Pandemic tech left out public health experts. Here’s why that needs to change.

Susan Landau is a Tufts University professor of cybersecurity and computer science. She is also the author of PeopleCount ,, which explains how and why contact trace apps were created. She also published an essay in Science last week arguing that new technology to support public health should be thoroughly vetted for ways that it might add to unfairness and inequities already embedded in society.

The pandemic won’t be the end of humanity,” Landau writes. She urges societies to use and build tools and support health care policies that will ensure people’s safety, rights, and health and promote equity in health-care.

This interview has been reduced and edited for clarity.

What have we learned since the rollout of covid apps, especially about how they could have worked differently or better?

The technologists who worked on the apps were really careful about making sure to talk to epidemiologists. They probably didn’t realize that these apps would change the way people are notified about their potential exposure to covid. They will change how [public health] services are delivered. This is the conversation that never took place.

For example, if I got an exposure notification last summer, I would call my physician and ask him to test me for covid. Maybe I’d go into my bedroom and have my husband bring me food. Perhaps I wouldn’t take the time to go to the grocery store. Other than that, I wouldn’t change much. I don’t own a bus. I am not a foodservice worker. It is very different for those people to receive an exposure notification. Social services are required to support you, something that public health is aware of.

Susan Landau
Susan Landau

COURTESY PHOTO

In Switzerland, if you get an exposure notification, and if the state says “Yeah, you need to quarantine,” they will ask, “What’s your job? If you answer no, the state will provide financial assistance to allow you to work from home. This is the support of exposure notification by putting in social infrastructure. The US was an exception.

Epidemiologists study how disease spreads. Public health [experts] examines how we care for people and has a different role.

Are there other ways that the apps could have been designed differently? What would have made them even more useful?

I think there’s certainly an argument for having 10% of the apps actually collect location, to be used only for medical purposes to understand the spread of the disease. When I talked to epidemiologists back in May and June 2020, they would say, “But if I can’t tell where it’s spreading, I’m losing what I need to know.” That’s a governance issue by Google and Apple.

There’s also the question of effectiveness. This is related to the equity issue. I live in a rural area and the nearest house is several hundred yards away. I won’t get an exposure notification if I receive a Bluetooth signal on another person’s phone. My bedroom could be directly next to the apartment next door’s bedroom. The signal can pass through wood walls so I might get several exposure notifications.

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

Where you’ve been is really revelatory because it shows things like who you’ve been sleeping with, or whether you stop at the bar after work. It shows you whether you go to church at seven on Thursdays, but not if you never go there any other day. And it turns out that Alcoholics Anonymous meets at the church at these times. It’s clear that journalists and human rights workers will find it very risky to track who they have been with. This exposes their sources. Even for us all, the privacy of who we spend time with–the closeness of people–is something that is very private.

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

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

Singapore said, “We’re not going to use your data for other things.” Then they changed it, and they’re using it for law enforcement purposes. The app, originally voluntary, is required to gain access to schools and offices. The government must know with whom you are spending your time.

I’m curious about your thoughts on some bigger lessons for building public technology in a crisis.

I work in cybersecurity, and in that field it took us a really long time to understand that there’s a user at the other end, and the user is not an engineer sitting at Sun Microsystems or Google in the security group. It’s your uncle. It’s your little sister. You want people who can understand how people use the things. It’s not something engineers are qualified to do. The public health professionals or social scientists have to do it, and they must be part of the solution.

I want a public health person to say to me, “This population is going to react to the app this way.” For example, the Cambodian population that’s in the United States–many of them were traumatized by government. They will respond in one direction. Indian immigrant populations may respond differently. My book is about the Apache reservation in eastern Arizona. It took into consideration the social factor. It is a public health measure, not a contact tracing method. This allows you to ask about the grandparents of someone else.

Digital vaccine apps and credentials are now rolling out in a wide array of states and countries, and being required by private entities. Who should be present in the room where they are designed to function?

You want the technologists who have thought about identity management and people who think about privacy. How can you disclose one piece of information while not revealing all the rest?

You want people who are sensitive to the privacy implications of disease. What jumps to mind is the epidemiologists and contact tracers who worked with AIDS, which was really an explosive issue back in the 1980s. You want them because they understand public health, and they really understand the importance of the privacy issue. They feel it in their gut.

It’s getting smart people on both sides of the room. Because it is difficult to understand the language of another person, they must be intelligent. Both groups must be able to understand each other’s language, but they should also be confident enough to ask many questions. It’s the really understanding that’s hard.

This story is part of the Pandemic Technology Project, supported by the Rockefeller Foundation.

https://www.technologyreview.com/2021/09/13/1035429/covid-apps-public-health-susan-landau/, Technology Review Read More

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