Digital Health for Pandemic Preparedness: A Critical Review of Innovations, Equity Gaps, and Governance in Infectious Disease Surveillance

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AuthorAbdolreza Babamahmoodien
AuthorFarhang Babamahmoodien
AuthorMajid Marjanien
OrcidAbdolreza Babamahmoodi [0000-0002-3730-5268]en
OrcidFarhang Babamahmoodi [0000-0003-4239-9569]en
OrcidMajid Marjani [0000-0003-1466-8645]en
Issued Date2025-07-31en
AbstractContext: Recent infectious disease emergencies, including SARS-CoV-2, mpox (2022 - 2024), highly pathogenic avian influenza A(H5N1) in US dairy cattle (2024 - 2025), and the Marburg virus in Rwanda (2024), have strained traditional surveillance systems. Digital health has been proposed as a paradigm shift; however, most reviews have focused on diagnostic accuracy while neglecting equity and governance. Evidence Acquisition: We conducted a structured thematic narrative review of peer-reviewed and grey literature published from January 2010 to March 2025, reported in accordance with PRISMA 2020 and PRISMA-ScR. PubMed, Scopus, and Web of Science were searched from February 5 to 18, 2025. Search keywords combined three concept blocks: (1) Digital-health technologies (artificial intelligence, machine learning, mHealth, eHealth, telemedicine, electronic health records, wearables, wastewater surveillance, genomic surveillance, natural-language processing); (2) infectious diseases (outbreak, pandemic, epidemic, COVID-19, Ebola, Zika, mpox, influenza, antimicrobial resistance, Marburg); and (3) public-health functions (surveillance, detection, forecasting, contact tracing, governance, equity). Full Boolean syntax is provided. Records were deduplicated in EndNote X20 and screened by 2 blinded reviewers in Rayyan (Cohen κ = 0.81). Empirical studies were appraised using the Mixed Methods Appraisal Tool 2018, and reviews were appraised using Joanna Briggs Institute checklists. The synthesis followed Braun and Clarke's reflexive thematic analysis and was interpreted through sociotechnical systems and data justice lenses. Results: Of 1498 records, 142 studies met the inclusion criteria; 48% (69/142) were rated as high quality. The evidence base was heavily skewed regionally (high-income countries [HICs], 41%; sub-Saharan Africa or South Asia, 19%). No technology was universally superior. Artificial intelligence (AI) studies were concentrated in HICs (18/32, 56%), whereas short-message-service (SMS) mHealth studies were concentrated in low- and middle-income countries (LMICs; 15/25, 60%). Recurring barriers included algorithmic bias, fragmented interoperability, donor-dependent sustainability, and slow benefit-sharing of pathogen data with LMICs. Conclusions: Across 142 included studies the synthesis supports a measured conclusion: Digital health is necessary but not sufficient for pandemic preparedness. The patterns most consistently observed in the evidence — regional skew, recurring governance failures, donor-dependent sustainability, and design choices that determine equity outcomes — together indicate that equity, sustainability, and accountability are constituents of effectiveness rather than obstacles to it. The binding constraint is increasingly political and institutional will rather than analytic uncertainty.en
DOIhttps://doi.org/10.5812/iji-169286en
URIhttps://brieflands.com/journals/iji/articles/169286en
KeywordArtificial Intelligenceen
KeywordPublic Health Surveillanceen
KeywordCommunicable Disease Controlen
KeywordMobile Healthen
KeywordTelemedicineen
KeywordHealth Equityen
KeywordGlobal Healthen
KeywordPandemic Preparednessen
PublisherBrieflandsen
TitleDigital Health for Pandemic Preparedness: A Critical Review of Innovations, Equity Gaps, and Governance in Infectious Disease Surveillanceen
TypeReview Articleen

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