Pandemic Prevention through Video Games

COVID-19 has evolved into the greatest health and economic challenge of our generation. Awareness and education is critical for empowering healthcare workers (HCWs) and building their capacity in dealing with the pandemic. 

The project leverages the power of video games to educate, engage and empower the general public as well as frontline HCWs for enhanced prevention, accurate detection, and rapid response. Games have several use cases to serve as solutions for raising awareness during emerging pandemics; this proposal will demonstrate one particular use case -  digital games for building the awareness and capacity of frontline healthcare workers in the US and Pakistan. 

This proposal builds on our on-going work around the game "CoronaCombat" which raises awareness on COVID-19. 

The potential impact of CoronaCombat is immense. Think Pokemon Go for fighting COVID19, a game that had people around the world chasing a shared goal. 

Currently, there are 1.2 million physician HCWs in the US and around 127,859 doctors in Pakistan (catering to a population of over 170m people). When COVID19 hit, these HCWs became the frontline in the fight against an unknown enemy. A recent study found that 48% health care workers in Pakistan do not believe that their organization is prepared for an infection outbreak. It is therefore absolutely critical to arm HCWs with the knowledge to deal with health emergencies. 

There are two types of information gaps associated with COVID-19:

• Lack of information: Given the novel nature of the pandemic HCWs do not have access to practical guidance on dealing with sick patients in a safe manner. 
• “Infodemic”: The coronavirus outbreak sparked an overwhelming amount of misinformation on social media and websites. It is critical to equip HCSw with skills that allow them to identify and fight misinformation. 

Communication is essential when preparing for a health emergency and attention should not only be given to ensuring that the information being provided is evidence-based, accurate and consistent but also that it is delivered in a fashion that is actionable, easily digestible, demonstrative and retainable.  

At GRID we create digital games offer a platform to educate, engage and empower our players in an effective manner. We believe in the saying “Tell me, & I will forget, show me, & I may remember, involve me, & I will understand” Confucius. 

The solution expands the current game CoronaCombat  to include a specific focus on strengthening preparedness and rapid response capacity of HCWs in dealing with the COVID-19 pandemic. Currently CoronaCombat is hosted on a dedicated webpage in English and Urdu and had 1000 game plays in less than 2 months. 

Increasingly games are being used by health organizations for training purposes. Mercy Medical Center in Baltimore, Maryland is using games to teach skills and information to its nurses and reports: "The nurses love using games in learning. They enjoy the fact that it is self-paced, providing them with as little or as much time as they need to learn the content. The environment provides them with opportunities to make mistakes and learn from them without feeling incompetent".

CoronaCombat will provide a template that can be easily scaled and replicated for building awareness of the general public, HCWs and vulnerable populations in times of public health emergencies. 

The proposed solution provides important information to HCWs in an interactive and iterative manner. CoronaCombat for HCWs will leverage 3 key game features:

• Animations to simulate concepts like spread of disease, patient care, flattening the curve, social distancing etc.
• Leverage game features to allow HCWs to play at their own pace and encourage them to keep coming back to the game for iterative exposure to key messages;
• Create a sense of community within the game environment to reduce HCW stress and burnout;
• Allow for high-quality virtual learning in cases where face-to-face workshops are not feasible.

The game will provide tips and guidance to HCWs on topics including, but not limited to, the following:

• Performing hand hygiene
• Contact and droplet precautions
• Precautions when performing aerosol-generating procedures
• Precautions when handling laboratory specimens from patients with suspected COVID-19
• Guidance on cleaning soiled bedding, towels and linens from patients with COVID-19
• What personal protective equipment (PPE) to use when performing nasopharyngeal (NP) or oropharyngeal (OP) swabs on patients with suspected or confirmed COVID-19
• Strategies to stay protected during severe shortages of PPE

All content will be derived from WHO, CDC and in particular JHU's knowledge product on synthesized guidance for covid19 messaging. 

The solution is inspired directly by the Challenge. The game provides a low-cost, innovative way to raise awareness during health emergencies. MIT Solve is seeking tech innovations that can slow and track the spread of an emerging outbreak and highlights tools that support and protect health workers as an example. This solution falls within that category. 

CoronaCombat is an awareness and capacity building intervention targeted at improving operational capacities of HCWs through digital games. CoronaCombat will ensure that guidance provided is tailored for the resource-constrained realities faced by health workers in countries like Pakistan. 

Current approaches that train HCWs are not only logistics-heavy given that they are facilitator-based and require in-person training, but also have low rates of message retention.The proposed solution aims to leverage the power of mobile games to deliver remote and interactive training to HCWs for prevention of infectious diseases. 

Why Games: 

• Games have the 3 iS: Given the interactive, iterative, and inspiring nature of digital games, they appeal to the human psychology in a way most other communication tools don’t and their impact on our brains far transcends the boundaries of the virtual world. 
• Crystal Ball effect: With regards to the coronavirus, games offer a safe environment to simulate the effects of everyday decisions and depict their long-term consequences. Behavior change for COVID19 is hard because of what psychologists call our “present bias.” It is hard to convince people to make lifestyle changes in the present to prevent a negative future outcome. We believe the crystal ball effect of games helps tackle the "present bias" and provides a sneak peek into the many possibilities of flattening the curve.
• Universal coverage: We are approaching a world where smartphones as low as $20 are spreading to all places — even areas where basic conditions like proper sanitation are luxuries. This boom opens a window of opportunity to use simple mobile games to inspire people around the world towards tackling the spread of COVID19. 
• Measuring learning progression: Video games, with knowledge tracking functions, create individualized learning plans for the learner versus a one-size-fits-all. 

All GRID games are designed for low-resource settings and hence compatible with low-end smartphones and devices. Most games are small in size and do not require internet connectivity for gameplay. 

The current game can be played on any smartphone, tablet or pc, including low-end android phones through a free-to-access webpage; of the 1000 current users, 51% access the game on mobile devices, while the remaining 49% do so on desktops. The expanded version for HCW will leverage the existing webpage but also be launched as an app. 

The solution leverages digital games to equip HCWs with accurate information, guidance and access to resources related to COVID-19.  Since games are popular across borders and age groups they present a unique platform to reach the masses in a fun & engaging manner. Stopping the spread of infectious disease demands that we meet people where they are: on their screens. As the coronavirus COVID-19 global health emergency continues, better awareness, through entertainment, could be a key strategy for successful intervention.

Digital games are immensely popular; by age 21, the average American will have spent more than 10,000 hours playing video games — the equivalent to 5 years of work at a full time job! Increasingly, people seek content that allows them to be a part of the story and therefore a part of the solution. We need entertainment that activates our agency. The COVID-19 outbreak is an opportunity to reinvent public health engagement and use entertainment as a means for pandemic prevention.

Mercy Medical center have tested the use of games for training of nurses and found that "staff is more excited to learn because learning doesn’t seem like a chore anymore. The games are clearly more pleasing to the senses, using a wide variety of aesthetics and music which connects the player’s emotions with the content". They conducted research demonstrating gaming as better in terms of user satisfaction and retention of information when compared to didactic classroom learning and e-learning modules in a learning management system.

Furthermore, GRID's own experience with games demonstrates their  effectiveness as behavior change tools. We have created games on reproductive health (MoHiM, Nari Paila & SurrEndo) on compassion for animals (KritterKneads), climate change (EarthFenders), and Coronavirus awareness (Coronacombat). Our reproductive health game, Nari Paila was launched in Nepal and had more than 10,000 downloads within the first ten weeks, exceeding it’s target reach by 3000. 32% of Nari Paila players are females of whom 71% are under the age of 24.  

The first version of CoronaCombat was created as a proof of concept. We created this version in 9 days using our internal funds and launched it on April 10th. The game received immense attention, including a shout out by Chelsea Clinton on Twitter, as well as media coverage by ABC News. Since it's launch, the game has reached more than 1000 people with no marketing budget. CoronaCombat was translated into Urdu through a grant provided by American Pakistani Foundation. 

During a pandemic, actions taken willingly by the public in response to accurate, scientific information will reduce contagion and suffering. Clear, trusted, and coordinated communication with the public will be essential to avoid unnecessary risk of infection, confusion, anger, and the overwhelming demand for health care.

This solution aims to provide a use-case of games being used in low-resource settings to provide (i)interactive, (ii) timely and (iii) virtual information to HCWs in an attempt to strengthen their capacity for dealing with health emergencies. 

The theory of change can be broken down as below: 

Problem: 

HCWs risk their personal health each time they tend to COVID-19 patients and this is made worse by the absence of clear guidelines and shortage of PPE (Personal Protective Equipment). The physical and psychological well-being of HCWs are being tested as patient loads continue to increase and fellow co-workers become infected with COVID-19, contributing significantly to burnout among healthcare workers. The information gaps surrounding the current COVID19 pandemic has brought to light the value of raising awareness in an interactive, inspiring and iterative manner.

Assumptions:

• A large share of HCWs have access to low-end smartphones and 
• Enhanced training will translate into better healthcare (barring other factors such as shortage of resources and low-employee motivation)

Inputs: 

• Development of CoronaCombat to ensure that accurate COVID19 guidance is delivered in a fun and engaging way. 
• Content tailored to provide practical tips to HCWs for dealing with health emergencies
• Outreach measures to ensure the games reach HCWs in Pakistan and US. 

Outputs:

• Number of HCWs that access the games measured through app downloads/game plays

Outcomes:

• Enhanced prevention awareness: Increased awareness among HCWs in Pakistan and US on keeping themselves safe while taking care of covid19 patients. Knowledge gains will be measured through surveys embedded in the game design to track learning progression.
• Games mainstreamed as communication and behavior change tools in response to health emergencies. 

Longterm Impact: 

• Strengthened capacity of HCWs to deal with health emergencies and provide rapid response
• Improved healthcare and reduced vulnerabilities during epidemics and pandemics 

We have reached 10,000 players through existing GRID games. The current version of CoronaCombat has been played more than 1000 since its launch.  

Outreach in 1 year: 

• Launch of revised CoronaCombat which includes a dedicated module for HCWs in English and Urdu
• In our first year, we hope to reach 5000 HCWs with the revised CoronaCombat, of which at least 40% will be in Pakistan. 

Outreach in 5 years: 

• Over the next 5 years we aim to create a suite of games that leverage the current template to create awareness and inspire behavior change during disease outbreaks. The current version of the game will be scaled up and replicated to cater to different target audiences such as groups that are disproportionately impacted by epidemics and pandemics including minorities, LGBTQ, refugees and women and girls or games that build general public awareness in different languages (including spanish, arabic and hindi).
• Grow to impact at least 100,000 people in low-income, minority, immigrant populations in the US and in developing countries;

The potential outreach for the solution is immense. Think Pokemon Go for building prevention awareness; a game that had youth around the world chasing a shared goal. Our model has the potential to mobilize players on a large scale and have them playing together to avoid the spread of infectious diseases. 

Our goal in the first year is to develop a proof of concept by creating a dedicated module within CoronaCombat for HCWs. This module will:

• provide tips and guidance to HCWs to treat COVID19 patients effectively and efficiently
• Link players to sources of accurate information about the virus. 
• A bonus stage will also bust common myths around infectious diseases such as corona virus to avoid public hysteria. 
• Equip players with the ability to question sources of information and identify facts from myths

Five year goal: 

Product and technology: Create a suite of 5 games that leverage the current template to create awareness and inspire behavior change during outbreaks. Proposed modules can vary by beneficiaries (audience type) or the type of outbreak (content):

• Different modules that will raise awareness around the disproportionate impacts of CODIV19 on vulnerable populations such as minorities, women, LGBTQ communities, people living with addiction, homeless populations and those that are incarcerated. 

• Different modules that provide prevention, hygiene, detection and self-quarantine tips for different outbreaks including cholera, Ebola, SARS, Chikungunya and influenza. 

• Content: Establish content partnerships for different modules and ensure the games are available in regional languages where they are being launched. 

We foresee the following barriers:

Concerns around inclusion: There are concerns around the reach of mobile games since there are areas with smartphone penetration. While we fully acknowledge this concern and encourage hybrid (digital + face to face) approaches of raising awareness in this case, we do know that smartphone penetration will continue to rise and it will be a lost opportunity to not act until there is 100% coverage. 

Conversion of apps to new countries: We are committed to scaling up our game to new regions. With expansion comes risks associated with ensuring context vigilance and appropriateness of messaging. We will proceed cautiously, but continuously learning from our experiences.

Publishing information during health emergencies: In the current environment neither Google nor Apple are accepting apps related to Covid19 unless they are from (or endorsed by) large health orgs such as WHO. While this an admirable effort to curb misinformation, it is proving to be a major challenge for indie developers working on digital tools for Covid19. Tech entrepreneurs are being encouraged to developed digital solutions to help with the crisis but the last mile is broken and solutions cannot be deployed. 

Access issue: In order to ensure inclusive international access and sustainable impact, GRID games are developed to be compatible with low-end Android phones, are free to play and do not require consistent internet connectivity to run. The games are also developed at one-fifth the cost of comparable commercial games and are available for free downloads, hence providing a long-term scalable solution for meaningful behavior change. Given that the upfront costs of game development are already incurred, the games can be scaled up across different regions and adapted to different contexts in a cost effective manner. 

Context-vigilance: GRID games have a focus on user-centered design and we ensure that all aspects of our games (scripts, character depiction, art, language) are context-vigilant. 

Publishing: In the case of CoronaCombat we have tackled the publishing issue by being proactive in two ways (i) We deployed a web based version of the game to ensure that there were no delays while we await the approval of the apps. We also realized that the webpage expanded our reach, since 42% of our current players are accessing the game through desktops; (ii) we are currently exploring partnerships to get endorsements from WHO, CDC of our games since the content is directly sourced from these sites and we have designed the game with a zero-tolerance policy on spreading any information that cannot be validated. 

GRID is a social impact gaming studio that tackles global problems with a global team. With a core team of 7 members and an extended team of 5 others, our group of 12 is diverse in gender, ethnicities and experience. More than 65% of our team is female (8 women, 4 in core team and 4 in extended team), we are spread across 4 different countries (USA, Pakistan, Australia and Greece) and we come from different professional backgrounds including graphic designers and software development professionals with extensive experience in app development, international development practitioners and marketing experts. 

At GRID, we aim to leverage the universal language of video games to inspire social change. We have created games on reproductive health (MoHiM, Nari Paila & SurrEndo) on compassion for animals (KritterKneads), climate change (EarthFenders), Math learning (Gumbers & Calculasia) and Covid19 (Coronacombat) and are currently working on games on financial literacy, opioid crisis and entrepreneurship. 

While serious games have immense potential, the growth has been relatively slow because (i) the average cost of game development is very high (ii) the marriage between gaming studios and social sector is rare and (iii) when games are developed, they focus largely on a western audience. Being a Pakistani woman, an innovator and an international development practitioner, GRID's founder, was able to not only identify these gaps but also find a way to solve them. She focused on putting together a multidisciplinary team and make games that (i) are fun and interactive, (ii) appeal to a global audience and (iii) where the costs of game development are 1/5th of comparative costs in US. 

The GRID team has extensive experience in dealing with technical and contextual issues involved with the design of serious games. We will leverage our game design experience in ensuring the game is fun and interactive and has a high engagement rate.

We created the first game to raise COVID19 awareness and did so in 9 days, using our internal funds. Since it's launch, the game has reached 1000 people with no marketing budget. 

We have several partnerships focused on funding, content development and implementation of our games.Key partners include: 

American Pakistani Foundation: CoronaCombat was translated into Urdu through a grant ($1000) provided by American Pakistani Foundation. 

Georgetown University Institute of Reproductive Health (IRH): Content and implementation partners for Nari Paila, a game that raises awareness on reproductive health. Nari Paila was launched in Nepal in collaboration with the National Health Education, Information and Communication Center (NHEICC) within the Nepali Ministry of Health and Population. The game was funded by IRH as part of a USAID project. 

George Mason University: Development of "SurrEndo" - a game that build empathy for Endometriosis patients. The partnership with GMU was aimed at funding and evaluating this game through the Public Health school. 

UNICEF Pakistan: With UNICEF Pakistan, we have an MoU around our menstrual health game MoHiM. MoHiM is being integrated into UNICEF’s activities to promote positive hygiene practices around MHM in Pakistan.

FLOC DC: GRID has an on-going partnership with FLOC DC where FLOC students are involved in the development of GRID’s game StereoWiped, a game that aims to wipe racial, gender and cultural stereotypes to promote tolerance and diversity.

Value Proposition: Making behavior change interactive, scalable and fun through digital games, on a global scale. 

Key GRID activities:

• Serious games development, with a focus on behavior change among the bottom billion
• Thought leadership in the serious games space 

Customers & Beneficiaries:

GRID's beneficiaries are often people around the world that are aspiring for positive behavior change, while our customers are social impact organizations and donors who are implementing programs to support behavior change in social sectors. E.g: Our game Nari Paila's consumers/beneficiaries are young adolescents in Nepal while our customer was Georgetown University's Institute for Reproductive Health who had an on-going reproductive health awareness project in Nepal. 

Revenue Generation:

• Fee for development of games
• grant funding, 
• innovation competitions, 
• potentially in-app purchases and advertisements (to be explored in the future)

GRID will employ three strategies to expand financial growth:

(i) Continue partnerships with organizations working in the social sectors to generate revenue by providing game development services.  

(iii) Partnerships with private sector: GRID games are tackling behavior change among the bottom billion and hence creating a niche market for the private sector. For instance, through our menstrual health game MoHiM, we are not only raising awareness and mainstreaming the conversation around menstruation but also tapping a new niche of customers for feminine care products. Through private sector partnerships, we will pursue a model where the game can be used to boost sales of pads using real-life game mechanics. As the player progresses along the game, she will be able to gather game rewards that can be traded for discount coupons on the sales of Always pads. Conversely, codes found on products (pads and soaps) can be used to "unlock" different game features.  

(iii) Explore revenue generation options through game features such as in-app purchases, advertisements and donation buttons. 

1. Validation: Being recognized as one of the Solvers for Solve's 2020 Global Challenges provides us with the validation that is critical when we are forging new partnerships. The visibility and prestige attached to the Award will benefit us in our next stage of growth. Our key means for growth is through collaborations with partners. We identify organizations that are working on the same issues and are interested in using our games to enhance the impact of their programs. We then explore opportunities to either have them directly fund game development or co-apply for grants that align with our joint priorities. Being a Solver will allow us to forge new partnerships. 

2. Opportunity to collaborate with other game-changers: Given that we are creating games that enhance the work of organizations in our focus areas, we see collaboration opportunities with most fellow Solvers. In particular, we would like partnerships that enable us to embed with real-life linkages to information and action in our games. 

3. The Solve prize will allow us to expand on CoronaCombat. We are able to implement game enhancements in a phased-in manner and therefore align them with the availability of resources. We will define the scope of the HCW module based on the funding available through Solve and external partners. 

We are currently looking for collaborators who can help us in the following ways:

• Expanding the game design to incorporate animated gameplay that can capture the concepts of social distancing, practicing hygiene and flattening the curve. 
• Translating and localizing the game into other regional languages to scale its reach
• Incorporating linkages to real-life resources including sources of accurate, updated information, health facilities that have testing capacity, contact tracing, two-way communication etc. 
• Supporting us in publishing the apps on Google and iOS app stores: We would benefit immensely from an endorsement or support from WHO, CDC etc. 
• We are interested in partnering with researchers who can help evaluate the impact of the game as well as grassroots organizations that can enhance our outreach. 

If we were to receive the Innovation for Women prize, we would utilize that funding to create a dedicated module of CorornaCombat focused on the needs of women during health emergencies. The game would include, but not be limited to, the following:

• Identify and highlight ways in which COVID19 disproportionately impacts women and girls
• Provide practical tips for mothers to protect their children during disease outbreaks
• Create a sense of community for women and girls during pandemics that require physical isolation
• Provide tips for ensuring financial independence through remote work
• Provide real-life linkages to victims of domestic abuse which has seen an increase during COVID19 and stay at home orders

If we were to receive the Andan Prize for Innovation, we would utilize that funding to create a dedicated module of CorornaCombat focused on the needs of refugees during health emergencies. The game would include, but not be limited to, the following:

• Identify and highlight ways in which COVID19 disproportionately impacts refugees
• Provide content-vigilant and practical tips for refugees to practice hygiene and social distancing in refugee camps
• Create a sense of community for refugees during health emergencies
• Provide tips for ensuring financial independence through remote work

GRID is one of the very few gaming studios that is creating games that target 60% of the SDGs. Most gaming studios develop games in English for high-end devices. We have committed ourselves to taking games to the bottom-billion and focusing on creating games that they can relate to, learn from and get inspired with. The games are not only built for low-end smartphones but are also adapted to the context in terms of content, language and art. 

With over 10 years of human development experience across Africa, South Asia and Middle East, GRID's Founder, Mariam has developed a passion for leveraging technology to address the Last Mile problem rooted in behavioral and information constraints. This the same last mile that prevents oral salts from treating diarrhea, hinders the use of bed nets for the prevention of malaria or allows open defecation to persist despite rapid expansion in provision of toilets. We believe that if we want to achieve the SDGs, we need to focus on the supply AND demand side of interventions and ensure that the bottom billion is equipped with the information and inspiration they need to change their lives for the better.