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= Cyber Diplomacy in Biomedicine = Nowadays, the role of cyber security in diplomacy has become so important that the term “cyber diplomacy” has come into global use, and countries are even deploying their own “cyber diplomats.” Cyber diplomacy is broadly defined as the use of diplomatic tools and initiatives to achieve a state's national interest in cyberspace that are commonly crystallized in the national cybersecurity strategies.

Cyber diplomacy is essentially applying a diplomatic tool set to cyber challenges, and encompasses: building alliances and collective response to cyber threats; negotiating a cyber stability framework that includes rules of the road for state actions in cyberspace; negotiating bilateral agreements and cooperative frameworks; ensuring human rights are respected in cyberspace; using diplomatic tools to respond to threats; fostering capacity building; and integrating cyber issues into larger discussions of national and economic security, among other issues.

Cybersecurity can be defined as the art of protecting networks, devices, and data from unauthorized access or criminal use and the practice of ensuring confidentiality, integrity, and availability of information. With many services such as communications, entertainment, transportation, shopping, and medicine relying on computers and the internet now, cyber diplomacy caters to the rising prominence of cybersecurity in the pursuit of foreign policy or the role of new technologies in the processes and structures of diplomacy.

Cyber security topics have been part of national defense discourses for more or less the past thirty years. With a growing number of cyber attacks originating in one state and targeting another, cyber security has slowly entered the agenda of the international community, the health organization, biotechnology organization, and the vaccine community as well. The discussion has mainly been concerned with technology and technical solutions, but as the topic has gained greater attention, it is now being addressed by the world of international diplomacy.

Cyber Diplomacy in Pandemics
As society has become increasingly technology dependent, it has also become increasingly vulnerable to cybercrime and cyberattack. Cybersecurity threats are expected to cost the world US $6 trillion a year by 2021, doubling from US $3 trillion dollars in 2015.

This wiki-page outlines why cyberattacks have been particularly problematic during COVID-19 and ways that healthcare industries can better protect patient data. For example, Zoom, has also loosened physical and technical safeguards to cyberattacks. This is especially problematic given that 90% of health care providers had already encountered data breaches. Companies must implement well-defined software upgrade procedures, should use secure networks like virtual local area networks, and conduct regular penetration tests of their systems.

Studies have shown that, the number of cyberattacks launched has increased five-fold during the COVID-19 pandemic. A similar phenomenon was seen in 2005 after Hurricane Katrina, where thousands of fraudulent websites appeared soliciting fake donations and offering false government relief.

Additionally, health care organizations become prime targets during health crises. The use of telemedicine has proven vital to helping many patients during pandemics such as the COVID-19 crisis, especially as traditional in-person visits have become increasingly inaccessible. For example, New York University saw a 4330% increase in non-urgent virtual visits after the outbreak of COVID-19.

One of the primary reasons cybercriminals thrive during pandemics is because heightened emotional states like fear make victims more susceptible to falling for scams and cybercriminals often pretend to be credited and trusted organizations like the WHO and, therefore, exploit individual feelings of vulnerability in the uncertain times of a pandemic.

The Office for Civil Rights has loosened enforcement of the Health Insurance Portability and Accountability Act (HIPAA), which, useful in opening up new platforms for care like Zoom, Skype, and FaceTime, has loosened physical and technical safeguards to cyberattacks. This is especially problematic given that 90% of health care providers had already encountered data breaches in the past with these safeguards. There is also a significant positive correlation between workload and the probability a health care worker will open a phishing email, which is particularly problematic in that, during pandemics, workloads can be at an all-time high.

Access to patient records is a gold mine for cybercriminals, as they often contain information like date of birth, insurance and health provider information, as well as genetic and health data—information that cannot be easily altered, unlike the case of a credit card being stolen. This information is particularly lucrative for hackers because a patient’s health information can be sold for 10-20 times more than the amount for credit card information or even their social security number on the dark web.

Cyber Diplomacy in Healthcare
The usage of digital health technologies to provide patient care has increased during the pandemic. Digital health includes “mobile health, health information technology, wearable devices, tele-health, and telemedicine”. Healthcare practitioners, hospitals, pharmacists, and other providers use digital technology to provide personalized medicine to patients at a reduced cost. The knowledge accessible via Digital health tech help practitioners manage illness and promote wellness. There are still some challenges of digital healthcare such as cybersecurity, privacy, and misinformation. Cybersecurity ensures that confidential information is protected from people and companies who are allowed access. This involves “unauthorized access, use, and disclosure”. Cyberattacks on Protect Health Information (PHI) and Personal identification information (PII) can produce a risk to patient safety and privacy.

An example of a common digital health tool is the Internet of Medical Things (IoMT). IoMT is a technology that connects patients to their physicians and allows the transfer of medical data. Before IoMT, patients’ interactions with doctors were limited to physical visits. Physicians can determine the effective and most suitable treatment plan for patients based on data collection tools created by IoMT devices. IoMT allows for improved diagnoses, better treatment plans, and remote monitoring. The IoMT tool has increased patient engagement with their practitioner due to device convenience and efficiency. There is a decrease in patients’ length of stay at the hospital and rate of readmission which has reduced health costs significantly. A drawback with IoMT is the risk for patient’s privacy and safety. Data shows from 2005 to 2019 about 249 million individuals were affected by healthcare breaches. Cybersecurity is still a concern for IoMT tools due to weak data storage security and lack of device management. Hacking and AI is still a threat to IoMT due to its software vulnerabilities, room for human errors and security failures. These threats to IoMT can lead to loss in finance and patient trust. It can also threaten human life, and cripple the whole healthcare system. Despite these issues, IoMT can still in its developing stages and can be improved.

Cyber Diplomacy in Biohacking/Brain-Jacking
Wireless Internet of Things (IoT) gadgets make human lives smarter and convenient, however, it makes us more exposed to cybersecurity threats than ever before in today's interconnected society. From implanted chips to smart cars, almost any connected piece of technology may be hacked. A cyberattack, in general, affects the victim's device(s) and takes control of its functions. Cyberattacks against implanted medical equipment, on the other hand, are the most worrying issue for the healthcare field. Several cybersecurity experts have suggested that particular wireless medical devices implanted in a person's body or brain may be hijacked, a phenomenon known as Brainjacking.

A cyberattack in which a hacker gains unapproved entry to neural implants in the human body is known as brainjacking. Hacking surgically implanted medical devices in the brain might give an invader complete control over the patient's functions and cognition, with potentially detrimental ramifications. Brain implants, commonly known as neural implants, are microchips that link directly to a human's brain in order to create a brain-computer interface (BCI) in a brain that has become damaged due to a medical condition(s). Unapproved control of brain implants had previously been shown in films as science fiction, but with developments in medical technology, it is now a great concern.

Medical implants, based on a 2016 Oxford Functional Neurosurgery study, are exposed to a variety of cyberthreats. According to the experts, hackers use several strategies such as Blind attacks to get unauthorized entry to an implant. A blind attack on human implants might result in significant harm, such as blocking stimulation, depleting implant batteries, creating tissue or cell damage, data breaches, degradation of motor activity, manipulation of impulse control, change of emotions, and production of pain, among other things. Even in 2018, Belgian researchers discovered that a neurostimulator, a wireless brain implant, may be hacked using off-the-shelf equipment. They revealed that hackers might cause sensory deprivation, impairment, or even death by using remote exploitation. These experiments show how cybercriminals can use a simple brain implant for nefarious reasons. The deep brain stimulation (DBS) system is the most prevalent form of brain implant, according to Laurie Pycroft, a doctorate candidate at Oxford's Nuffield Department of Surgical Sciences who led the Oxford study.

Health-care cyberattacks have recently grown more common. With several incursions and assaults on linked medical equipment, hackers have continued to target health care professionals. According to a study, roughly 83 percent of connected medical equipment are vulnerable to security threats due to outdated software. The US Food and Drug Administration (FDA) issued a draft of marketing authorization guidelines for medical device cybersecurity back in October, 2014. The FDA created this draft to help industries by outlining cybersecurity concerns that manufacturers should address when designing and developing medical devices, as well as when completing premarket proposals for those technological products. The number of IoT devices is expected to approach 83 billion by 2024, rising from 35 billion in 2020, representing a 130 percent increase over the next few years. With the increasing number of cyberattacks on internet-connected technology, IoT security has become a significant concern for many medical and non-medical organizations worldwide.

Cyber Diplomacy in Vaccines
With the role of cyber diplomacy involving the protection of data from unauthorized access and ensuring that human rights are respected in cyberspace, organizations involved in vaccine distribution, use, or production have seen an increase in cyber security challenges. For instance, with the increase in technological advances and a recent global scheme to produce and distribute COVID-19 vaccines, vaccine diplomacy has seen an increase in cyber security challenges, with several recent cyberattacks on hospitals, pharmaceutical companies, the US Department of Health and Human Services, the World Health Organization and its partners, and others. These cyber-attacks on global health goals have exploited the vulnerabilities in technology and cyber defense, bringing the collaboration of vaccine diplomacy and cyber diplomacy.

Vaccine Diplomacy can be defined as almost any aspect of global health diplomacy that promotes the use and delivery of vaccines to achieve larger global health goals and shared foreign policy objectives and encompasses the work of the international organizations. Although vaccine diplomacy has been primarily discussed in the context of COVID-19 vaccines, vaccine diplomacy has existed for a long time, such as its major role in the distribution of the smallpox vaccine when during the war between Britain and France during the early 1800s, Edward Jenner’s smallpox vaccine was able to be shipped to France for a successful smallpox inoculation. International cooperation for purposes of infectious and tropical disease control goes back to at least the 14th century when early concepts of quarantine were introduced in Dubrovnik on the Adriatic Coast of Croatia. In more recent times, there was an urgent need for diplomatic collaboration to combat pandemics caused by HIV/AIDS and seasonal and avian influenza, which came with the revelation that such diseases are threats to economic development and both national security and foreign policy interests.

Cyber security events affecting healthcare organizations have been increasing in frequency, ranging from breaches affecting millions of patient records, to attacks that shut down hospitals across the country, impacting the availability of vaccines. With the COVID-19 pandemic outbreak, much of the world moved online, accelerating a digital transformation that has been underway for decades. With most of the research and data on vaccines being digitized, it has been made more vulnerable to cyber-attacks. A recent study found that 81% of global organizations have experienced increased cyber threats during the COVID-19 pandemic, with many organizations not prepared to deal with the increased cyber-attacks. These recent cyber incidents have demonstrated the complex and severe consequences that such events can have on health and safety, as well as the crucial need for organizations and nations to strengthen their cybersecurity for the protection of data from unauthorized access and ensuring that human rights are respected in cyberspace - major components of cyber diplomacy.

The international community has yet to develop a common understanding of what constitutes a norm violation, and which specific categories of targets should be off-limits to certain types of cyber operations. Although in 2021 the United States President, Joe Biden, has presented Russian President, Vladimir Putin, with a list of critical infrastructure sectors that should be off-limits to hacking, it did not seem to stop them. There are 16 critical infrastructure sectors whose assets, systems, and networks, whether physical or virtual, are considered so vital to the United States that their destruction would have a debilitating effect on national economic security, and national public health or safety. One of them is the Healthcare and Public Health Sector which protects all sectors of the economy from hazards such as infectious disease outbreaks, which includes collaborations to build a framework for vaccine distribution nationwide.

The greatest impact of the cyber incidents during the COVID-19 pandemic on healthcare organizations affecting vaccine distribution and production has revealed how there are few rules overseeing cyber security. With the increase in cyber-attacks and no international law set to regulate what sectors should be off-limits to certain types of cyber operations, it poses a more crucial problem that should address and integrate cyber issues into larger discussions of national and economic security.