TECHNOLOGY

Epidemic technology has excluded public health experts. Here’s why it needs to change.


Author of Susan Landau, Professor at Tufts University in CipherSecurity and Computer Science People count, A book about how and why contact tracing apps were created. He also published an essay Science Last week argued that new technologies to support public health should be thoroughly scrutinized so that it could add to the injustices and inequalities already inherent in society.

“The epidemic will not face the last man,” Landau wrote, urging society to “use the tools and build and support health care policies” that will protect human rights, health and safety and enable greater healthcare equality.

This interview has been shortened and edited for clarity.

What have we learned since the Kovid apps rolled out, especially how they could work differently or better?

The technicians working on the apps were really careful about making sure to talk to epidemiologists. What they probably didn’t think was good enough: these apps are about to change for those who are notified of potentially coming into contact with Kovid. They are going to change the delivery [public health] Services. That conversation didn’t happen.

For example, if I received an exposure notice last year, I would call my doctor, who would say, “I want you to get tested for covid.” Maybe I would isolate myself in my bedroom, and my husband would bring food for me. Maybe I shouldn’t go to the supermarket. But without that, not much will change for me. I don’t drive. I am not a food service worker. For those people, getting an exposure notice is really different. To help them you need to have social services that know something about public health.

Susan Landau

Pictures of the court

In Switzerland, if you get an exposure notice, and if the state says “yes, you have to quarantine,” they will ask, “What is your job? Can you work from home?” And if you say no, the state has to stay home Will bring some financial support. It is setting up social infrastructure to support exposure notifications. For example, the United States was not in most places.

Epidemiologists study how the disease spreads. Public health [experts] See how we take care of people and they have different roles.

Is there any other way that apps could be designed differently? What could make them more useful?

I think the 10% app has an argument to actually collect the location, only to be used for treatment to understand the spread of the disease. When I spoke to epidemiologists in May and June 2020, they said, “But if I can’t tell where it’s spreading, I’m losing what I need to know.” This is a problem managed by Google and Apple.

There are also problems with how effective it is. It is again related to the issue of equity. I live in a somewhat rural area and my nearest home is a few hundred feet away. I’m not going to get a Bluetooth signal from someone else’s phone which leads to exposure notifications. If my bedroom is just opposite the bedroom in the apartment next door, I can get a full exposure notice if the person next door is sick – the signal can go through the wooden walls.

Why has privacy become so important to the designers of contact tracing apps?

It’s really true where you were because it shows things like who you were sleeping with, or whether you stopped at the bar after work. It shows whether you go to church at seven on a Thursday but you never go to church again, and it turns out that the alcoholic Anonymous then visits the church. For human rights activists and journalists, it is clear that it is very dangerous to track who they were with, because it reveals their source. But even for the rest of us, with whom you spend time – the closeness of people – it’s a very personal matter.

“The end user is not an engineer … it’s your uncle. This is your baby sister. And you want to get people who understand how people use things.

Other countries use a protocol that includes more location tracking – Singapore, for example.

Singapore said, “We are not going to use your data for any other purpose.” Then they changed it, and they are using it for law enforcement purposes. And the app, which was started voluntarily, now needs to be accessed in office buildings, schools, etc. The government has no choice but to find out who you are spending time with.

I’m interested in your thoughts on some big lessons for creating public technology in a crisis.

I work in cyber security, and in that case it took us a long time to realize that there is a user on the other end and the user is not an engineer sitting in Sun Microsystems or Google Security Group. This is your uncle. This is your baby sister. And you want to have people who understand how people use things. But it’s not something that engineers are trained to do – it’s something that public health people or social scientists do and should be an integral part of those people’s solutions.



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