In the rush to contain COVID-19, the world has plunged head-first into contact-tracing apps. In the hopes that with sufficiently surgical digital precision we might not only stop the spread of the disease, but also soon return to work, applications to enable digital contact tracing of the disease are being rolled out around the world. But the decision to deploy a digital contact-tracing system is as much a political decision as it is a technological intervention, and the public health impact of these interventions will be deeply shaped by political considerations.
Contact tracing isn’t, traditionally, a technology-heavy process. It involves testing patients and, for those that test positive, interviewing them about their whereabouts and human contact during the known infectious period. Effective contact tracing requires a clear understanding of how a virus transmits and for how long and the people with whom an infected person has been in contact.
Unfortunately, the science of how COVID-19 transmits remains unsettled, as is often the case in emergent epidemics. As a result, contact tracers are left casting a wide net. Smartphone apps that track a person’s movements and the people with whom they cross paths can potentially provide a more complete record of the places a person has been while contagious. National governments, leading universities, and major technology companies are now rolling out ways to collect that kind of information and share it with public health authorities.
But in countries where new technology for contact tracing has been employed with some success, such as in South Korea and Singapore, this technology is mostly experimental and in addition to work carried out by human contact tracers. And they haven’t been enough to achieve containment. South Korea has recently recorded fresh clusters of the disease, and Singapore is only now beginning to open back up after extending its lockdown.
When evaluated against the ultimate goal of contact tracing—containing the pathogen without requiring lockdown—technology-led approaches are nascent at best. The more common uses and abuses of contact-tracing apps aren’t defined by the architecture of the technology, but by the political context into which they’re deployed.
Contact-tracing apps have to be administered by someone, and that someone is usually a government-led public health system. Many communities have deep and justified concerns that their governments will use the public health crisis to expand surveillance and violate their rights. There are reports that the Syrian government is using malware, branded as a contact-tracing app, to pursue its goals in that country’s civil war. In countries across Africa, authorities have been accused of brutal methods in enforcing COVID-19 lockdowns. In Israel, doctors argue that the involvement of the country’s Shin Bet security service in tracing cases is undermining the public health response. In Australia, the government has tried to address mistrust around data-use and contact tracing by pledging that data won’t be retained after the pandemic and the country’s contact-tracing app is not part of a “hidden agenda.”
The deployment of a digital contact-tracing app doesn’t happen in a vacuum. That deployment will be shaped by the people and institutions the app connects, and the authority exercised based on that data. These considerations are political, not technological, and will have an important impact on the app’s effectiveness.
Moreover, technology isn’t evenly spread across society, and this will shape the success of a digital intervention in a public health crisis. Technology adoption across economies, geographies, and cultures is deeply fragmented. Of the world’s 4 billion smartphones, 88 percent use the Android operating system, but Android adoption is split among the different generations of the software and a number of different forks developed for various commercial device ecosystems. Any attempt at tracking a pathogen using a mobile phone is inherently biased toward those with the hardware, access to electricity, and bandwidth to run the system.
By focusing on the quality of the technology over the equity of impact it has on people, the developers of the many different technological interventions currently under discussion are likely to find that the tech itself won’t help containment. In societies with strong institutional trust and public health systems, COVID-19 has claimed relatively few lives. By contrast, in countries with weaker public health systems and wider socioeconomic disparities, the impact has been far worse. In the United States, for example, African American communities are dying at significantly higher rates than others, and the full impact on marginalized communities probably won’t be fully understood until the crisis is over. There is little indication that the technological interventions being contemplated are being designed with these disparities in mind.
The most political dimension of contact-tracing apps isn’t what they’re being used for right now, it’s the role they are likely to play in attempts to reopen societies. While the science around immunity remains unclear, governments face intense pressure to restart their economies and are turning to digital tools to do it. In Chile, the government is contemplating a controversial “release certificate” for those who have been infected and recovered. South Korea is considering electronic trackers. Germany has embraced a joint Google-Apple design for phone-based contact tracing. But the reliance on these technologies may only provide false hope and legitimacy for reopening and prioritize economic growth over the well-being of the people relying on these technologies.
No country has resumed life beyond lockdown without increasing infection rates, as in Germany, or returning to lockdown, as in South Korea and Singapore. Public health contact tracing, along with political and health system capacity to implement containment strategies, are critically important to containing the virus, but there are no examples of unmitigated success. Ultimately, contact tracing can only alert leaders to the presence of the virus, it cannot convince them to prioritize public health. If only there were an app for that.
Sean McDonald is the co-founder of Digital Public and a senior fellow at the Centre for International Governance Innovation.