomic and environmental outer space interrelated dimensions. Sustainable Space For humanity advocacy aims to keep the peaceful use of outer space while achieving the economic and social development for the present and future generations without deteriorating the outer space environment.

Mrs. Loeb is a Lecturer in International Relations and Diplomacy, Academic Legal Researcher in International Space Law and a PhD Candidate addressing interdisciplinary research on International Space Law and Sustainable Development. Her writings are addressing various areas in the space fields that are interconnected, such as Space Economy, Space Environment and their Social Impact.
Mrs. Loeb obtained, with honor, her bachelor’s degree with dual majors in Law and Economics from the University of Al Jazeera, UAE. She then earned her first master’s in public international and European Law in 2018 and the second master’s in international business law from Paris Sorbonne University, Abu Dhabi/ Paris Descartes University, France, with excellent achievements and top of the batch GPAs.
In the course of her professional journey, Mrs. Loeb has been advocating for employees right’ and assist them to settle their conflicts with their employers. She is a human rights activist and strives to fight against human trafficking. Mrs. Loeb has received the title of Champion of Tolerance from the UAE Ministry of Tolerance in 2018. She endeavors to empower woman and raises awareness to achieve the United Nations Sustainable Development Goals.