Human challenge studies in the study of infectious diseases
What can deliberately infecting healthy people tell us about infectious diseases? How is this useful for developing treatments, and how do we manage the risks?
The digital divide is the gap between people in society who have full access to digital technologies (such as the internet and computers) and those who do not. Concerns about the digital divide have been particularly acute during the COVID-19 pandemic as the internet and digital devices have played an important role in allowing people to access services, attend medical appointments and stay in touch with friends and family. What impact has the digital divide had on children and adults in the UK during the COVID-19 pandemic and what has been done to tackle it?
Concerns about the digital divide have been particularly acute during the COVID-19 pandemic as internet access has become increasingly important for accessing public services, health information, shopping, and staying connected to family and friends. In some cases, services, activities and information have moved exclusively online, or offline alternatives may be limited or restricted. For children, the internet and device access may be required for remote schooling and adults may require additional digital skills for working from home.
Office for National Statistics (ONS) survey data from 2020 found that 95% of UK adults had used the internet in the past 3 months. Other survey data suggest that for adults who do not use the internet, some of the main reasons include a lack of interest or perceived need, privacy and security concerns, lack of ability to use it, and cost of access.
The UK consumer digital index 2020, an annual survey of about 4000 bank customers by Lloyds Bank, found that, although the number of people in the UK lacking digital skills is declining, 16% of participants could not carry out a full set of seven basic digital tasks (such as connecting a device to a Wi-Fi network and opening an internet browser to find and use websites), and 9% of participants were unable to carry out any of the seven tasks.
Certain groups are more likely to be digitally excluded than others. The main factors that influence the digital divide in the UK include age, region, socioeconomic status and whether a person has a disability. The ONS 2020 survey found that the likelihood of an individual regularly using the internet decreases with age (Figure 1); 100% of respondents in the 16–34 age group said they go online daily or almost daily, compared with 67% in the 65+ age group. The survey also found that 76% of adults in Great Britain used internet banking, however this fell to 49% of those aged 65+. Those with a disability are also less likely to use the internet; the proportion of respondents who said they used the internet daily or almost daily was lower for adults who were disabled (84%) compared with those who were not disabled (91%).
Internet non-users and those with fewer digital skills are more likely to be in lower socioeconomic groups. According to the Lloyds Bank UK Consumer Digital Index 2020 survey, people with an annual household income of £50,000 or more are 40% more likely to be able to carry out basic digital tasks than those earning less than £17,499. The survey also found that Wales, the East Midlands and North East of England have the lowest proportions of people with a full set of digital skills and the highest proportions of internet non-users.
Digital exclusion during the pandemic may affect adults in several ways. For example, they may not be able to readily access health advice, medical appointments, or support services for housing or social care. The pandemic may also have an adverse impact on people seeking work, as those who are less digitally skilled or do not have internet access may struggle to search for and apply to jobs online, and may not be able to access online employment support services. Internet access is important for managing mental health during social distancing, not just for communicating with friends and family, but also because many social and welfare activities, such as gym classes and pub quizzes, are now being offered online. There are also concerns that those without internet access or digital skills may find it harder to access and manage their finances, as banks and retailers have increasingly encouraged their customers to use online services. Moreover, digital exclusion is most prevalent among elderly and disabled people who are at risk of being negatively affected by the pandemic in other ways, such as having higher vulnerability to the virus.
As part of the UK Consumer Digital Index 2020, Lloyds bank surveyed 2,137 people on their attitudes towards digital engagement during the pandemic. 78% of those surveyed said that the pandemic had escalated the need for digital skills and 80% agreed that using technology had provided them with vital support. 37% of participants said they had used more technology than usual to support their health and well-being during the lockdown and 31% had learned new digital skills for work related purposes since the lockdown began. However, 7% of respondents could not get online as much as they would like because they had nobody to help them do so and 55% of respondents said that there are key services that they need in their day-to-day lives that can’t be fulfilled by technology.
For adults with access to the internet but insufficient online safety skills or cybersecurity knowledge, the pandemic may put them at higher risk of online harms such as misinformation, fraud and computer viruses. The Consumer Digital Index 2020 found that 37% of the UK’s workforce lack the basic skills needed for fully safe and legal online behaviour, and 36% of those surveyed did not think that understanding how to stay safe online had been important to them since the lockdown began. A survey by insurance company Aviva found that 1 in 5 respondents had received coronavirus-related correspondence that they suspected was a financial scam. UK Finance (the trade association for the UK banking sector) published a list of COVID-19 scams that people should be on high alert for. These include fake government emails containing links that steal victims’ personal or financial information, and phishing emails claiming a recipient has been in contact with someone with the virus.
Most children across the UK have experienced disruption to their education as school closures and COVID-19 related absences have necessitated home-schooling and online distance learning. Much of the remote teaching offered by schools, as well as resources offered by other organisations, require internet and/or device access. An Ofcom survey carried out between January and March 2020 found that 9% of households containing children did not have home access to a laptop, desktop PC or tablet.
The extent to which children’s education may have been impacted due to school closures is likely to vary widely depending on what remote education schools and families have been able to provide. However, there have been concerns that children from disadvantaged backgrounds have experienced the greatest disruption to their education, as they are less likely to have the devices and internet connections required for home learning. A June 2020 report by the Education Endowment Fund said that school closures are likely to have widened the attainment gap between disadvantaged children and their peers.
Section 3 of the Commons Library Briefing Paper Coronavirus and Schools: FAQ (2020) cites some survey evidence on the differences in remote learning, including an April 2020 survey of 4559 children carried out by the UCL Institute for Education that found that one in five of those eligible for free school meals had no access to a computer at home. Another April 2020 survey of over 7,000 teachers by the Sutton Trust found that 15% of teachers in the most deprived schools said that more than a third of their students would not have adequate access to an electronic device for home learning, compared with 2% of teachers in the most affluent schools. 12% of teachers in deprived schools also thought that more than a third of their students would not have sufficient internet access. The survey also found that children from disadvantaged backgrounds are less likely to participate in online lessons, whether live or recorded. There are also differences in how well-prepared different schools were for providing online education during lockdown, with evidence that schools in deprived areas were less well-prepared. For example, the Sutton Trust survey found that 60% of private schools and 37% of state schools in the most affluent areas already had an online platform in place to receive students’ work, compared with 23% of the most deprived schools.
From October 2020, the Department for Education has required state-funded schools in England to provide immediate access to remote education in cases where students need to self-isolate or schools are closed due a local lockdown. This duty to provide remote education was outlined in a temporary continuity direction under the Coronavirus Act 2020, and came into force on 22 October. Government guidance on the full opening of schools states that schools must provide printed resources, such as textbooks and workbooks, for pupils who do not have suitable online access. For more information on temporary continuity directions in the Coronavirus Act see Commons Library Briefing Paper Coronavirus Bill: childcare and education settings (2020).
Since April, the BBC has offered an expanded selection of educational content on its website and via television. The television content is accessible via the red button and does not require internet access, but does require a television and TV Licence. The UK Government has provided £4.84 million of funding to support the Oak National Academy, an online classroom and resource hub created by teachers in England in response to the pandemic. Some of the Academy’s resources are downloadable and can be printed in cases where poor internet connectivity and lack of access to devices are issues. Information on access to devices for education support is discussed later.
In September, NHSX, a unit of the NHS responsible for digital innovation, launched a mobile phone app for contact tracing in England and Wales. Similar contact tracing apps have also been launched in Scotland and Northern Ireland. Contact tracing is the process of identifying all the people who have come into contact with an infected individual so they can be warned that they may be at risk of illness; mobile phone apps can automate this process. The apps available in the UK are being used as part of wider test, trace and isolate programmes to prevent the spread of the virus.
Concerns have been raised that those who are digitally excluded may not be able to use the app, as they may lack the digital skills required to operate it, may not have a smartphone that can support the app, or may not own a smartphone at all. This could lead to further social exclusion if uptake of the app becomes widespread or access to certain locations or services becomes conditional upon having the app installed. For example, if an employer requested that employees have the app installed before they enter the workplace. There are also concerns that those who are excluded from the app may experience negative health impacts, as vulnerable groups such as the elderly are at higher risk of serious illness from COVID-19 and are also more likely to be digitally excluded. A 2020 Ofcom survey of over 3600 people found that older people and those from lower income households are less likely to own a smartphone, which is needed in order to use contact tracing apps. For example, 5% of respondents in the 35–54 age group did not own a smartphone, compared with 30% in the 55+ age group. An October 2020 survey of around 650 people aged 60+ by Silver Voices, a charity for older people, found that 31% had reported downloading the app. Out of those who had not downloaded it, nearly 6 in 7 said it was because their phone was too old to support it.
Prior to the app being launched, some academics proposed that legislation should be passed to govern it, as has been done in Australia, and that this should include some safeguarding against discrimination based on who does or does not have the app installed. The Joint Committee on Human Rights also emphasised the importance of ensuring measures are in place so that those who do not have access to the app are not discriminated against in accessing services.
To tackle the issue of device access, the Ada Lovelace Institute suggested that devices able to replicate the app’s functionality could be distributed to those without smartphones. This approach has been adopted in Singapore, where the Government has handed out wearable Bluetooth-connected contact-tracing tokens for those who don’t have a smartphone, as part of its TraceTogether contact tracing app. Initial rollout happened in areas with a higher proportion of older people.
The UK Government does not have plans to distribute wearable Bluetooth devices for non-smartphone owners. It has said that people without the app will still benefit from it, as the app users will help break the chains of virus transmission. The Government also said that the app is only one part of the wider Test and Trace programme and, for those who cannot use it, advice is available via NHS 119 and the phone-based manual contact tracing system.
98% of households across the UK have access to the physical infrastructure required to receive a ‘decent’ fixed broadband connection (defined as a connection allowing a download speed of 10 Mbit/s and an upload speed of 1 Mbit/s, see Constituency data: broadband coverage and speeds for regional differences). Therefore, a lack of internet access generally relates to a lack of a broadband or mobile data service. Concerns have been raised that, in addition to those households already lacking internet access, the economic impacts of the pandemic could mean that more households become unable to afford internet access. This may be compounded by the closure of workplaces, schools and public spaces, such as libraries and cafes, meaning that many people have no alternative to accessing the internet from home.
In March, following discussions with the Government, the UK’s major internet service and mobile providers agreed to temporarily remove data allowance caps on fixed line broadband services and added free extras to customers’ plans as a result of the pandemic. Mobile network operators removed data charges for accessing NHS websites offering information on COVID-19 and when using the NHS COVID-19 app. Some fixed line broadband providers have since reinstated data caps and others have removed certain bonus features that were available earlier in the year. Details of support for customers struggling to pay their broadband or mobile bills are given in section 5.3 of the Commons Library Briefing Paper Coronavirus: Support for household finances (2020).
Other stakeholders have suggested further courses of action may be required. Digital inclusion charity Good Things Foundation has recommended the creation of a ‘Data Poverty Lab’, which recognises internet access as an essential utility, like electricity. It has suggested initiatives including data donating (similar to a scheme that exists in Australia, whereby people can donate unused mobile data to others who can’t afford it), Wi-Fi sharing between neighbouring households, subsidised broadband schemes, and extending public Wi-Fi in towns and cities.
DevicesDotNow is a UK-wide initiative asking companies to donate IT kit such as laptops, tablets and mobile SIM cards/dongles, which are then distributed to community online centres through the Online Centres Network supported by the Good Things Foundation. The government supports the initiative but has not provided it with funding. In June 2020, the Good Things Foundation reported that DevicesDotNow had distributed around 2000 devices and data packages to vulnerable adults shielding in their homes during the pandemic.
During the 2020 summer term, the Department for Education provided laptops, tablets and 4G routers to disadvantaged children who could not access these from other sources such as their school. Young people who qualified for this support included: disadvantaged Year 10 pupils, care leavers and children aged 0–19 with a social worker. Over the summer term the Government delivered around 220,000 devices (including laptops and tablets) and around 51,000 4G routers.
The Government has committed to distributing further devices for the 2020–2021 school year to help children access remote education. These devices are for disadvantaged children experiencing disruption to their face-to-face education as a result of the virus, or who have been asked to shield as they are extremely vulnerable. They are also available to disadvantaged children who attend hospital schools. According to the latest Department for Education data, 105,508 devices were despatched between 1 September and 22 October as part of this second phase of support. More information on the distribution of laptops and the associated debate around the rollout can be found in Commons Library Briefing Paper Coronavirus: exams in 2021 (2020).
As part of its 2019 education technology strategy, the Government launched a network of ‘demonstrator’ schools and colleges to support other schools and colleges in using technology effectively. During the pandemic, the Department for Education changed the aims of the demonstrator programme to focus on helping schools and colleges access training and advice on remote teaching.
In Scotland, the Scottish Government is encouraging flexible use of The Attainment Scotland Funding (which supports schools to close the attainment gap between the most and least disadvantaged pupils) to support disadvantaged pupil’s remote learning, for example by providing them with devices.
The Connecting Scotland programme, delivered by the Scottish Government, in partnership with local authorities, Healthcare Improvement Scotland, charities and the digital and IT sectors, was set up in response to the pandemic. It aims to get 50,000 digitally excluded households online by the end of 2021. The programme offers an internet connection, devices, training and support to vulnerable people who are not already online. The latest phase of the programme involved delivering laptops and tablets to digitally excluded low-income families and care leavers. The Scottish Government also ran a separate programme with £9 million of funding to deliver 25,000 laptops to disadvantaged children to support remote learning during the pandemic.
In Wales the Welsh Government pledged up to £3 million to enable local authorities to provide digitally excluded schoolchildren with internet connections and devices. In June 2020, it reported that it had delivered 745 devices to 401 care homes to help people access digital health services and stay connected to loved ones.
April 2020, the Department of Education in Northern Ireland outlined plans to loan devices to disadvantaged children who require them for remote learning. An initial batch of 3000 laptops was distributed in June 2020, and more were made available in August.
A report by the Education Policy Institute, commissioned by the Nuffield Foundation, analysed the education policy responses of England, Scotland, Wales and Northern Ireland during the height of the pandemic, including the timeliness of the provision of digital devices to disadvantaged students. It found that Wales acted quickly to provide students with equipment, with stocks of laptops and routers distributed by the end of May. In England, most devices were distributed in mid/late June, meaning some pupils may have had only a few weeks of access to the devices before the end of the summer term. The analysis found that Northern Ireland and Scotland were slower to roll out devices, with distribution completed by or after the end of the school term.
A number of organisations are offering online courses to help people improve their digital skills. Good Things Foundation offers online resources to help with basic digital skills. These include its ‘Learn My Way’ and ‘Make it Click’ courses. During the pandemic, it launched a new resource (‘Using the internet to get ready for coronavirus’) for tutors to help others carry out tasks such as finding health information online and conducting video calls.
At the beginning of the pandemic the UK Government launched The Skills Toolkit, a new, free online learning platform to improve workplace skills. The platform offered furloughed employees an opportunity to maintain their skills development. In September 2020, the Government announced £8 million of funding for digital skills ‘boot camps’, to expand on trials carried out in the West Midlands and Greater Manchester. It also committed to expanding the range of courses offered in the Skills Toolkit.
During the school closures, concerns were raised that children who do have internet and device access at home, but may not have good online safety skills, would be spending longer online and could thus be more exposed to online harms such as inappropriate content or cyberbullying. The UK Government has published a list of resources for parents and carers to keep children safe online during coronavirus and separate advice for safeguarding children and teachers during remote learning. In September 2020 it published its revised ‘Keeping Children Safe in Education’ statutory guidance to include additional information and support on safe remote education. The Government has also published advice for individuals and businesses on how to protect themselves from fraud and cybercrime during the pandemic.
Following its 2019 Online Harms White Paper, in December 2020 the Government published draft proposals for its Online Safety legislation. The new laws will require companies to take measures to remove and limit the spread of illegal content online, and protect children from being exposed to online harms such as bullying. Ofcom will be responsible for enforcing the legislation and will have the power to levy fines of up to £18 million or 10% of a company’s annual global turnover.
In March 2020 the Government set up a Counter Disinformation Unit, specifically to identify and respond to COVID-19 misinformation and scams. In November, the Government announced that it had agreed a package of measures with social media companies to limit the spread of misinformation about COVID-19 vaccines. The measures included a principle that no company should profit from COVID-19 vaccine misinformation, and a commitment to quick responses to flagged content. Ofcom has collated a range of online resources that focus on debunking common misconceptions or harmful claims about COVID-19, as well as tools to help people find reliable news and information about the virus.
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