Corporate contact tracing as a pandemic response

Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review

BACKGROUND

The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups).

OBJECTIVE

We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance.

METHODS

Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines.

RESULTS

We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability.

CONCLUSIONS

A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-https://doi.org/10.1136/bmjopen-2021-053962.

Global health security and the health-security nexus: principles, politics and praxis

The past four decades have seen a steady rise of references to 'security' by health academics, policy-makers and practitioners, particularly in relation to threats posed by infectious disease pandemics. Yet, despite an increasingly dominant health security discourse, the many different ways in which health and security issues and actors intersect have remained largely unassessed and unpacked in current critical global health scholarship. This paper discusses the emerging and growing health-security nexus in the wake of COVID-19 and the international focus on global health security. In recognising the contested and fluid concept of health security, this paper presents two contrasting approaches to health security: neocolonial health security and universal health security. Building from this analysis, we present a novel heuristic that delineates the multiple intersections and entanglements between health and security actors and agendas to broaden our conceptualisation of global health security configurations and practices and to highlight the potential for harmful unintended consequences, the erosion of global health norms and values, and the risk of health actors being co-opted by the security sector.

Use of digital technologies for public health surveillance during the COVID-19 pandemic: A scoping review

Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for public health surveillance worldwide. However, concerns remain around the rapid development and deployment of digital technologies, how these technologies have been used, and their efficacy in supporting public health goals. Following the five-stage scoping review framework, we conducted a scoping review of the peer-reviewed and grey literature to identify the types and nature of digital technologies used for surveillance during the COVID-19 pandemic and the success of these measures. We conducted a search of the peer-reviewed and grey literature published between 1 December 2019 and 31 December 2020 to provide a snapshot of questions, concerns, discussions, and findings emerging at this pivotal time. A total of 147 peer-reviewed and 79 grey literature publications reporting on digital technology use for surveillance across 90 countries and regions were retained for analysis. The most frequently used technologies included mobile phone devices and applications, location tracking technologies, drones, temperature scanning technologies, and wearable devices. The utility of digital technologies for public health surveillance was impacted by factors including uptake of digital technologies across targeted populations, technological capacity and errors, scope, validity and accuracy of data, guiding legal frameworks, and infrastructure to support technology use. Our findings raise important questions around the value of digital surveillance for public health and how to ensure successful use of technologies while mitigating potential harms not only in the context of the COVID-19 pandemic, but also during other infectious disease outbreaks, epidemics, and pandemics.

Governing digital health for infectious disease outbreaks

ABSTRACTHow can governing digital health for infectious disease outbreaks be enhanced? In many ways, the COVID-19 pandemic has simultaneously represented both the potential and marked limitations of digital health practices for infectious disease outbreaks. During the pandemic's initial stages, states along with Big Data and Big Tech actors unleashed a scope of both established and experimental digital technologies for tracking infections, hospitalisations, and deaths from COVID-19 - and sometimes exposure to the virus SARS-CoV-2. Despite the proliferation of these technologies at the global level, transnational and cross-border integration, and cooperation within digital health responses to COVID-19 often faltered, while digital health regulations were fragmented, contested, and uncoordinated. This article presents a critiquing reflection of approaches to conceptualising, understanding, and implementing digital health for infectious disease outbreaks, observed from COVID-19 and previous examples. In assessing the strengths and limitations of existing practices of governing digital health for infectious disease outbreaks, this article particularly examines 'informal' digital health to build upon and consider how digitised responses to addressing and governing infectious disease outbreaks may be reconceptualised, revisited, or revised.

Sovereignty in the Digital and Contact Tracing Apps

Recently, the concept of sovereignty in the digital has attracted much attention. Several publications dealing with this concept assume that it can best be described as a network of different, overlapping exercises of power. Nevertheless, there is a need for further research on how exactly sovereignty in the digital can be understood. In order to contribute to a better understanding of this concept, I illustrate its complex structure using contact tracing apps as a paradigmatic example. I conduct a narrative review to show what sovereignty looks like in the context of these apps. In the context of digital contact tracing apps, sovereignty is best understood as a complex network of three actors-nations, (big tech) companies, and individuals-that exercise various forms of power against or on behalf of each other to claim sovereignty for themselves and to either weaken or strengthen the sovereignty claims of other actors. Since large parts of the results can be generalized from the particular context of contact tracing apps, they contribute to a better overall understanding of the concept of sovereignty in digital. This might, in turn, be helpful for discussions about this technology as well as about the regulation and governance of the digital in general.

COVID-19 and the opportunity for gender-responsive virtual and remote substance use treatment and harm reduction services

The COVID-19 pandemic has increased the uptake of virtual and remote service delivery in the substance use field, which was previously uncommon. This swift uptake of virtual services provides an opportunity to improve service design to meet the diverse needs of women and gender-diverse people. Such services have the potential to better meet the needs of women and gender-diverse people by allowing for increased choice, control, and autonomy, enabling empowerment, facilitating greater considerations of power relations, violence, childcare responsibilities, and fostering greater inclusion of trans and non-binary people. This commentary aims to identify how virtual and remote delivery of substance use treatment and harm reduction services can be gender-responsive. We highlight the role gender transformative services play in meeting the unique needs of women and gender-diverse people who use drugs both during and after the COVID-19 pandemic. By using the unique window of opportunity COVID-19 has created to develop and deliver gender-transformative programs, we can help address the detrimental gaps in service accessibility and effectiveness that have persistently been experienced by women and gender-diverse people who use drugs.

How is "solidarity" understood in discussions about contact tracing apps? An overview

Background

In the context of the COVID-19 pandemic, there is much discussion about contact tracing apps, their use to contain the spread of the virus as well as the ethical, legal, and social aspects of their development, implementation, acceptance, and use. In these discussions, authors frequently mention "solidarity" when making key points in arguments. At the same time, authors rarely specify how they understand "solidarity". This lack of specification about how they understand "solidarity" can lead to misunderstandings in discussions.

Objective

To prevent such misunderstandings, it is important to specify how one understands "solidarity" when mentioning it in the discussions on contact tracing apps. Therefore, the aim of this paper is to elaborate how "solidarity" is understood in the context of contact tracing apps, i.e., how different authors understand "solidarity" when using it in discussions about these apps.

Methods

In order to find out how different authors understand "solidarity" when discussing contact tracing apps, I conduct a literature review. I collect papers from several databases, inductively work out central differences and similarities between the different uses of "solidarity", and use them to code and analyze relevant passages.

Results

In the final sample, five different understandings of "solidarity" in the context of contact tracing apps can be identified. These understandings differ in how different authors (1) imagine the basic concept of solidarity, i.e., what "solidarity" refers to, (2) how they temporally relate solidarity to contact tracing apps, and (3) how they perceive the causal interactions between solidarity and contact tracing apps, i.e., the different ways in which solidarity and contact tracing apps influence each other.

Conclusions

The five understandings of "solidarity" in the context of contact tracing apps presented here can serve as guidance for how "solidarity" can be understood in discussions-thus contributing to a better mutual understanding and preventing communicative misunderstandings.

Should Digital Contact Tracing Technologies be used to Control COVID-19? Perspectives from an Australian Public Deliberation

Mobile phone-based applications (apps) can promote faster targeted actions to control COVID-19. However, digital contact tracing systems raise concerns about data security, system effectiveness, and their potential to normalise privacy-invasive surveillance technologies. In the absence of mandates, public uptake depends on the acceptability and perceived legitimacy of using technologies that log interactions between individuals to build public health capacity. We report on six online deliberative workshops convened in New South Wales to consider the appropriateness of using the COVIDSafe app to enhance Australian contact tracing systems. All groups took the position (by majority) that the protections enacted in the app design and supporting legislation were appropriate. This support is contingent on several system attributes including: the voluntariness of the COVIDSafe app; that the system relies on proximity rather than location tracking; and, that data access is restricted to local public health practitioners undertaking contact tracing. Despite sustained scepticism in media coverage, there was an underlying willingness to trust Australian governing institutions such that in principle acceptance of the new contact tracing technology was easy to obtain. However, tensions between the need to prove system effectiveness through operational transparency and requirements for privacy protections could be limiting public uptake. Our study shows that informed citizens are willing to trade their privacy for common goods such as COVID-19 suppression. But low case numbers and cautionary public discourses can make trustworthiness difficult to establish because some will only do so when it can be demonstrated that the benefits justify the costs to individuals.

Expert insights on digital contact tracing: interviews with contact tracing policy professionals in New Zealand

Digital contact tracing (DCT) is the application of digital tools to assist with identifying and informing close contacts of a COVID-19 case. DCT is a potential solution to capacity constraints of current manual contact tracing processes. Expert opinion from contact tracing professionals rarely informs public discourse on the benefits and limitations of DCT solutions. Three focus groups were undertaken in New Zealand to understand benefits and limitations of DCT solutions from contact tracing professionals. One was with the National Investigation and Tracing Centre (NITC) and two were with Public Health Units (PHUs). Participants highlighted four key themes including: (i) equity, (ii) privacy, (iii) communication and public perception and (iv) the operational model. Participants were concerned DCT solutions could exacerbate existing health inequities due to lack of access to, or familiarity with, technology. Poor communication and public understanding of DCT were seen as a major threat to both the efficacy of DCT solutions and the wider COVID-19 response. Most importantly, end-users were cautious of the operational model for DCT data that might: (i) attempt to replace manual processes that cannot or should not be automated by technology (case investigations, follow-ups); (ii) place undue burden on citizens and (iii) increase the workload for the current system beyond its capacity, for unproven or limited benefit. To be effective, contact tracing professionals believed DCT technologies must have strong privacy safeguards, a clear and simple communication strategy, interoperability with the existing contact tracing system and a foundation of health equity.

Delineating privacy aspects of COVID tracing applications embedded with proximity measurement technologies & digital technologies

As the COVID-19 pandemic expanded over the globe, governments implemented a series of technological measures to prevent the disease's spread. The development of the COVID Tracing Application (CTA) was one of these measures. In this study, we employed bibliometric and topic-based content analysis to determine the most significant entities and research topics. Additionally, we identified significant privacy concerns posed by CTAs, which gather, store, and analyze data in partnership with large technology corporations using proximity measurement technologies, artificial intelligence, and blockchain. We examined a series of key privacy threats identified in our study. These privacy risks include anti-democratic and discriminatory behaviors, politicization of care, derogation of human rights, techno governance, citizen distrust and refusal to adopt, citizen surveillance, and mandatory legislation of the apps' installation. Finally, sixteen research gaps were identified. Then, based on the identified theoretical gaps, we recommended fourteen prospective study strands. Theoretically, this study contributes to the growing body of knowledge about the privacy of mobile health applications that are embedded with cutting-edge technologies and are employed during global pandemics.

Virality, desire and health assemblages: mapping (dis)continuities in the response to and management of HIV and COVID-19

In this paper, we explore the relationship between "viral load" as a virological, immunological, epidemiological and social category and how it links the four decades-long global HIV pandemic to the ongoing response to COVID-19. We argue, metaphorically, that the response to SARS-CoV-2 contains 'genetic' material from HIV, which has (as a result of the digital age which reproduces error-filled data at incredible speed) mutated and is being transmitted into the social and political body. Using sexual health and substance use as focal points, we turn to Deleuzoguattarian theoretical insights about the assemblage of desire, affect and material factors that produce epidemics. Contrasting historical and contemporary scenes and issues, we explore the complex assemblage created by viral loads, medical and public health protocols, conceptions of risk, responsibility and fear that connect both pandemics. Finally, we consider the goal of viral eradication and related militaristic metaphors, alongside the increasing convergence of medicine, public health, the law and corporate interests, and contrast this with community responses that engage with what it means to be living and dying in viral times.

Normative positions towards COVID-19 contact-tracing apps: findings from a large-scale qualitative study in nine European countries

Mobile applications for digital contact tracing have been developed and introduced around the world in response to the COVID-19 pandemic. Proposed as a tool to support 'traditional' forms of contact-tracing carried out to monitor contagion, these apps have triggered an intense debate with respect to their legal and ethical permissibility, social desirability and general feasibility. Based on a large-scale study including qualitative data from 349 interviews conducted in nine European countries (Austria, Belgium, France, Germany, Ireland, Italy, the Netherlands, German-speaking Switzerland, the United Kingdom), this paper shows that the binary framing often found in surveys and polls, which contrasts privacy concerns with the usefulness of these interventions for public health, does not capture the depth, breadth, and nuances of people's positions towards COVID-19 contact-tracing apps. The paper provides a detailed account of how people arrive at certain normative positions by analysing the argumentative patterns, tropes and (moral) repertoires underpinning people's perspectives on digital contact-tracing. Specifically, we identified a spectrum comprising five normative positions towards the use of COVID-19 contact-tracing apps: opposition, scepticism of feasibility, pondered deliberation, resignation, and support. We describe these stances and analyse the diversity of assumptions and values that underlie the normative orientations of our interviewees. We conclude by arguing that policy attempts to develop and implement these and other digital responses to the pandemic should move beyond the reiteration of binary framings, and instead cater to the variety of values, concerns and expectations that citizens voice in discussions about these types of public health interventions.

COVID-19 contact tracing apps: UK public perceptions

In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the ‘test, track and trace’ approach of containing the spread of the novel coronavirus. These technologies include mobile ‘contact tracing’ applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for ‘genuine participation’ in public health interventions and emphasises the need to take citizen’s knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees’ range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK.

On the imperative of thinking through the ethical, health equity, and social justice possibilities and limits of digital technologies in public health

The COVID-19 pandemic has demonstrated both the positive and negative use, usefulness, and impact of digital technologies in public health. Digitalization can help advance and sustain the core functions of public health, including health promotion and prevention, epidemiological surveillance, and response to emergent health issues. Digital technologies are thus—in some areas of public discourse—presented as being both necessary and inevitable requirements to address routine and emergency public health issues. However, the circumstances, ways, and extent to which they apply remain a subject of critical reflection and empirical investigation. In this commentary, we argue that we must think through the use of digital technologies in public health and that their usefulness must be assessed in relation to their short- and long-term ethical, health equity, and social justice implications. Neither a sense of digital technological optimism and determinism nor the demands of addressing pressing public health issues should override critical assessment before development and implementation. The urgency of addressing public health emergencies such as the ongoing COVID-19 pandemic requires prompt and effective action, including action facilitated by digital technologies. Nevertheless, a sense of urgency cannot be an excuse or a substitute for a critical assessment of the tools employed.

The Smartphone Pandemic: How Big Tech and public health authorities partner in the digital response to Covid-19

Digital technologies harnessed through smartphones have been deployed widely to support the response to Covid-19 internationally, often through partnerships between 'Big tech' and telecoms corporations and public health authorities. This paper provides an overview and critical analysis of the rapid rise of such new forms of public-private cooperation, focusing on their manifestation in the European region in the first phase of the pandemic. Drawing on a review of international media and documents, we discuss three main domains of public health action in which private technology companies and public health authorities have converged: contact-tracing, epidemic modelling and public health communication to manage the 'infodemic' of misinformation about the new coronavirus. Critics have raised concerns about how the digital response to Covid-19 may threaten privacy and enable greater state surveillance and control, and the possibility that semi-automated decision-making may exacerbate existing discrimination and inequalities. Our analysis extends such critiques by considering what the digital response to Covid-19 reveals about tech corporations' growing power to influence public health agendas. We discuss how they promote technical solutions to public health challenges that are politically seductive, but that have uncertain effectiveness and societal implications that warrant critical scrutiny.

Developing a digital health strategy for people who use drugs: Lessons from COVID-19

COVID-19 has significantly exacerbated negative health and social outcomes for people who use drugs (PWUD) around the world. The closure of harm reduction services, ongoing barriers to employment and housing, and pre-existing physical and mental health conditions have increased harms for diverse communities of PWUD. Adapting current models of health and human service delivery to better meet the needs of PWUD is essential in minimizing not only COVID-19 but also drug-related morbidity and mortality. This article draws on research, practice, and advocacy experiences, and discusses the potential for digital health tools such as remote monitoring and telecare to improve the continuum of care for PWUD. We call for a digital health strategy for PWUD and provide recommendations for future program development and implementation.