Agility in R&I Policy - how much is too much? - Eu-SPRI 2021
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Agility in R&I Policy - how much is too much? Authors: Doris Schartinger1, Matthias Weber2, Peter Biegelbauer2 & Christoph Brodnik2. AIT Austrian Institute of Technology GmbH 1 AIT Austrian Institute of Technlogy 2 Recent research has come up with a definition of the subject matter, criteria for agility in R&I policy and provided an array of elements already implemented in several R&I policy areas in different countries. While this enables a characterization of agile R&I policy practices already in place and the further development of basic recommendations and conducive measures, it leaves us with the paradox that the implementation of the sum of all agile practices and resulting recommendations would most likely result in increased administration, vast complexity and a large amount of resources needed. This leads us to the overall question guiding this paper: Can we identify patterns, contexts or particular framings that make single practices in agile R&I policy or combinations of practices more effective? A number of selected German and international case studies were used as examples of agile R&I policy in order to examine them for their elements and patterns. In our set of illustrative examples from existing policies we find recurring elements of agile R&I policy. We present a framework that turned out to be useful to categorise current practices of agile R&I policy, and to effectively support the sense-making process.
Post Covid mobility – towards a social tipping point for sustainable mobility Authors: Floor Alkemade1. Eindhoven University of Technology. 1 EXTENDED ABSTRACT Introduction Transport is responsible for 24% of global emissions and meeting climate goals of the Paris agreement requires an acceleration of the pace of the transition to sustainable mobility. Typically, measures requiring behavioral changes and new mobility practices (avoid and shift) have been very difficult to successfully implement on a large scale. These behavioral changes have however been identified as important to realize mobility patterns compatible with the Paris agreement (Akenji et al., 2019). Recent insights from sustainability transitions research (Kern et al., 2019; Rogge & Reichardt, 2016) and on social tipping points (Sharpe & Lenton, 2021) argue that the required acceleration of the mobility transition can only be reached through systemic approaches, and policy mixes that set in motion positive feedback loops, targeting multiple aspects of the transport system. The COVID-19 crisis may offer new evidence on such social tipping points as it has provided unprecedented and much needed insights in the potential impacts from changes in mobility practices. It has dramatically changed mobility patterns worldwide. Most notably the crisis has led to a turnaround in the attitude towards working from home. Such changes in behavioral patterns may provide hopeful openings that initiate positive feedback loops that accelerate the transition to sustainable mobility. However, without supporting policy it is likely that the mobility system will return to its previous state. The policy challenge is to now scale back COVID measures while keeping the sustainability advantages that became apparent in the past months. The main goal of the paper is to identify a set of measures and instruments that support this. To this end we have surveyed mobility experts in the Netherlands. These experts were asked to evaluate 48 possible mobility related policy instruments. These 48 instruments have been mentioned in the policy discussions in recent years. Some have broad support whereas others have not, however this may have changed due to the pandemic. More specifically, following (Hepburn et al., 2020) we asked the experts to evaluate the measure along 4 dimensions: climate impact, economic growth, access/social inequality, and 1.5 meter compatibility. Policy design for sustainable mobility The literature on policy design emphasizes how policy mixes for sustainability should consists of a coherent, congruent and consist set of policy instruments, that reinforce one another and work towards a common goal (Howlett & Rayner, 2013). Empirical studies of the policy mixes that are in place reveal that this is typically not the case as the policy mix is an outcome of path dependent, political processes at different levels of governance. We build on recent observations(Sharpe & Lenton, 2021) of positive feedback loops and social tipping points, to propose a pragmatic approach where opportunities for creating such dynamics are seized and reinforced through policy layering, That is, by supporting positive turns towards sustainable mobility in order to prevent a return to the previous practices. Policy for sustainable mobility is often analyzed using the ASI (Avoid, Shift, Improve) framework (Creutzig et al., 2018). Avoid refers to measures that aim to reduce the number and length of trips, shift concerns measures that stimulate a shift to more environmentally friendly modes of
transportation, and finally, improve refers to the improvement of mobility technologies and infrastructures. Survey of sustainable mobility policies Table 1 below lists the 48 policy measures as well as their classification using the ASI framework. The list includes the options with large reduction potential identified in the 1,5 degree lifestyles report(Akenji et al., 2019) car-free private travel and commuting, electric and hybrid cars, vehicle fuels efficiency improvement, ride sharing, living nearer to workplaces. Overall, the set includes 11 ‘avoid’ measures, 13 measures that aim for a shift to more sustainable modes of transport and 21 measure seeking to improve the efficiency of the transport system, and 3 measure that were difficult to classify. Also, the distinction between avoid and shift is not always clear as measure often will have both effects: some people will not travel at all using ICT as a substitute for mobility while other will shift to more sustainable modes of transport. Moreover, some of the measure are typically initiated at the city level, such as environmental zones, while other are initiated by national governments or employers. This provides an alignment challenge for consistent and coherent policy design. Finally, the measures differ in timing. Some measure can be implemented right now whereas others will take a bit more time. Similarly, the lag time between the implementation of the measure and the expected effects also differs. Table 1 Overview of measures Policy measure (Avoid,Shift, Improve) 1. Reduce car dependence by building compact cities / through compact cities Avoid 2. Reduce car dependence by (re)designing cities as 15-minute cities Avoid 3. Reduce car dependence by increasing perceived safety in public spaces Avoid 4. Car-free inner cities / car-free city centers Shift 5. Dedicate space outside inner cities to walking, cycling and public transport Shift 6. Expand existing low emission zones and create new ones Shift 7. Reduce the number of parking spaces Shift 8. Change the national infrastructure investment fund into a mobility fund. Other 9. Reduce speed limits on freeways and arterial roads Improve 10. Reduce speed limits in cities Improve 11. Government support for air transport sector Other 12. Introduce national flight tax Avoid 13. Execute plans for restructuring air transport sector Improve 14. Greening of air transport through stimulating electric flying and hydrogen fueled planes. Improve 15. Increase use of public transport through increased connectivity Shift 16. Reduce public transport fees Shift 17. Reduce emissions associated with public transport Improve
18. Invest in multi-modal hub infrastructure Shift 19. Stimulate use of multi-modal hubs Shift 20. Substantially increase subsidies for buying electric vehicles Improve 21. Stimulate charging infrastructure development Improve 22. Subsidize hydrogen as a fuel for freight and long-distance transport Improve 23. Stimulate hydrogen fuel infrastructure development Improve 24. Subsidize biomass as a fuel for freight transport Improve 25. Subsidize electric bicycles Shift 26. Introduce eco-label for tires Improve 27. Stimulate modal shift from trucks to train and ship for freight transport Shift 28. Realize zero-emission city supply logistics Improve 29. Shorter designated loading and unloading times for freight in cities Avoid 30. Invest in intermodal transport hubs for freight at the edge of cities Shift 31. Stimulate use of intermodal transport hub at edges of city. Shift 32. Reduce long, global supply chains Avoid 33. Create strategic reserves to ensure security of supply Other 34. Better match demand and supply - Increase usage of truck space through ICT Avoid 35. Stimulate smart mobility technologies / technology for smart mobility Improve 36. Improve traffic information through increased digitization of traffic management Improve 37. Invest in intelligent traffic management systems (that adapt to actual traffic flows) Improve 38. Invest in smart shipping Improve 39. Subsidize research and development for automated driving Improve 40. Prepare infrastructure for (semi-)automated driving Improve 41. Spread work hours by employers Improve 42. Spread of school / university hours Improve 43. Stimulate working from home (new norm 1-3 days a week) Avoid 44. Reduce traffic expense reimbursements for unsustainable transport modes Shift 45. Stimulate car sharing and ride sharing Avoid 46. Include externalities in prices of mobility Avoid 47. Use congestion tax as alternative pricing scheme for road traffic Improve 48. Introduce CO2 tax on fuels Avoid
Results and conclusions. The survey was sent out to 280 experts, of which 66 completed the survey, a response rate of 23%. Figure 1 below presents the outcomes of the survey. First, we note that most measures are evaluated by the experts as reducing the climate impacts of mobility (except measures 11, 29, 33, 39, and 40). Of the 43 measures that are considered beneficial for the climate, our expert group identified potential trade-offs with economic growth for nine measures. In the full paper we further analyze and discuss how these measures can be combined into policy mixes for sustainable mobility. Figure 1: Outcomes of the survey Akenji, L., Lettenmeier, M., Koide, R., Toivio, V., & Amellina, A. (2019). 1.5-Degree Lifestyles: Targets and options for reducing lifestyle carbon footprints. Institute for Global Environmental Strategies, Aalto University, and D-mat ltd. https://www.iges.or.jp/en/pub/15-degrees-lifestyles-2019/en Creutzig, F., Roy, J., Lamb, W. F., Azevedo, I. M. L., Bruine de Bruin, W., Dalkmann, H., Edelenbosch, O. Y., Geels, F. W., Grubler, A., Hepburn, C., Hertwich, E. G., Khosla, R., Mattauch, L., Minx, J. C., Ramakrishnan, A., Rao, N. D., Steinberger, J. K., Tavoni, M., Ürge-Vorsatz, D., & Weber, E. U. (2018). Towards demand-side solutions for mitigating climate change. Nature Climate Change, 8(4), 260– 263. https://doi.org/10.1038/s41558-018-0121-1 Hepburn, C., O’Callaghan, B., Stern, N., Stiglitz, J., & Zenghelis, D. (2020). Will COVID-19 fiscal recovery packages accelerate or retard progress on climate change? Oxford Review of Economic Policy, 36(Supplement_1), S359–S381. https://doi.org/10.1093/oxrep/graa015 Howlett, M., & Rayner, J. (2013). Patching vs Packaging in Policy Formulation: Assessing Policy Portfolio Design. Politics and Governance, 1(2), 170–182. https://doi.org/10.17645/pag.v1i2.95 Kern, F., Rogge, K. S., & Howlett, M. (2019). Policy mixes for sustainability transitions: New approaches and insights through bridging innovation and policy studies. Research Policy, 48(10), 103832. https://doi.org/10.1016/j.respol.2019.103832 Moreno, C., Allam, Z., Chabaud, D., Gall, C., & Pratlong, F. (2021). Introducing the “15-Minute City”: Sustainability, Resilience and Place Identity in Future Post-Pandemic Cities. Smart Cities, 4(1), 93– 111. https://doi.org/10.3390/smartcities4010006 Rogge, K. S., & Reichardt, K. (2016). Policy mixes for sustainability transitions: An extended concept and framework for analysis. Research Policy, 45(8), 1620–1635. https://doi.org/10.1016/j.respol.2016.04.004 Sharpe, S., & Lenton, T. M. (2021). Upward-scaling tipping cascades to meet climate goals: Plausible grounds for hope. Climate Policy, 1–13. https://doi.org/10.1080/14693062.2020.1870097
Sociotechnical expectations in the government’s early response to the COVID-19 crisis: Assessing the hype-disappointment cycle of contact tracing apps in Colombia Juan Pablo Centeno Mónica Paola Vásquez 1. Research problem Technology is frequently optimistically regarded as a solution for societal challenges in multiple realms (van Lente, 1993; Konrad, van Lente, Groves, & Selin, 2017). It appears in the form of tools that enable governments to provide agile responses to complex multilevel challenges (Mergel, Gong, & Bertot, 2018), and it broadens the spectrum for multiple governance approaches in context of uncertainty (Kuhlmann, Stegmaier, & Konrad, 2019). In this context, agility often translates into raising expectations on the promising character of technology, which serves as governances tools by providing future-oriented instruments and heuristics for governments to perform during complex uncertainty contexts (Konrad & Böhle, 2019; Hielscher & Kivimaa, 2019; Budde & Konrad, 2019). The context of uncertainty during the early months of the COVID-19 pandemic depicted governments deploying multiple tools based on information and communications technologies (ICT) in order to tackle the crisis. Multiple digital and technological tools quickly appeared as potential instruments to tackle epidemiological challenges that exceed the ability of manual-human labor to trace cases of disease transmission (Whitelaw, Mamas, Topol, & Van Spall, 2020; Gasser, Ienca, Scheibner, Sleigh, & Vayena, 2020; Horgan, y otros, 2020). Contact tracing apps quickly received public attention both by the public and governments, considering the successful experience of some countries in this regard, as well as their controversies, for instance, in the case of South Korean (Lee & Lee, 2020; Ryan, 2020). In this paper, we discuss the role of expectations in the case of contact tracing mobile apps in Colombia during the early month of the Corona crisis. As in many countries, in 2020 the Colombian government implemented a contact tracing app called ‘Coronapp’ with the purpose of tracking possible new cases of infection in the country. By early March the Minister of Health announced the implementation of the app, and by April the Minister of ICT depicted Coronapp as an app that saves lives (MinTIC, 2020), attributing such an agency to this tool under which technology is regarded as a mechanism to preserve biological life. However, such optimistic expectations quickly declined with the appearance of criticism regarding the efficacy, inclusiveness and, specially, privacy risks of the app. Such criticism deepened when the app was found to be ineffective in tracking down potential cases of contagion, as opposed to apps in other countries that used Bluetooth technology for this function (Botero, Sáenz, Labarthe, & Velásquez, 2020). Some other international experiences have also raised such efficacy criticisms on technological interventions (Berardi, et al., 2020). Literature also underscores the ethical and privacy concerns on contact tracing apps around the globe (Rowe, 2020; Dubov & Shoptawb, 2020; Galloway, 2020; Guinchard, 2020; Hoffman, et al., 2020; Hsu, 2020; Klar & Lanzerath, 2020; Klenk & Duijf, 2020; Lapolla & Lee, 2020), which have an impact on their acceptability by the public (Abuhammad, Khabour, & Alzoubi, 2020; Guillon & Kergall, 2020; Jonker, et al., 2020; Joo & Shin, 2020; Kaspar, 2020; Altmann, y otros, 2020; Trang, Trenz, Weiger, Tarafdar, & Cheung, 2020), specially in countries 1
of the Global South which still deal with major digital gaps (Arakpogun, Elsahn, Prime, Gerli, & Olan, 2020). The case of Coronapp in Colombia suggests a permanent tension between the multiple expectations that might exist regarding a specific technological tool in order to address the challenges of the pandemic. On the one hand, some regard Coronapp as a promising solution that poses positive expectations regarding the governments response to the pandemic. On the other hand, it is perceived by other actors as a threat to privacy and individual freedom, as well as a efficacy and inclusiveness-lacking tool. This case, therefore, illustrates the hype-disappointment dynamics that shape the implementation of technological solutions in addressing complex challenges (Borup, Brown, Konrad, & van Lente, 2006; Ruef & Markard, 2010). This paper analyzes the hype-disappointment cycle regarding the expectations on Coronapp as depicted in the public debate in Colombia. We aim at characterizing the process of disappointment that followed the high expectations of the app, deriving insights on what are the main factors, dynamics and processes that explain the decline of specific technological solution that does not meet the expectations raised. With this, we intend to contribute to the broader discussion on the role of expectations and promises in the case of technologies that connect multiple realms: the social, the political, the biological and the informatic. Even tough contact tracing apps have been designed as technical devices to address public health challenges, they are perceived to have an impact on the social and private spheres. Furthermore, they are transformed into a potential solution in the realm of policy and, therefore, they are subject to permanent political and social scrutiny. Furthermore, the paper adds to the literature discussing the performative role of sociotechnical expectations in society, and how their dynamics inform the governance of the pandemic in countries of the Global South like Colombia. 2. Conceptual approach As suggested above, this paper builds on sociology of expectations (van Lente, 1993; Borup, Brown, Konrad, & van Lente, 2006; Konrad, van Lente, Groves, & Selin, 2017) in order to assess the governance dynamics of the pandemic in Colombia and the interplay of future-oriented discursive tools in this regard. Borup, et al. (2006) define expectations as “real-time representations of future technological situations and capabilities” (p. 286). Emphasizing their collective and plausible character1, Konrad, et al. (2017) suggest a broader conceptualization of expectations as “statements about future conditions or developments that imply assumptions about how likely these are supposed to be and that travel in a community or public space” (pág. 466). They vary in terms of content, including a broad range of aspects beyond the technical sphere such as economic, political and cultural concerns (van Lente, 2012). Their scope also ranges from specific references to certain future-oriented manifestations of technology, to generalized envisions of broader technological fields, to overarching societal frames to approach technology (Ruef & 1 This distinguishes expectations from other future oriented notions such as imaginaries or visions, which stress a more normative character (Borup, et al., 2006). 2
Markard, 2010; van Lente, Spitters, & Peine, Comparing technological hype cycles: Towards a theory, 2013). Expectations have a performative character, i.e. they are more than just normative descriptions of possible future realities, but contribute to creating and shaping them. This generative or constitutive character in the dynamics of expectations depicts their capacity in building obligations out of promises, in what van Lente calls the ‘promise-requirement cycle’: actors are expected to meet the features of reality posed by such technological statements and, in this regard expectations can be understood as ‘self-fulfilling’ promises (van Lente, 2012). This performative character is represented in three main functions of expectations: i) providing guiding heuristics for sociotechnical processes; ii) mobilizing resources towards legitimized techno- scientific developments; and iii) coordinating actors’ interactions in networks (van Lente, 2012, p. 772). In doing so, expectations operate and materialize at different governance levels, ranging from broad macro policy abstractions to micro detailed envisions within networks (van Lente, 2012). 3. Methodological approach This paper assesses hype-disappointment cycle of contact tracing apps in Colombia by analyzing the expectations raised in this regard within the public debate in the country. In order to do that, and based on the work of Ruef & Markard (2010) and van Lente et al. (2013), we conduct a systematic media review in order to trace the attention that ‘Coronapp’ received during 2020, which illustrates the increase and decline of expectations regarding them. Following the authors, media attention and expectation statements in media documents account for potential hypes in the evolution of a specific technological development. We identify the frequency of discussions regarding ‘Coronapp’ that appear in the Colombian media with a national scope: Revista Semana, El Espectador, El Tiempo and Portafolio. These are selected considering their broad circulation and audience. Media documents are systematized in a table that distinguishes the characteristics of their content regarding expectation statements on ‘Coronapp’: do they suggest generic or specific expectations? Are those positive, negative or neutral expectations? Do these expectations have a time scope for their materialization? This implies a quantitative analysis on the frequency of media attention, and a qualitative analysis on the content of media statements. The latter is complemented with a documental survey and by conducting semi-structured interviews with relevant stakeholders regarding ‘Coronapp’ such as civil society organizations, academics, users of the app, and public officials from the National Health Institute, the Ministry of Health, the Ministry of ICT, among others. 4. Expected results and contributions This paper contributes to the discussion of track 13 ‘Agility, tentativeness and resilience: how to govern innovation systems and STI policies in times of crises and transformative change?’. It does so by discussing how sociotechnical expectations are a governance device whose performative role allows governments to provide agile responses to complex crises such as the COVID-19 pandemic. Such expectations revolve around technical devices based on ICT, such as contact tracing apps, which are expected to contribute to tacking the pandemic. Raising expectations can be then 3
regarded as an anticipatory practice that enables tentative and agile governance response in contexts of uncertainty. Furthermore, this ongoing research will provide additional empirical insights to better understand the characteristics of hypes regarding a convergent technological tool that operates in the boundary of political, ICT and social realms. We expect to build the evolution of expectations in time, and to identify different moments in this evolution process that might have differential characteristics. Furthermore, we add to the literature on sociology of expectations interested in hype- disappointment cycles (Ruef & Markard, 2010; van Lente, Spitters, & Peine, 2013), providing insights into how expectations have an impact in governance processes in countries of the Global South such as Colombia. This research offers a critical approach on technological solutions that are often pushed by governments as ‘silver bullets’ to address complex challenges such as the COVID-19 crisis, and highlights how multiple actors approach to and discursively frame contact tracing apps. However, rather than just criticize, we are interested in understanding their performative character. We identify how the performative functions of expectations are operationalized in this case, and discuss how this performative role has shaped the governance of the pandemic in Colombia. This adds to the discussions on the tensions of contact tracing apps around the globe, and underlines some explanatory elements of why these technical devices have been successful or not in different countries. We believe that this reflection is relevant for a better understanding of how governments deploy agile solutions to complex sociotechnical challenges. 5. Bibliography Abuhammad, S., Khabour, O., & Alzoubi, K. (2020). Covid-19 contact-tracing technology: Acceptability and ethical issues of use. Patient Preference and Adherence, 14, 1639-1647. Altmann, S., Milsom, L., Zillessen, H., Blasone, R., Gerdon, F., Bach, R., . . . Abeler, J. (2020). Acceptability of app-based contact tracing for COVID-19: Cross-country survey study. JMIR mHealth and uHealth, 8(8), 1-9. Arakpogun, E., Elsahn, Z., Prime, K., Gerli, P., & Olan, F. (2020). Digital contact-tracing and pandemics: Institutional and technological preparedness in Africa. World Development, 136, 105105. Obtenido de https://doi.org/10.1016/j.worlddev.2020.105105 Berardi, C., Antonini, M., Genie, M., Cotugno, G., Lanteri, A., Melia, A., & Paolucci, F. (2020). The COVID-19 pandemic in Italy: Policy and technology impact on health and non-health outcomes. Health Policy and Technology, 9(4), 454-487. Retrieved from https://doi.org/10.1016/j.hlpt.2020.08.019 Borup, M., Brown, N., Konrad, K., & van Lente, H. (2006). The Sociology of Expectations in Science and Technology. Technology Analysis & Strategic Management, 18(3), 285–298. doi:10.1080=09537320600777002 Botero, C., Sáenz, P., Labarthe, S., & Velásquez, A. (2020, April 23). ¿Qué dice que hace y qué es lo que realmente hace CoronApp? Fundación Karisma. Retrieved from 4
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Klenk, M., & Duijf, H. (2020). Ethics of digital contact tracing and COVID-19: who is (not) free to go? Ethics and Information Technology(0123456789). Obtenido de https://doi.org/10.1007/s10676-020-09544-0 Konrad, K., & Böhle, K. (2019). Socio-technical futures and the governance of innovation processes— An introduction to the special issue. Futures, 109(March), 101-107. Konrad, K., van Lente, H., Groves, C., & Selin, C. (2017). Performing and Governing the Future in Science and Technology. En K. Konrad, H. van Lente, C. Groves, C. Selin, & Clark Miller; Ulrike Felt; Rayvon Fouché; Laurel Smith-Doerr (Ed.), The Handbook of Science and Technology Studies (págs. 465-493). Cambridge: MIT Press. Kuhlmann, S., Stegmaier, P., & Konrad, K. (2019). The tentative governance of emerging science and technology—A conceptual introduction. Research Policy, 48(5), 1091-1097. Lapolla, P., & Lee, R. (2020). Privacy versus safety in contact-tracing apps for coronavirus disease 2019. Digital Health, 6, 1-2. Lee, S., & Lee, D. (2020). Lessons learned from battling COVID-19: The Korean experience. International Journal of Environmental Research and Public Health, 17(20), 1-20. Mergel, I., Gong, Y., & Bertot, J. (2018). Agile government: Systematic literature review and future research. Government Information Quarterly, 35(2), 291-298. MinTIC. (14 de April de 2020). CoronApp, la aplicación que salva vidas. Ministerio de Tecnologías de la Información y las Comunicaciones. Obtenido de https://mintic.gov.co/portal/inicio/Sala- de-Prensa/Noticias/126573:CoronApp-la-aplicacion-que-salva-vidas Rowe, F. (2020). Contact tracing apps and values dilemmas: A privacy paradox in a neo-liberal world. International Journal of Information Management, 55(June), 102178. Obtenido de https://doi.org/10.1016/j.ijinfomgt.2020.102178 Ruef, A., & Markard, J. (4 de 2010). What happens after a hype? How changing expectations affected innovation activities in the case of stationary fuel cells. Technology Analysis & Strategic Management, 22(3), 317-338. Ryan, M. (2020). In defence of digital contact-tracing: human rights, South Korea and Covid-19. International Journal of Pervasive Computing and Communications, 16(4), 383-407. Trang, S., Trenz, M., Weiger, W., Tarafdar, M., & Cheung, C. (2020). One app to trace them all? Examining app specifications for mass acceptance of contact-tracing apps. European Journal of Information Systems, 29(4), 415-428. Obtenido de https://doi.org/10.1080/0960085X.2020.1784046 van Lente, H. (1993). Promising Technology: The Dynamics of Expectations in Technological Developments. Ph.D. dissertation. University of Twente. van Lente, H. (2012). Navigating foresight in a sea of expectations: lessons from the sociology of expectations. Technology Analysis & Strategic Management, 24(8), 769-782. doi:10.1080/09537325.2012.715478 6
van Lente, H., Spitters, C., & Peine, A. (2013). Comparing technological hype cycles: Towards a theory. Technological Forecasting & Social Change, 80, 1615–1628. Whitelaw, S., Mamas, M., Topol, E., & Van Spall, H. (2020). Applications of digital technology in COVID-19 pandemic planning and response. The Lancet Digital Health, 2(8), e435-e440. Obtenido de http://dx.doi.org/10.1016/S2589-7500(20)30142-4 7
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