COVID-19 Technology: Balancing Ethics and Public Health

Featured Health Tech Smartphone Tech Wearable Tech

John Hopkins University has been tracking the spread of COVID-19 since its early days, making that information available to the public, even before the first small dots appeared in the U.S. on its map.  Now, the U.S. is by far the unfortunate leader in confirmed cases, up to almost 1.7 million today.  Even as that figure continues to climb, governments across the world are actively implementing re-opening plans to bring people back to their workplaces and hopefully jumpstart a global economy that has largely been shut down for more than two months. 

Included in most strategies is digital contact tracing.  Simply, the idea is the idea is to leverage mobile technology to rapidly identify people who may have come in contact with infected people to help reduce further spread as people begin to move about their communities again.  Google and Apple have collaboratively launched collaborative APIs to enable governments to develop device-agnostic contact tracing apps.  The first reported app based on their work just launched in Switzerland – the SwissCovid app.

The benefits of being able to track activity in light of how rapidly the novel coronavirus has spread is undeniable.  But, many questions remain, including where the fine line is between public benefit and individual privacy.  In an effort to help answer some of those questions, JHU has now released a new report, Digital Contact Tracing for Pandemic Response: Ethics and Governance Guidance, providing guidance and recommendations on ethics and governance around using digital technologies to combat pandemics.  The report includes input from more than two dozen experts from medical, legal, biotech, security, and other fields from around the world.

With governments across the globe struggling to contain the virus, a challenge that becomes inherently more difficult as public movement increases, they also are seeking to maintain a delicate balance between public health and civil liberties.  Ultimately, the report concludes individual privacy cannot outweigh public interest if that would increase significantly increase risk.

“As we move forward, we must strike a balance between privacy and values like equity, choice, economic well-being and solidarity.  Too much emphasis on privacy could severely limit the ability to gather information that is critical for effective and efficient contact tracing to help beat the pandemic, and so the full range of interests and values of the public must drive this conversation—and not just those asserted by tech companies.” 

Jeffrey Kahn, Ph.D., MPH, Johns Hopkins Berman Institute for Bioethics

With many major tech companies being in the news over privacy issues in recent years, though, the report also suggests that big technology companies should not be allowed to unilaterally set terms when broad public interests are at stake.  In other words, there is plenty of concern over the motivation behind tech firms’ activity, and little trust in their use of data they collect.

Recommendations from the report include:

  • Technology design should not be static. There is no “one size fits all” approach. Design should be capable of evolving depending upon local conditions, new evidence and changing preferences and priorities.
  • Technology companies alone should not control the terms, conditions, or capabilities of DCTT. Nor should they presume to know what is acceptable to members of the public.
  • DCTT should be designed to have a base set of features that protect privacy, with layers of additional capabilities that users can choose to activate. A default should be that user location data are not shared, but users should be provided with easy mechanisms and prompts to allow for opting-in to this capability, especially if opting-in is critical to achieving public health goals.
  • De-identified data collected through DCTT should be made available to public health professionals and researchers to support population-level studies and analyses.
  • Those who authorize use of DCTT within a particular jurisdiction or institution should continuously and systematically monitor the technology’s performance in that context. This should include monitoring for effectiveness and benefit, monitoring for harms and monitoring for the fair distribution of both benefits and harms.
  • Governments should not require mandatory use of DCTT given the uncertainty about potential burdens and benefits. Additional technology, user and real-world testing is needed.
  • Congress should enact legislation specifically tailored to use of DCTT as part of the response to COVID-19, which would facilitate uses of DCTT to promote the public health response while protecting citizens.

It’s understood that technology is the way forward – not only to beat COVID-19, but to more effectively identify and react to future pandemics.  The good news is tech companies have, from the beginning of the pandemic, worked to develop viable solutions to assist individuals, businesses, and governments in managing this crisis.  But there are challenges, including political and corporate agendas that have the potential to distract leaders from making the best possible decisions. 

“In this time of COVID-19, digital technologies have an unprecedented capacity to accelerate and improve the way the world responds to infectious disease outbreaks and pandemics.  The digital contact tracing technologies represent great opportunity. They also present significant ethical, legal and governance concerns that we, as a society, must grapple with.”

RONALD J. DANIELS , President, Johns Hopkins University

This collaborative project provides at least a beginning framework for continued efforts to leverage technology to safely bring society back to some level of normalcy.  The truth is, the public isn’t responsible enough to do it on its own, so technology has to be the basis for controlling the virus, especially as experts continue to predict a significant second wave.