By Alisha Gauhar, Rebecca Babcock and Jennie Phillips
Are There Any Other Issues to be Concerned About?
It should also be stressed that there are many other known risks associated with digital contact tracing that have been identified in research that do not necessarily pertain to privacy. For instance, the digital divide (defined as the notable gap between those that have access to technology and those who do not) is a particular concern. For certain communities – such as the homeless population who may not own any type of mobile phone, the elderly population who may have a smartphone but not know how to use it, and communities of lower socioeconomic status who may own a phone but not a ‘recent’ smartphone that is capable of hosting the contact tracing application – this application becomes inaccessible. This would indicate these individuals are being left out and potentially being disproportionately impacted by the COVID-19 pandemic as these communities also are often more vulnerable populations. Concerns over accessibility have already been raised as phones that have not been updated within the last five years have been reported as unable to download the app. Furthermore, certain groups such as serving military members, First Nations people on reserves, and refugees are also raising concerns about the usage of the app. In a privacy review of the COVID Alert app the report stated “the Government of Canada has not yet determined how to onboard these groups.”
Another issue associated with digital contact tracing apps include garnering enough trust with the population to get more people to use the app. Increasing trust will in turn increase uptake, making the app more effective. Garnering trust however, is more difficult with some communities than others. Communities that have a history of being discriminated against or are less privileged may have a more difficult time trusting the government. People are also skeptical when trusting politicians who are promoting apps such as COVID Alert. In order to combat this, the federal government should ensure that the app is not discriminatory and that certain populations will not be targeted if for example they test positive. As well, the government should be stimulating interest in downloading and correctly using the app through incentives, awareness, and education.
Conversely, the consequences that can arise from not using digital contact tracing methods to respond to the COVID-19 pandemic must be considered. COVID-19 is a highly contagious, fast-spreading disease and manual contact tracing – which is a very effective public health tool used to identify and manage the spread of other diseases – is resource intensive, time consuming, and provides more delayed results. In many situations, it is not sufficient for containing this virus. This is not to say digital contact tracing applications are the panacea of a public health response to COVID-19, but that they are likely a vital component of an effective and comprehensive pandemic response. Therefore, there is value in trying to pilot digital contact tracing tools in real-time to expedite the process and try to make an impact on the spread of the virus. For example, app-based contact tracing was tested during the Ebola outbreak in 2015. During COVID-19, although national implementation has raised more push-back, places like the UK and Spain have done small-scale trials with mixed to positive results.
It is also important to recognize that, with any form of innovation, there are many unknown risks yet to be realized. Studies outlining the risks and benefits of exposure notification apps are still ongoing and apps are rolling out around the world faster than they can be studied.
Moving Forward
As of September 19th 2020, the COVID Alert app has been downloaded 3.9 million times nationally which is about 10% of Canada’s population. Although an uptake of sixty percent of the population has been the standard target for most exposure notification apps, researchers are stressing that the app “starts to have a protective effect at much lower levels.” Yet the number of downloads may be limited due to the app only being officially rolled out in half of Canada’s provinces.
The government however, is encouraging people in other provinces to download the app for two purposes. First, in case an individual from a non-reporting province or territory comes into contact with an individual from a reporting province or territory (i.e. Ontario, New Brunswick, Saskatchewan, or Newfoundland) then the person from the non-reporting province can be notified of an “exposure” to COVID-19. Second, once the application rolls out to other regions, people who have already downloaded the application will not only be notified but will also be able to report if they have tested positive for COVID-19 through the application. In fact, the Government of Alberta has announced they will be switching over to the COVID Alert app after experiencing technical difficulties with their province wide app ABTraceTogether.
Interestingly, despite 86-445 people testing positive for COVID-19 each day in Ontario within the past month, only 110 individuals in total have reported their positive COVID-19 diagnosis through the application since its release almost two months ago. Although there are many theories pointing to why this may be the case, i.e. many of the issues raised in this paper for example (e.g. privacy concerns, lack of awareness, trust, and access to digital technologies), little research exists specifically focusing on the user end of digital contact tracing tool implementation. Study is needed to identify why some users download the app and others don’t, and, broader, why uptake and engagement varies so vastly between countries. This is the primary focus of our research in the coming months, and will be accompanied by a series of complementary blog posts providing commentary, examining specific questions and shedding insight on the evolution and efficacy of digital contact tracing. It is hoped that through this research we will be able to provide deeper insight into why app engagement may be high or low, and work towards providing guidance to enhance engagement using an ethical approach that prioritizes risk prevention and mitigation as much as possible.
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Header Image Source: The Government of Ontario; Retrieved from https://covid-19.ontario.ca/covidalert