COVID-19 Digital Health Innovation Policy: A Portal to Alternative Futures in the Making

"The pandemic is a portal." In the words of the novelist scholar Arundhati Roy, the COVID-19 pandemic is not merely an epic calamity. It has opened up a new space, a portal, to rethink everything, for example, in how we live, work, produce scientific knowledge, provide health care, and relate to others, be they humans or nonhuman animals in planetary ecosystems. Meanwhile, as the intensity of the pandemic escalates, digital health tools such as the Internet of Things (IoT), biosensors, and artificial intelligence (AI) are being deployed to address the twin goals of social distancing and health care in a "no touch" emergency state. Permanent integration of digital technologies into every aspect of post-pandemic civic life-health care, disease tracking, education, work, and beyond-is considered by governments and technology actors around the world. Although digital transformation of health care and industry are in the works, we ought to ensure that digital transformation does not degenerate into "digitalism," which we define here as an unchecked and misguided belief on extreme digital connectivity without considering the attendant adverse repercussions on science, human rights, and everyday practices of democracy. Indeed, the current shrinking of the critically informed public policy space amid a devastating pandemic raises principled questions on the broader and long-term impacts that digital technologies will have on democratic governance of planetary health and society. To this end, a wide range of uncertainties-technical, biological, temporal, spatial, and political-is on the COVID-19 pandemic horizon. This calls for astute and anticipatory innovation policies to steer the health sciences and services toward democratic ends. In this article, we describe new and critically informed approaches to democratize COVID-19 digital health innovation policy, especially when the facts are uncertain, the stakes are high, and decisions are urgent, as they often are in the course of a pandemic. In addition, we introduce a potential remedy to democratize pandemic innovation policy, the concept of "epistemic competence," so as to check the frames and framings of the pandemic innovation policy juggernaut and the attendant power asymmetries. We suggest that if epistemic competence, and attention to not only scientific knowledge but also its framing are broadly appreciated, they can help reduce the disparity between the enormous technical progress and investments made in digital health versus our currently inadequate understanding of the societal dimensions of emerging technologies such as AI, IoT, and extreme digital connectivity on the planet.