As the Biden administration ramps up, it inherits soaring cases and a muddled vaccine rollout— so it’s reasonable to wonder what else can possibly slow the spread of covid-19. Some strategies in the administration’s covid plan are basics, like calling on people to wear masks, doing more testing, and communicating more clearly. But digital technology gets a nod, too: tucked into a list of promises and plans is a vow to look at state-level contact tracing efforts and scale up what’s working. That could mean building a new national app based on what’s succeeded at the state level, supporting more states in developing their own apps, or some combination of tactics.
National leadership on contact tracing and exposure notification apps would be a big change for the US. In many other countries, national apps rolled out last spring, but in the US, apps emerged unevenly from state health agencies that struggled to cope with the demands of the pandemic and the complexity of tracing technology. And although programmers and health experts agree that exposure notification apps are not enough to box in the virus, renewed attention from the federal government could mean they get a second chance to be part of the broad response to the pandemic.
Although we don’t yet know what the Biden administration will do, experts say there are a few approaches that could help apps fulfill their potential.
Have a unified vision—but that doesn’t have to mean a single app
Until now, the federal response hasn’t supported states in building technology to fight covid. In fact, Washington may even have slowed down individual states’ progress on apps; according to reporting from Jacobin, officials in Pennsylvania had to work around silence from the CDC when they were trying to get their service up and running.
Although 22 states had rolled out exposure notification by the end of 2020, according to our covid-19 tracing tracker, others never even attempted it. Some states have wavered for months on whether to deploy the technology. Illinois, for example, faced a sharp increase in covid-19 cases between October and November, but officials hesitated over the possibility of using an app, saying they had privacy concerns.
NearForm, a software development company from Waterford, Ireland, built the app used by the Irish government, which has also been adopted by several US states. Larry Breen, the company’s chief commercial officer, says the smart approach wouldn’t be to introduce a single, centralized national app. Instead, he suggests, the White House could provide resources that local officials need to make their own apps, or help them get more widely adopted.
It’s about “pulling away some of the politics around it,” says Breen.
Make sure the technology works across state lines
Because most state-level apps were developed separately, they don’t always work across borders, not even in neighboring states. The virus, of course, doesn’t care where you are, so this is a major problem. To get around this, states have needed to form their own alliances—for example, New York joined with New Jersey, Delaware, and Pennsylvania.
Some back-end infrastructure built by the Association of Public Health Laboratories allows for apps from about 20 states and territories to work together so far. But this system still doesn’t cover the entire country. The Biden administration will need to coordinate a solution that works for all states, and make sure local health authorities have the information they need to accurately communicate with the public about the technology.
Take a global approach
Once global travel becomes easier, the technology will need to work across international borders, too. While the federal government develops a national contact tracing plan, Breen says, it should also work with foreign governments to ensure that travelers can track covid exposure with an app they’re used to, rather than having to switch to the local version.
That’s especially important as we learn that some countries, like Singapore, are rolling back freedoms and privacy. If US travelers could still use their US app, they could potentially keep their data out of Singapore’s central system.
Although some countries in Europe already have cross-border exposure apps up and running, getting every country in the world on a global system would be a tough—if not impossible—task.
“You need to convey that as the government, you’re here to help; you’re not here to harm.”
Cyd Harrell
But the US could choose to lead, and one way to get there would be directing more money to public health technology, period. The Linux Foundation is already working on boosting interoperability for covid-related technologies, and Jenny Wanger, director of programs for Linux Foundation Public Health, says funding is part of the challenge. She says the sector has been underfunded for decades, which means that “there are lots of systems that don’t work very well together.” She adds, “The fax machine still reigns supreme. Everyone knows we can do things much better, but the only way to do that is change the business model.”
There’s a long road ahead, and no international approach or negotiation can be settled on a state-by-state basis, Breen says. Instead, it “needs to be driven on a national level.”
Build trust and improve transparency with states and with the public
Mixed messages and misinformation about the virus coming from the White House have battered public trust in science and medicine, including attitudes toward contact tracing apps. But Stephanie Mayfield, who directs US covid programs for the nonprofit Resolve to Save Lives, is optimistic about the Biden administration’s ability to restore trust.
“We’re hopeful in the world of public health that there will be transparency, there will be candor about this virus, there will be evidence- and science-based leadership going forward,” says Mayfield. “We’re hopeful that uniform leadership will help our nation drive down [cases].”
Earning trust isn’t easy, especially with at least 40% of Americans already wary of sharing personal information with public health officials. And historically marginalized groups may distrust the government for any number of good reasons. Mayfield says a national push could support health providers in making recommendations to local communities.
“In general with health care, building trust is at the level of the provider,” she says.
Cyd Harrell, author of A Civic Technologist’s Practice Guide, says trust is critical in getting people to use apps and other technologies created by the government. “Especially for more vulnerable people,” she says, “you need to convey that as the government, you’re here to help; you’re not here to harm. And you’re respecting some of those key aspects of people’s humanity—whatever abilities they might have in terms of reading or language.”
Harrell says this basic process of earning trust is not just about the underlying technology but also about implementing it thoughtfully. Otherwise, “people inevitably feel like you don’t care about them,” she says. “Tech can’t lift up all that communication work that you need to establish trust during a scary time.”
—Additional reporting by Lindsay Muscato
This story is part of the Pandemic Technology Project, supported by the Rockefeller Foundation.