Contact Tracing. To App or Not To App Is That The Question?

In the UK and in many other parts of the world there has been a lot of discussion recently about contact tracing and how it could be used to safely end Covid19 lockdown. Much of the debate has been about what kind of app would be most effective. There has however been some discussion based on the pros and cons of app based approaches vs more manual approaches.

The debates within different app based approaches mostly focus around whether governments should adopt a centralised or a decentralised approach. In this context a decentralised approach is one where data is only kept on people’s phones, whereas a centralised approach allows data to be uploaded to a central database. The UK government claims that this approach has the advantage of giving them data that could be used to help them understand people’s behaviour, which in turn could help them put more effective interventions in place. Whilst that might be true, there is a powerful argument against, it’s an invasion of privacy. The argument is, who could get access to this data and what might they do with it.

Controversy about the centralised NHSX app is amplified by the involvement of the firm Palantir, who allegedly had links with Cambridge Analytica, see this article for more details on that story. Such privacy concerns resonates with me as I explored privacy and social control issues with monitoring devices and information technologies in my PhD. Through this research I am very aware of what could go wrong. Evgeny Morozov one of the academics I referenced in my thesis has also expressed concern increased surveillance from governments attempting to tackle Covid19. He expresses his views in this article. Morozov is however only one of many who have expressed concern, some take reservations a step further and associate pandemic surveillance with surveillance capitalism. One example of such concern is outlined here. In terms of creating a solution that will work, whether such concerns are justified or not is almost irrelevant, as either way they undermine trust. To be effective, it has been reported, an app based approach needs 60% uptake to be successful. To achieve such a target the majority of the population will need to trust that doing so will be safe. Some people are likely to be sceptical of any app and so involving a company accused of links with a high profile data scandal is not helpful in alleviating their concerns.

In my PhD I concluded that whilst such technologies have the potential to be used for good, they could also lead to a dystopian future. To harness the positive impacts of technologies whilst reducing the risk of unforeseen dystopian consequences I argued we should not defer to technology but instead work with it and this collaboration should empower communities. From this perspective, even though a more decentralised approach might have less privacy risks I am not convinced that by itself any app solution would be able to solve the problem.

This image of a prison inside a phone is by the artist Felipe Luchi and not by Banksy as sometimes indicated on social media (Felipe Luchi 2013)

If apps by themselves are not the answer, what about more manual, human based approaches. Well there lies another debate, one about who is best placed to conduct it. Some, as argued in this article, argue that we need a local approach that includes existing public health expertise and local knowledge. The UK government, as they have done with their contact tracing app, have decided on a more centralised approach, and have appointed the private company, Serco to lead the process. The main argument seems to be that, there is real urgency in scaling this process up and the private sector is more capable of moving faster than local government. Serco’s involvement has however got off to a rocky start with a data breach, the accidental sharing of the emails of 300 people recruited to carry out contact tracing. For more details see this article.

As is often the case, there is a third way. Over recent weeks I have been lucky enough to get involved in helping to evaluate a local community contact tracing project. It is neither public nor private sector led, but instead led by a group of volunteers, most of whom are from health and public health backgrounds. It is also closely aligned to a local charity The Heeley Trust. The group have conducted a pilot community contact tracing project in the Heeley and Meersbrook area of Sheffield. It felt good to be supporting a local initiative as this is where I live. As well as explaining how a community contact tracing project can work as outlined here in the British Medical Journal, the project has also highlighted opportunities and challenges that will be faced by any organisation carrying out contact tracing, some of which are communicated in this Guardian article.

From interviews I conducted, messages that came across strongly included: its complex, community connections are valuable and the involvement of health experts is essential. The community connection was emphased as volunteers spoke about developing trust with the people they contacted, they explained how trust was needed before people contacted were willing to have honest conversations about who they had been in contact with. They found that being able to talk about shared understanding of the local environment in developing this trust.

An unexpected finding was the benefit to people contacted. People isolating with Covid19 often felt cut off and alone and so the emotional support from the connection with the community tracers provided emotional support to people who were dealing with the emotional anxiety of dealing with isolating with Covid19. Shared understanding of the local area came across as extremely helpful in providing such support. Practical knowledge of other local help resources was also highlighted as valuable.

Interviewees suggested that the involvement of people with medical expertise was essential for two reasons. The first was due to the complexity involved, at times unexpected issues inevitably emerged and volunteers found being able to discuss such challenges with relevant expertise essential in providing a good level of support. Health experts were also highlighted as essential because of the contacts and networks they had.

The potential integration of apps and community provision was also discussed. The argument was that an app might be able to help identify people to contact quickly, but it would miss some people and wouldn’t be able to provide the wider support that was needed. These networks enabled connections to be made with the wider network of health and care provision in the city. More details about the evaluation are outlined here.

So in conclusion, getting contact tracing to work effectively isn’t just a choice between human or app based solutions. It’s more complex than that. Trust is a central issue with both human and app based approaches. A national approach that is disconnected from the communities it is attempting to contact trace in is likely to find it difficult to develop the trust needed to conduct contact tracing in. It may also find it difficult to gain the trust of senior managers in organisations employing people who might need to be self-isolated. Contact tracing does not take place in a vacuum. It takes place in the messy fragmented world where people live and work. This wider context is filled with conflicting motivations and often also local politics. Thinking about this complex environment I am reminded of the complex health map in the foresight report on obesity. I am concerned that if we ignore the complexities involved contact tracing is not going to work.

With the current state of contact tracing in the UK I am left feeling conflicted. On one hand I feel that contact tracing is essential to help ensure a safe end to lockdown, but at the same time I do not feel re-assured by the main approaches that are being taken. Both the human and app based approaches that are being taken in the UK are centralised approaches that seem to ignore the complexities of local context. Without engaging in such local context I do not feel confident that the UK approach to contact tracing is likely to be successful. The combination of a local community approach, linked to local networks, including public health expertise and apps to help identify contacts I feel might be a more effective way forward.

One comment

  1. […] In a previous blog post I highlighted some of the reasons why the approach being taken by the UK government was not instilling trust in people. I highlighted issues with the private companies commissioned to conduct contact tracing. Issues that detracted from trust included a data breach by Serco at the beginning of the contact tracing process and alleged links between the company commissioned between the company commissioned to make the app and Cambridge Analytica. For more detail, see the earlier blog post here. […]

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