Public health research using cell phone derived mobility data in sub-Saharan Africa: Ethical issues

Stuart Rennie; Caesar Atuire; Tiwonge Mtande; Walter Jaoko; Sergio Litewka; Eric Juengst; Keymanthri Moodley

doi:10.17159/sajs.2023/14777

Authors

Stuart Rennie 1.Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; 2.UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA https://orcid.org/0000-0003-3844-972X
Caesar Atuire Department of Philosophy and Classics, University of Ghana, Accra, Ghana https://orcid.org/0000-0001-6825-6916
Tiwonge Mtande Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa https://orcid.org/0000-0003-1706-6615
Walter Jaoko KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya https://orcid.org/0000-0002-7134-6581
Sergio Litewka Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida, USA https://orcid.org/0000-0002-4196-5998
Eric Juengst UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA https://orcid.org/0000-0002-8374-5774
Keymanthri Moodley Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa https://orcid.org/0000-0003-3404-4901

DOI:

https://doi.org/10.17159/sajs.2023/14777

Keywords:

ethics, mobility data, public health, community engagement, surveillance

Abstract

The movements of humans have a significant impact on population health. While studies of such movements are as old as public health itself, the COVID-19 pandemic has raised the profile of mobility research using digital technologies to track transmission routes and calculate the effects of health policies, such as lockdowns. In sub-Saharan Africa, the high prevalence of cell phone and smartphone use is a source of potentially valuable mobility data for public health purposes. Researchers can access call data records, passively collected in real time from millions of clients by cell phone companies, and associate these records with other data sets to generate insights, make predictions or draw possible policy implications. The use of mobility data from this source could have a range of significant benefits for society, from better control of infectious diseases, improved city planning, more efficient transportation systems and the optimisation of health resources. We discuss key ethical issues raised by public health studies using mobility data from cell phones in sub-Saharan Africa and identify six key ethical challenge areas: autonomy, including consent and individual or group privacy; bias and representativeness; community awareness, engagement and trust; function creep and accountability; stakeholder relationships and power dynamics; and the translation of mobility analyses into health policy. We emphasise the ethical importance of narrowing knowledge gaps between researchers, policymakers and the general public. Given that individuals do not really provide valid consent for the research use of phone data tracking their movements, community understanding and input will be crucial to the maintenance of public trust.

Significance:

Mobility data derived from cell phones are being increasingly used for health research and public health purposes in sub-Saharan Africa, with minimal individual consent and largely without public awareness.
While such data can have significant potential public health benefits, risks and concerns related to their collection and use in sub-Saharan African contexts have not been widely discussed.
Innovative community engagement initiatives, which are appropriate and responsive to sub-Saharan African contexts, need to be developed to address ethical challenge areas and help warrant public trust in mobility research.