Author: Mary Harasym
“Technology advances at exponential rates, and human institutions and societies do not. They adapt at much slower rates. Those gaps get wider and wider.” Mitch Kapor
In this quote, Kapor highlights the idea that as technology advances, governments and institutions must work to adapt to and regulate the technologies that are applied in society, such as biometric technology. Biometrics can be understood as the unique physical characteristics of a person that become their personal code. Examples of biometrics include fingerprints, irises, voices, palm geometrics, gait, ear shapes, DNA matching, signatures, and facial recognition.
Why Use Biometrics in Global Health?
Biometrics are beneficial in the field of global health for several reasons. One major advantage is their convenience and simplicity: there is no need for passwords or papers but simply the body for identification. Personal identification is not often an issue in high income countries, but may be challenging in low- and middle-income countries and for vulnerable populations such as forcibly displaced persons (refugees, internally displaced persons, and asylum seekers). Among larger non-governmental organizations (NGOs) and intergovernmental organizations, there is a current discussion around the global ‘identity gap’. This refers to the situation in which millions of people are not registered with their government, and run into problems when they try to access government services or provisions, including health care. Biometrics provide a means to access such services, and can therefore ultimately improve an individual’s health. If the biometric data is stored securely and safely, it can also provide more anonymity for the user. Additionally, biometric tools are becoming more cost-effective as the cost of the technology has greatly decreased.
Along with the advantages of using biometrics, there are the persistent disadvantages that include numerous ethical debates. The first and most obvious issue is infringing on people’s privacy. Biometrics must be used where informed consent is given by the individual, but there are reports of facial recognition technology being used without the public’s knowledge, often by a trusted provider or government. There are also grave concerns around the use biometrics to support discrimination by race, gender, physical or mental handicap, sexual orientation, religious orientation, political affiliations or age. Despite numerous ethical concerns, biometrics are being used by a variety of governments, NGOs, and intergovernmental organizations. The development of this technology seems inevitable, thus we need to work on how we can use it to our advantage in the health sector, with the least detrimental effect. With the increase in sustainable energy sources, access to the internet and smart devices, the global health field is implementing this technology, often before scientific research is conducted and policies are employed to protect citizens.
Biometrics in Global Health: Who’s using them right now?
Several governments are using biometric indicators to promote identification of nationals and promote access to government services. Perhaps the most widely known government biometric database is that of the Xinjiang region of China, where citizens are subject to surveillance and collection of DNA samples which are linked to their household registration cards. CCTV cameras are linked to the biometric database which are linked to educational institutions, medical and housing benefits. There are numerous reasons to be wary of such technology used by a central government. If there is a change in the government’s political ideology, a breach in privacy or abuse by the government, citizens’ identities may be vulnerable to several kinds of exploitation. Most countries in the world do not use biometric indicators with their citizens. The majority of European and North American countries use a compilation of different methods for identification to confirm a person’s identity.
Currently, the world’s largest biometric database is being built in India via a government programme called Aadhaar, with the goal of improving access to government services, education, and health services. The biometric data is also linked to citizens’ cellphones and bank accounts; there are reports of employers using this information for background checks. There are several reports of biometric identification failing to authenticate the individual, leaving them without the needed assistance like pensions or food rations. Indians who have been manual labourers their whole lives, often slip through the cracks as scanners fail to read fingerprints eroded by constant wear and tear. When fingerprint authentication fails, grave consequences ensue, such as not being granted access to necessary health services.
GAVI, the vaccine alliance, is a public-private partnership that aims to increase access to vaccines in the Global South. It comprises developing and donor country governments, the World Health Organization, UNICEF, the World Bank, the Bill and Melinda Gates Foundation, as well as civil society. In July 2018, GAVI partnered with the company Simprints, who have created a fingerprint reader that is built to work with even the most weathered hands , delivering a reported “228% higher accuracy than existing mobile scanner in low-resource settings”. This partnership aims to link a child’s health record to their (or their mother’s) fingerprint, in order to document vaccinations to ensure they received the required schedule. Simprints is currently working in Bangladesh, Afghanistan, Kenya, Malawi, and Zambia on a number of projects related to maternal health, immunisation, and even aid distribution.
How to promote effective use of biometrics in Global Health? Start with strengthening policies
While biometrics are increasingly used in global health in several ways through registration and tracking, legal frameworks to protect the rights of the individual are lacking. The General Data Protection Regulation (GDPR) for the European Union, contains several sections that monitor the implementation and utilization of biometrics. These outline the need for explicit consent and state that data must be kept private and secure. The GDPR is the first policy to address the ethical issues with collecting and processing biometric data.
Other nations, continents, and intergovernmental organizations must follow the example of the EU’s GDPR by creating policies and laws that increase accountability and transparency to help them apply biometric technology in ways that benefit their citizens. 
Policy development to protect the rights of the individual- developed alongside improved inclusive code- could help to overcome many of the ethical challenges associated with biometrics, and allow the global health community to create innovative and equitable solutions utilising this exciting technology.
Eye on Global Health 