Building a Chatbot in a Pandemic

"In all, the receipt of targeted, simplified information in a relevant local language via an already used platform from trusted organizations has the potential to increase the resilience of individuals in an emergency."

During health emergencies such as the COVID-19 pandemic, an absence of timely, evidence-based information can leave room for misinformation and disinformation to fill the void. Chatbots have been identified as a user-centred resource with a role to play in risk communication and community engagement (RCCE), particularly when infrastructure and human resources are strained. Launched in May 2020 across the World Health Organization (WHO) European Region, the HealthBuddy+ chatbot aimed to translate the swiftly developing, complex technical guidance and recommendations on COVID-19 into user-friendly, accessible messaging in local languages, adapted to each country's context. This article reflects on the first 2 years of HealthBuddy+, exploring the challenges, innovations, and lessons learned.

In January 2020, following the declaration of the novel coronavirus as a public health emergency of international concern, the WHO Regional Office for Europe and United Nations Children's Fund (UNICEF) Europe and Central Asia Regional Office forged a partnership to rapidly develop HealthBuddy+, an artificially intelligent conversational chatbot based on natural language processing principles. The chatbot is built on RapidPro, an open-source platform that allows users to design, build, and scale up mobile-based services, and is also connected via Bothub, another open-source platform.

Notably, HealthBuddy+ was designed to be a tool adapted to the individual at a time when individual action has the possibility to slow the pace of the pandemic. It seeks to harness the role of the individual by providing answers to their diverse questions through practical and empowering messages on how to protect themselves and their communities while using a friendly approach and tone.

To ensure that HealthBuddy+ was relevant and useful in countries across the region, the 2 regional offices worked closely with their counterparts in country offices, which were essential in partnering with national authorities, engaging communities, promoting the tool, and identifying the most relevant communication channels in which to embed HealthBuddy+. Over a 2-year period, the project expanded from a web-based chatbot in 7 languages to a multistream, multifunction chatbot available in 16 regional languages that included a rumour-reporting tool and a user poll function. Based on data from these polls, the project team embedded the chatbot on trusted channels in partnership with member states and partners (including the health sector, national mainstream media, and civil society organisations) and funneled trustworthy health information to the user.

Once HealthBuddy+ had been launched in several countries, user questions began to flow in, covering topics ranging from symptom recognition to local mis- and disinformation. The user questions presented the team with an opportunity to go beyond one-way information provision and to understand the user experience and what users wanted to know; they could then proactively aim to fill voids based on these insights. Working with the regional offices, country offices came up with ideas on how to respond to user questions while the bot's intelligence was growing.

Per the HealthBuddy+ team, maintaining a massive content repository in multiple languages posed a significant challenge; the constantly evolving pandemic meant that the content had to be updated frequently. Also challenging was the push to incorporate content based on global guidance and to make it relevant and useful throughout the diverse region of 53 member states. To address this challenge, the team informed their understanding of the user through: (i) broader social listening insights via regular social and media listening and behavioural and cultural insights; (ii) user data; and (iii) insights from country focal points, who regularly shared "hot topics" circulating in their localities. As the technical guidance and recommendations evolved, the team worked to share trustworthy and evidence-based information on the newly-introduced COVID-19 vaccines, for instance, while simultaneously collecting listening data via the user poll.

Among the many lessons learned during the development and roll out of HealthBuddy+, the project team characterises the need to remain both agile and innovative as the most important. Building and maintaining trust is paramount to support the response to health emergencies; to do so, it is vital to always keep individuals and at-risk communities at the centre. Building trust for HealthBuddy+ meant working closely with focal points in country offices and maintaining an open feedback loop so that HealthBuddy+ could always remain adaptable to local contexts.

In conclusion: "Based on the experiences, challenges, and adaptations in the first 2 years of the HealthBuddy+ project, the WHO and UNICEF will continue to update and adapt the tool to meet the information-seeking needs of the public and support national authorities. Most notably, with the recent war in Ukraine and subsequent migration of millions of individuals to neighboring countries, HealthBuddy+ is being adapted to respond to this emergency. Working with focal points from Hungary, Poland, the Republic of Moldova, and Romania has helped this effort by consolidating crucial health information and resources all in one location for refugees on the move, illustrating the agility of HealthBuddy+ and what it is capable of."

Full list of authors, with institutional affiliations: Kimberly Rambaud, World Health Organization (WHO) Regional Office for Europe; Simon van Woerden, WHO Regional Office for Europe; Leonardo Palumbo, WHO Regional Office for Europe; Cristiana Salvi, WHO Regional Office for Europe; Catherine Smallwood, WHO Regional Office for Europe; Gerald Rockenschaub, WHO Regional Office for Europe; Michail Okoliyski, WHO Country Office Bulgaria; Lora Marinova, WHO Country Office Bulgaria; Galina Fomaidi, WHO Country Office Uzbekistan; Malika Djalalova, WHO Country Office Uzbekistan; Nabiha Faruqui, United Nations Children's Fund (UNICEF) Europe and Central Asia Regional Office; Viviane Melo Bianco, UNICEF Europe and Central Asia Regional Office; Mario Mosquera, UNICEF Europe and Central Asia Regional Office; Ivaylo Spasov, UNICEF Country Office Bulgaria; Yekaterina Totskaya, UNICEF Country Office Uzbekistan