Public health in the midst of a smart pandemic

The COVID-19 pandemic is the first truly global pandemic where phones and personal devices are “smart” enough to make mass surveillance of the population possible. This technological reality has led to the rapid recognition by governments around the world that these devices can be used to identify and track disease status trends. As the pandemic has grown, the most common public policy approach to controlling its spread has been to enforce reporting of health status and limit personal movement. As a result, throughout the developed world, rapid increases in the use of these technologies have led to the evolution from manual contact tracing to digital contact tracing (DCT), in the form of voluntary applications.

Apple and Google (“Gapple”) teamed up to design the first wave of DCT systems in the spring of 2020. Announced on April 10, 2020, their technology “promised to automatically scale up entire population groups rather than just small disease groups — a distinct feature of tracking A rapidly spreading disease. More than a year later, the so-called “Gapple” system has been adopted by the vast majority of US and EU member states. Soon after, a group of 300 international scientists published a joint statement calling for a decentralized data storage (DP-3T) approach for DCT systems, and publicly supported the decentralized exposure notification system “Gapple”. By May 2020, only about ten percent of the total US population has voluntarily chosen DCT technologies. Later, in September 2020, Apple released a system update that automatically installed DCT in users’ phones, allowing them to opt in or out.

The massive government adoption of DCT systems has sparked concern among privacy experts and consumers. Not only has the DCT been largely ineffective, it has also reinforced citizens’ current mistrust toward government, big tech companies, and public health institutions. The lack of transparency in the implementation and deployment of the DCT app has reinforced the view that consumer data is viewed as a commodity in the United States, and that privacy concerns are at best secondary considerations when digital technologies are used.

DCT implementation and digital health privacy

The implementation of the COVID-19 DCT applications provides a useful case study of today’s landscape focused on digital health tracking. One of the facts that consumers care about when they interact with the digital world is the issue of privacy. While there are other factors that influence the use of technology, privacy concerns are the most dominant of these factors and consistently influence consumers’ desire to use digital products, as has been the case with contact tracing apps. A June 2020 survey found that 71 percent of respondents said they would not use contact tracing apps, citing privacy as the main reason.

To get around these concerns, consumers will have to view the risks to privacy as less than the risks of failing to download an app that they believe has been released by the government. This is a tough standard at any point in time, but doubles as that government implements lockdown and isolation measures.

Citizens have to engage in a privacy calculus, choosing between the trade-offs of providing access to their personal data and losing out on benefits from using technology. In this case, calculus has resulted in assimilation rates that vary widely across states. Arizona and North Dakota saw absorption rates of 1.2 percent and 1.4 percent, respectively, while Connecticut and Hawaii saw absorption rates of 37.8 percent and 45.7 percent.

To convince citizens to download DCT apps, the government will have to take the right steps to increase trust. This may include complete transparency regarding how applications are implemented, consistency, application interoperability, and data minimization, many of which haven’t happened.

This most central attempt to develop a single DCT by “Gapple” not only led to individual resistance, but also spawned a host of alternatives that all attempted to enter the market. An enormous number of applications of DCT have been circulated in various institutions, such as private and public universities, often developed to enforce or encourage DCT among the constituent population. For example, California implemented its own state application, CA Notify, while UC Public Institutions created the UC Applications Consortium. Columbia University has also piloted its campus-based application in partnership with Tech: NYS though New York State has launched the NYS ENX application. The University of Pennsylvania introduced the PennOpenPass COVID-19 symptom tracker, while Penn State implemented the COVID Alert PA (which has since been deleted as of July 27, 2022). These are just a few examples of attempts to create highly localized DCT applications.

The privacy concerns of these apps mirrored, or in some cases exceeded, those of the “Gapple” app. UCSF has reportedly donated location and health history data through the Eureka app. DCT apps like MassNotify are simply downloaded into people’s phones and run without prior notice. This new innovation, called Exposure Notification Express (ENX), is said to have “made it much faster for countries to rotate apps, and… called on millions of iPhone users to avoid downloading anything at all” by simply giving them the option to activate notifications on By flipping a toggle in their phone’s settings. Countries that have effectively implemented ENX have seen a significant increase in participation rates, regardless of whether this is voluntary. Hawaii, for example, has seen its users more than double after implementing ENX.

DCT’s applications and dissemination have reinforced Americans’ mistrust toward the government. In a survey conducted by the Harvard TH Chan School of Public Health in 2021, only 52 percent of Americans expressed high levels of confidence in the CDC. Likewise, a survey conducted by the Washington Post and the University of Maryland following the announcement of the DCT app found that 56 percent of Americans do not trust big tech companies when it comes to data privacy. The lack of trust and reluctance to provide information is evident in the results of both manual and digital contact tracing. In 2020, more than 50 percent of Americans who tested positive for the virus in some parts of the United States did not provide any details of close contacts when asked.

Gaining confidence is easier said than done

An October 2019 report by the Johns Hopkins Center for Global Health Security and the Nuclear Threat Initiative concluded that the United States is the country best prepared to deal with a pandemic. In fact, 23% of recorded COVID cases in the world have occurred among Americans, even though the United States represents just over 4% of the world’s population.

The erratic US response and poorly implemented technological “solutions” to COVID-19 come as no surprise. The competing incentives that elected officials and the public face leave many opportunities open for misinterpretation of how citizens view their digital privacy, as a result of failures in their public policy goals. Policy makers such as the National Institutes of Health, the CDC, and a host of elected and appointed officials have considered tracking the spread of COVID-19 to be the primary policy goal, and have focused on that goal to almost everything else, ignoring citizens’ privacy concerns. As a result, responses to these concerns have been accommodative, random, and transcendental. Consumer trust isn’t gained just by saying, as Apple did, “What happens on your iPhone, stays on your iPhone.” Instead, government officials and senior technologists alike must take seriously that with the advent of big data comes the corresponding concern about privacy and transparency. Both would do well to remember President Ronald Reagan’s warning about the nine most terrifying words in the English language. “I’m from the government, and I’m here to help.”

Ryan M. Yonk

Ryan M. Yonk

Ryan M. Yunk is a senior faculty member at the American Institute for Economic Research. He holds a Ph.D. from Georgia State University and a master’s and bachelor’s degree from Utah State University. Prior to joining AIER, he held academic positions at North Dakota State University, Utah State University, and Southern Utah University, and was one of the founders of Strata Policy. He is the author (co-editor) or editor of several books including Green in GreenAnd the Nature Unbound: Bureaucracy vs. Environment, the Reality of American EnergyAnd the Politics and quality of life: the role of well-being in political outcomes. He has also authored numerous articles in academic journals including general optionAnd the independent reviewAnd the Applied research in quality of lifeAnd the Special Projects Journal. His research explores how policy can be best crafted to achieve greater individual independence and prosperity.

Selected Academic Journal Articles

“Commercial Places: Effects of Voting Systems on Multiple Candidate Elections” (2011) (with Randy T. Simmons and Derek Johnson) general option, Volume 146, Numbers 3-4, 341-351, 2011.

“Smugglers, Baptists, and Political Entrepreneurs: Key Players in the Rational and Ethical Play in Regulatory Policy,” (2010) (with Randy Simmons and Diana Thomas) independent reviewvol. 15 (3).

Citizen Participation: Quality of Life in the Age of Direct Democracy (with Shauna Riley) Applied research in quality of lifeMarch 2012

“Battlegrounds and Budgets. Statewide Evidence for Budget Manipulation in Competitive Presidential Election States” State and local government audit. Volume 45, Number 2, June 2013 (with Daniel Franklin and Sean Ritchie)

Empty Intersection: Why is Public Choice Small in Political Science? general option July 2015 (with Randy T Simmons)

Regulatory Strangle: Logan’s Small Hydropower Adventures energies. June 2016 (with Randy T Simmons and Megan Hansen)

“Boon or Bust: Classifying the Wild and Local Economies” Special Projects Magazine. Fall 2016 (with Randy T Simmons and Brian C Stead)

Independent Review “From Equality and the Rule of Law to the Breakdown of Equality”. June 2017 (with James Harrigan)

Disincentives to Business Development in the Navajo Nation. Development Entrepreneurship Magazine. June 2017 (with Devin Stein and Sierra Hoover)

Human influences on the northern Yellowstone mountain range. pastures. January 2019 (with Jeff Mosley and Peter Hosby)

“Exploring the Effects of the Surface Mine Reclamation and Control Act” Resources. February 2019 (with Joshua Smith And the Arthur Wardle)

“Manufactured Yellowstone: The Political Governance of an American Icon: Institutions and Incentives in Managing Yellowstone” (with Jordan Lofthouse) May 2020, International Journal of Geographical Heritage and Parks.

Unauthorized innovation and land use regulation: How zoning can frustrate sustainability as an example from the United States. (with Josh Smith) December 2021, Journal of Sustainability Science and Management

Edited books and folders

Green versus green: the political, legal, and administrative dilemmas facing green energy production. Routledge Press. October 2012 (with Randy Simmons and Brian Stead)

Nature Unbound: Bureaucracy vs. Environment. Independent Institute. March 2016[1] (with Randy Simmons and Ken Sim)

The Reality of American Energy: The Hidden Costs of Electricity Policy. Brieger Press. July 2017 (with Megan Hansen And the Jordan Lofthouse)

Political Implications for Quality of Life: Springer International Press. January 2018 (with Josh Smith)

Direct Democracy in the United States: Petitioners as an Expression of Society. Routledge Press. October 2012 (volume edited with Shauna Reilly)

[1] [1] Winner of the 2017 Independent Publisher Book Awards (IPPY) Gold Medal in the Environment, Environment & Nature category.

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April Leo

April is a Research Intern at AIER. She graduated from Mount Holyoke College in May 2022 with a double major in Economics and International Relations. Her research interests lie in data privacy at the global and local levels.

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