This is a piece I contributed to a book on the Coronavirus pandemic, called Pandemic Where Did We Go Wrong? It is very slightly rewritten to suit the web, for example some footnotes have turned into links and others into text. The brief was to provide a summary of what happened to England’s contact tracing app for “second year journalism students”. It is deliberately non-technical and non-opinionated.
Intro from the book
The UK was not ready for Coronavirus. The UK needed to build a test and trace capability suitable for the scale of the pandemic. A key part of the Government’s strategy, a contact tracing app, broke on the Isle of Wight.Peter Wells explains why…
The need for contact tracing
As the pandemic struck it became clear that the UK had existing public health capability but not to the required scale. It would need a massive programme of work to strengthen it. Public health is a devolved matter, all four national administrations and local public health authorities across the UK started work.
Contact tracing is part of the public health response to any infectious disease. Expert contact tracers interview infected people to discover to whom they might have transmitted a disease , they then interview those contacts to discover if they might have the disease and to whom they could have transmitted it, and so on. The contact tracer uses their expertise to recommend what activity each possible contact should take.
Research into the Coronavirus showed that people became infectious before they showed any symptoms. Some researchers became concerned that this would lead to traditional contact tracing methods being ineffective. The disease would spread before contacts could be traced. This would lengthen the lockdown, cause more economic damage, and cost lives.
A group of scientists in Oxford led by Professor Christophe Fraser, the Coronavirus-Fraser group, started to explore whether technology, in the form of a mobile phone contact tracing app, could help.
The rise of the NHSX app
The app would use Bluetooth signals to detect which phones had been in contact with each other. If a user told the app on their phone that they had tested positive for Coronavirus, other app users who might be at risk would be informed and advised to take action. The methodology had previously been explored in theory, but had not been used in an actual pandemic response anywhere in the world.
In early March 2020 Professor Fraser met with Matthew Gould, the CEO of NHSX – a unit of the Department of Health and Social responsible for digital transformation – to explore the idea. The Government agreed that the scientists would develop the theoretical framework and models, while NHSX would work with partners to start developing an app.
In late March Matt Hancock, the Secretary of State for Health and Social Care, announced that NHSX had started developing a contact tracing app.
It quickly became clear that other people had views.
A group of technologists, including myself, asked the government to be wary of trusted untested technologies and recommended that it act transparently. The government said that it would act transparently and that people would be able to trust the app.
European academics specialising in privacy were concerned that an app which traced people’s contacts might reveal too much information about citizens to their governments. They started developing their own approach to digital contact tracing, known as DP-3T. This approach was termed ‘decentralised’ and ‘privacy-preserving’, in contrast to the UK’s approach which was framed as ‘centralised’ and as endangering privacy. They tried to persuade the public, European governments and the EU to support their approach.
Google and Apple, who make the operating systems for the vast majority of smartphones in use, announced that they supported this de-centralised, privacy-preserving approach and would release their own protocol that would make it easier for governments to build apps. They said that they would not support centralized apps, like the one that NHSX had started developing.
The Ada Lovelace Institute, an independent research body, performed a rapid evidence review and found “an absence of evidence to support the immediate national deployment of the technical solutions under consideration”.
The Coronavirus-Fraser group’s mathematical models showed that if the app tracked the disease well enough and the people using the app behaved as expected then the spread of the virus would be reduced, but it was not clear what would happen in the real world. Mathematical models help us understand what might happen. They do not tell us what will happen. The Government continued on their course.
Updates were given to the national press but despite the promises of transparency detailed information was not shared, whether with the general public or with experts outside the Government. In the absence of information public debate continued, often fuelled by social media speculation about who was building the app and what their motives were.
In late April 2020 NHSX told the BBC that they were running a limited trial on an RAF base in Yorkshire. No results from this trial were published, but the Government concluded that a bigger trial was needed to understand how the app might work in the real world.
The Isle of Wight trial
In an interview Dave Stewart, the leader of Isle of Wight council, suggested that the Isle of Wight could be used for a trial of the app. If the trial was successful then the island’s tourism industry could be one of the first to be reopened and the Government would owe a favour to the island.Matt Hancock agreed with Dave.
On 4th May he announced that a trial would take place on the island before the app was rolled out nationwide, saying “where the Isle of Wight leads, Britain follows”. Some island entrepreneurs started selling t-shirts with the slogan on it. It is not known how many they sold.
The government’s announcement of the trial said that its overall test, track and trace programme was being trialled on the island, but the press release and accompanying press coverage focussed on the app. The Isle of Wight Green Party spokesperson, Vix Lowthion, asked the Government how they would be measuring the success of the ‘test, track and trace’ programme. There was no answer.
By now it seemed like there were daily press stories about the app. It dominated questions in the Government’s press conferences.
In the week following the launch of the trial it was reported that the UK was building a second contact tracing app that would follow the Google-Apple de-centralised model; that any contact tracing app would face technical challenges in being accurate enough to be useful; that there were plans to expand the app functionality, and that Parliament’s Joint Human Rights Committee recommended new legislative safeguards before the app could be safely used.
Civil servants spent an increasing amount of time trying to understand the public debate and get their messages to cut through the noise, while the people on the Isle of Wight were still deciding whether to use the app at all.
In the circumstances it must have been pleasing that 55,000 people downloaded the app in the first few days. Unfortunately it was not clear how many were on the Isle of Wight and how many were curious journalists, technologists and politicians. Public surveys showed that a sufficiently high proportion of UK citizens would be willing to download the app, but surveys do not always reflect actual behaviour.
Unfortunately after the early enthusiasm about the number of downloads there were few official updates from the trial.
The promises of transparency were not being met. The reasons gradually became clear.
Time for a U-turn
On 19th May, two weeks after the trial had started, Government Health Minister Lord Bethell told the House of Lords that the trial had taught Government “one important lesson: that people wanted to engage with human contact tracing first, and quite reasonably regarded the app as a supplementary and additional automated means of contact tracing”.
Government publicly shifted their focus to the need for manual contact tracing and delivering on the Prime Minister’s statement that England would have a “world-beating” test and trace programme by the start of June.
Local news site NewsOnTheWight wanted more detail. They started asking questions of both Isle of Wight and NHS officials about how the app had performed on the island. They were promised answers, but none were given.
The UK Government launched England’s new national test and trace programme on 28th May. Like the new programmes in Scotland, Wales and Northern Ireland the programme did not have an app.
The Government said that the app would be added at a later date and would be the cherry on the cake. But it was unclear when the cherry or the cake would be in place.
There was talk of launching a second version of the app on the Isle of Wight, but it never appeared. Ministers said the app would launch at the end of June, and then that it would launch in Winter
It became clearer that the “world beating” test and trace programme was facing problems too.
What went wrong?
While central Government officials had built a new national contact tracing service, a new central data store and a new Joint Biosecurity Centre to help make decisions, local involvement was lacking and the system failed to cater for the many languages spoken in England. A more human approach was needed.
On the same day that news started to emerge of a major Coronavirus outbreak in Leicester, the Government announced that the original plan for the contact tracing app had been abandoned and that England would start to move to the de-centralised model proposed by Google and Apple .
As well as the important lesson that humans wanted to talk with humans, the Government’s announcement confirmed rumours that there were technical problems with the app. It would not work on Apple iPhones unless it used the technology that Apple had announced two months previously.
The wrong strategy?
Apart from these ministerial announcements there is still no official output from the Isle of Wight trial. We do not know whether the app found any cases of the virus that would not have been found by manual contact tracing.
Press stories continue to emerge about why the app had failed and how it could come back stronger than before, but there also seems to be a growing realisation that the app had been the wrong place to start all along.
Other countries, like Germany and France, had begun the pandemic in a similar situation to the UK and had built strong test and trace programmes rooted in local public health institutions that were trusted by the people they served. They were now trialling apps, but the apps were built on strong foundations. They really were just a cherry on an already baked cake. The cake was tasty, the cherry was a bonus.
The Government had trusted in untested technology solutions to respond to the pandemic. Perhaps putting more trust in institutions and humans would have been a better strategy.
(Reminder: this is from a book that has other things written by people who are not called Peter Wells. The contributors include Dave Miller, James Ball, Juliet Rix, Paul Corrigan, Angela Antetomaso Forbes, Dr Alex Connock, Matthew d’Ancona, Dr Steven Mccabe, Simon Morioka and Claire Kennedy, Dr John Lister, Dr Paul Davies, Dorothy Byrne, Paul Connew, Professor Barnie Choudhury, Neil Fowler, Ben Parsons, Professor Vicky Pryce, Professors David Bailey and Phil Tomlinson, and Professor John Howson. You can get the book printed and delivered by Amazon.)