The challenges facing the NHSx coronavirus contact tracing app
The UK Government is getting ready to roll out its Covid-19 track and trace smartphone app, which it hopes will support its fight against the coronavirus pandemic that is sweeping the country.
The app has been built by NHSx (the NHS’s digital, IT and innovation team), and is currently being tested in the Isle of Wight before its release onto UK App Stores in the next few weeks.
Contact tracing is an essential process used by public health professionals to control the spread of critical infections. But for it to work and give policy-makers the necessary insight it requires testing and trust, two things that are currently in short supply.
Current research tells us that Covid-19 has an incubation period of up to 14 days. We also know from testing carried out in locations around the world during the first phase of the pandemic that up to 50% if not more of those who tested positive showed no symptoms, which is why the World Health Organisation issued a statement demanding countries to test, test and test.
In a statement to the media in mid-March, World Health Organisation head Tedros Adhanom Ghebreyesus said there testing, isolation and contact tracing should be the "backbone" of the global response.
He said it is not possible to "fight a fire blindfolded", and social distancing measures and handwashing will not alone extinguish the epidemic.
Since that statement, countries around the world moved quickly to increase their testing and put their citizens under lockdown. Their immediate aim is to reduce transmission and avoid their respective healthcare services buckling under pressure from those who would need intensive care treatment. Most countries in Asia succeeded in their efforts to control the spread, while those in the western world like Italy, Spain, France and the United States reached a crisis.
The UK is now releasing its own contact tracing app but is doing so very late and with a lot of concern about its ability to support public health professionals.
The app alone is not a magic bullet. It needs to be integrated into a wider testing and isolation programme. Lockdown measures might be lifted, but any sign of an increase in transmission will force government’s to again enforce lockdowns until effective treatment or a vaccine is available.
Testing and contact tracing will become key in avoiding a second wave of infections and deaths in the months ahead. For the UK this will mean having an effective digital contract tracing solution in place, but for it to work there are key challenges that this solution needs to overcome.
Adoption of the contact-tracing app
The UK is not the first country to design and deploy a contact tracing app. In fact, it’s one of the last. To date there are over 25 apps worldwide, each serving specific countries and using one of four/five different infrastructure protocols (from Singapore’s BlueTrace and the EU’s DP-3T to Apple and Google’s own protocol).
Epidemiologists have calculated that a minimum number of 60% of Britons will need to use the app in order for it to deliver the level of data that will help public health official’s slow down the data. Think about that 60%, now let me show it to you in terms of population, 40 million people who need to download it and keep it open in the background as they go about their daily lives. 40 million who need to download it in as short a period of time as possible.
Singapore’s TraceTogether, which works on its own BlueTrace protocol and was launched on 20 March, has been downloaded by c.20% of the population, while Australia’s own COVIDSafe has had 4 million downloads, about 16%.
Singapore’s TraceTogether contact tracing app
Singapore is a country that has the ability to gather data quickly from its mobile infrastructure and even they have struggled and have recently entered a second wave of infections.
For context let me share this fact (though it’s worth considering that during a public emergency people can be swayed to park their concerns for the greater good!), it took Facebook 3 years to get 50 million users worldwide.
The call in some international markets is already gathering pace for making the use of contact tracing apps mandatory. Think of that.
Trust in contact tracing and government
Trust is essential in order to get service adoption, especially if there’s a need to get this app adopted by a minimum of 40 million users in the UK. And when we talk of trust, we have to identify the users and their concerns, by age, gender, political views and so much more.
Ignore these during the design and build and you are creating adoptions after launch. I have seen this during my time working with digital companies and team. Comms and engagement was not considered. In fact, it’s only an afterthought for many even though it helps clear up perception issues during Discovery, Alpha and Beta stage design and build work.
Saying that it’s “people’s duty” is just not effective.
People will make a decision to download the app based on other information, both positive and negative (misinformation will heighten concerns).
Looking at Twitter alone (never recommended!), research by MIT Sloan found that ‘Falsehoods are 70 per cent more likely to be retweeted on Twitter than the truth, researchers found. And false news reached 1,500 people about six times faster than the truth’.
Issues surrounding the access to testing will weigh on many. What is the point of downloading the app if you might get an alert, but are unable to get a test?
Political associations will also cloud people’s views. Using the NHS brand might be great, but will it be enough.
Also, different generational demographic groups will react differently. Older age groups, who are more vulnerable to severe complications, might need extra support in setting the app up on their smartphones.
To build trust, there is a critical need to understand user groups and design the integrated service around their behaviours and areas of concern.
The app will take you so far, but it will only do so if it is adopted by the general population. A dragnet messaging and engagement approach that ignores the battle against misinformation of people’s concerns would be a failure. What is the call-to-action and how will it nudge the public to use the app?
There is certainly a call for behavioural nudge actions to scale download and usage of the app if it remains voluntary.
Tech teams can be great at developing tools but have a risk of failing when it comes to user research and rolling out the product to the general public.
Going it alone or joining-up with Big Tech
The world is currently split on the best technical infrastructure and way forward in order to deliver policy-makers with the data they need to safeguard people until effective treatments or a vaccine is available.
From a technology standpoint, there are two routes, a centralised network-based location-tracing solution or a decentralised approach.
What divides these two is privacy and the developers approach to it.
The UK initially opted for a centralised network-based location-tracing solution, raising serious questions about privacy of data gathered and being pushed through a central server by public commentators. Other countries opted for this approach (South Korea and Israel are two), but they have a different culture and view of government and authority.
In a unique move, Apple and Google joined forces to create a decentralised protocol, with a strong focus on privacy. These two tech companies have a critical advantage in that their respective iOS and Android operating systems account for 99% of UK smartphone ownership.
Our smartphone is critical to helping us in our fight against this coronavirus and our relationship with it means that while questions might be asked about privacy from Google and Apple, we often put these aside because of the informational access and customer experience that we get from their products is good.
Since writing this post, The Financial Times Tim Bradshaw is reporting that the ‘NHSX has this week already started building a second contact tracing app, based on Google/Apple APIs, in parallel to homegrown version.’ Worth reading his thread on Twitter here.
Privacy
We can’t talk about tech, government solutions and data gathering without thinking of privacy concerns.
How is the data gathered stored, how is it used, do we trust the teams building the app, do we trust those indirectly associated with it? Perception is everything and when issues exist elsewhere in the management of the pandemic, people will be more guarded.
There is an increase in awareness of issues relating to data abuse with the UK’s Information Commissioners Office already issuing statements to ensure that the app adheres to the law and best practice.
In designing the app, NHSx has been working with cross-government agencies such as the National Cyber Security Centre (NCSC) as well as industry experts, to ensure that their work is presented as clear and transparent.
The NCSC has published various papers in an effort to be clear on privacy. But even with their support, people will still have concerns and this will need to be considered in comms and engagement activities.
There is a gap in the comms where people push messages that they want to tell rather than they want to the public to understand. At the moment, there is too much telling and not enough work to getting audiences to understand and have trust.
One common standard
Since the pandemic began the number of tech protocols that we have worldwide has reduced.
In countries around the world, the talk is about lifting the lockdown measures to build confidence and work towards a new normal, while working hard to avoid a second peak in the second half of the year.
For those who travel overseas, for business or leisure, there is now a need for a recognised standard that will help travel with limited disruption.
Sky News Mark Stone shared his experience when travelling to Israel.
To get the world moving and trading there is a need to work together. Failure would lead to even more damage to life and the economy. Just look at how the passenger aviation industry is struggling now.
I have my vaccine book here. Will we be considering this as a must, but in a digital form?
We are heading to a new normal and trust and engagement will be key for both governments and the private sector in getting us to use tech to support the restart of work and the world.
We’ll come out of this, there is no alternative!
I also published this post on LinkedIn: https://www.linkedin.com/pulse/challenges-facing-nhsx-coronavirus-contact-tracing-app-julio-romo/
