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Our digital vaccines build resistance to COVID-19 causing hygiene-related behaviours

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FriendsLearn, a health tech venture, in partnership with data scientists and AI researchers at the Heinz College of Information Systems and Public Policy at Carnegie Mellon University, US, is trying to create a digital vaccine to tackle to COVID-19. Recently, NASSCOM featured FriendsLearn’s digital vaccines as ‘2020 Digital Disruptor’ at the 2020 NASSCOM Technology Leadership Forum in Mumbai. Bhargav Sri Prakash, its Founder & CEO, explains what digital vaccines are, how they work, and the impact they can have on the world of medicine and healthcare, to Lakshmipriya Nair

What is a digital vaccine and how exactly will it work? Can you explain the science and technology deployed?

Digital vaccines are evidence-based technology-enabled prevention approaches that are delivered via smartphones and tablets. They are gamified, digital interventions that draw on principles of neuroscience, psychology, artificial intelligence (AI) and behavioural economics to provide safe and low-risk mechanisms to induce healthier habits.

Digital vaccines leverage clinically proven neurocognitive training to positively influence behaviours, reach a broad audience, and be deployed widely, quickly and updated frequently. Using these training methods and mobile technologies, digital vaccines have shown evidence of health outcomes in pilot randomised controlled studies. Highly interactive video games with animation activities train the brain to improve processing, understanding and memory by stimulating both the neurological functioning and the cognitive ability of individuals.

Everyone is talking about immersive technologies these days. Has it been used this endeavour?  

Yes, immersive environments are used as the primary method of our approach to Digital Vaccines. Our digital vaccines are deployed by embedding gamification to induce health hygiene practices that are critical for preventing/minimising coronavirus infections, such as using masks, social distancing, washing hands, etc., The digital vaccine uses neurocognitive training mechanisms that train the brain to improve processing, understanding and memory by stimulating both the neurological functioning and the cognitive ability of individuals.

Do you have any studies, examples to provide proof of concept? In which areas have you seen its maximum impact?

A paediatric digital vaccine using a gamified learning platform to improve dietary choices, physical activity and nutrition literacy has already been clinically proven in multiple clinical trials. We are currently in the process of adapting and scaling this digital vaccine, conducting randomised field trials and ongoing research and development to gather and analyse evidence of positive behavioural and physiological outcomes. It is also being evaluated for managing chronic disease-related risks in children via a longitudinal randomised controlled experiment.

Our school health co-curriculum platform is delivered via a mobile App – fooya! – for children enrolled in our school partners. The longitudinal impact among children during the habit formation years during childhood will deliver lifelong immunological memory to help lower the risk of diabetes, cardiovascular disease, hypertension and certain types of lifestyle-related cancer. We believe that this impact is important for India and the world.

How can it transform the way healthcare is practised and delivered currently?

Digital vaccines are highly scalable because of AI and VR enabled technology delivered via mobile devices. This enables the distribution of a safe and effective intervention focused on prevention, around the world. The ability of digital vaccines to be deployed across multiple geographies at scale makes the technology truly game-changing. The biological vaccine builds immunity to the disease-causing pathogens by training the immune system to recognise and fight the pathogen. Similarly, our digital vaccines build resistance to the COVID-19 causing hygiene-related behaviours by training the brain to recognise poor health hygiene habits and fighting to change them. This is neurocognitive training resulting in physiological modulation.

What kind of impact do you intend to create in COVID-19 management? Will it work in the management of other infectious diseases as well? 

Our idea of digital health technologies is supported by the US Food and Drug Administration. In the context of the COVID-19 public health emergency, the use of digital health technologies has the potential to facilitate social distancing by reducing patient contact with, and proximity to, health care providers, and can ease the burden on hospitals, other health care facilities and health care professionals that are experiencing increased demand due to the COVID-19 public health emergency.

Digital vaccines that are enabled via gamified, mobile applications can be culturally sensitive and customisable to specific regions and contexts. They can entail deep levels of personalisation to ensure that such vaccines meet the requirements of target audiences from all geographical, social and cultural realms. For example, to develop a COVID-19 digital vaccine that promotes hand-hygiene in a specific region in India, researchers are examining the sociological, environmental and regional norms to adapt an existing game for hand-hygiene literacy to include local preferences, which may include instructions in the regional language, game avatars resembling local appearances, recognisable icons in the game interfaces, and so on.

Adapting and re-purposing this platform for containment of infectious diseases could lead to a digital vaccine candidate for the COVID-19 pandemic that will need to subsequently undergo extensive evaluation. We are working to design, implement and deploy the technology at scale within populations that are at high risk. The key outcomes will be tracking the incidence of COVID-19, time factors and transmission rates as well as uptake of health-hygiene practices. If the trial is successful, this evidence-based digital vaccine candidate for infectious diseases could be made available for global adoption to help alleviate health challenges caused not only by COVID-19 but also address future infectious diseases to come.

Have you tied up with many organisations in India for this endeavour? If yes, please share the details.

We are tied up with VHS Hospital in Chennai to be our local clinical research and community medicine partner to localise the protocol for India. Dr Usha Sriram of VHS Hospital will continue to be a Co-Principal Investigator, along with a multi-institutional global team of researchers led by Prof Rema Padman at Carnegie Mellon University, with researchers from Hofstra University, National University of Singapore, Stanford University School of Medicine, Oxford University, and Bloomberg School of Public Health at Johns Hopkins University. The team from VHS is comprised of physicians who are infectious disease experts, clinical psychologists and community medicine/public health experts from VHS Hospital, to ensure localisation of the protocol.

Please explain the revenue model of your venture?

We currently have one commercially available digital vaccine which works towards shaping the diet-lifestyle-hygiene habits during childhood. We have it available for $100 per child per month. Based on our research, we recommend that a child is exposed to the digital vaccine for at least one year.

How can you make your endeavour accessible and affordable for a cost-sensitive country like India?

One of the key ways we are looking to make it more accessible and affordable to children across the world is by partnering with select groups of schools in India and other countries to deliver the digital vaccine to groups of students at a time. Our partnership with schools allows us to grant them access to the digital vaccine at more affordable rates.

What are your plans and strategies for India’s market over the next three to five years?

We already have a platform of digital vaccines which helps to lower the risk of diabetes, cardiovascular disease, hypertension and cancer through a curriculum for schools. Schools in India can submit an online application to become accredited and gain access to the curriculum and join the Digital Vaccine Project platform via the mobile App – fooya!. This product is already available on iOS and Android devices. We will be looking to deploy the digital vaccine for COVID-19 also through schools, which we are recruiting from our existing school partners in India, as well as from new eligible school partners based on inclusion criteria. There is an application process for interested schools.

The digital vaccine candidate will be delivered via mobile apps and the protocol is designed for the entire programme to be administered remotely, along the field with data collection that happens over a 12 month period. We will be looking to undertake a randomised controlled field trial with at least 15,000 children across India, which is 30-50 per cent of the total global sample size. Our focus will be urban and suburban areas, while we also attempt to reach a few rural schools to add to our population outcomes. Pending scientific, ethical and regulatory approvals, we aim to begin the trial immediately.

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