Local health authorities in states like North Dakota, as well as in countries such as Canada and the United Kingdom, say they’ve pleaded with the companies to give them more control over the kinds of information their apps can collect. Without the companies’ help, some worry their contact tracing systems will remain dangerously strained.
But Apple and Google have refused, arguing that letting the apps collect location data or loosening other smartphone rules would undermine people’s privacy. The companies are also concerned that easing the restrictions around apps’ Bluetooth use would drain phone battery life, which could irritate customers. That unbending stance has led some health authorities to abandon hopes of building a fully functioning contact-tracing app.
The struggle for effective digital contact tracing is reshaping the debate over the trade-offs between privacy and public health when lives are immediately at stake. Public officials say the need to understand how the virus is spreading is urgent, informing decisions about whether communities can reopen and detecting future outbreaks.
But the tech giants’ resistance to letting public health officials access people’s data has a long precedent of keeping personal information out of the hands of governments. Apple and Google said they reached out to hundreds of public health officials for input on the software before it was announced.
Though the companies first debuted the effort by calling it a “contact tracing” system, company executives now say it is designed to do no such thing. They said they intend to fully release the system in the middle of this month.
Company officials said public health authorities had asked for assistance because contact tracing apps that relied on Bluetooth would run into technical challenges without their help. They said their effort was not built to digitize contact tracing or to replace the human element of public health.
But Helen Nissenbaum, a professor of information science and director of the Digital Life Initiative at Cornell University, called Apple and Google’s use of privacy to defend their refusal to allow public health officials access to smartphone technology a “flamboyant smokescreen.” She said it was ironic that the two companies had for years tolerated the mass collection of people’s data but were now preventing its use for a purpose that is “critical to public health.”
“If it’s between Google and Apple having the data, I would far prefer my physician and the public health authorities to have the data about my health status,” she said. “At least they’re constrained by laws.”
The Apple-Google system uses the short-range Bluetooth antennas in smartphones to log when two people come into contact for a short period of time, but not where that contact took place. An alert is sent if one of the people tests positive for a coronavirus infection, but that information is not shared with public health officials or contact-tracing teams.
That limitation has led some health authorities to attempt to build their own apps outside of the Apple-Google design. But developers around the world who have tried to build their own systems have run into functionality issues. For example, Apple restricts all apps not made by Apple from tracking Bluetooth in the “background” to avoid battery drain and privacy issues.
That means that a user must keep one of the apps built by health departments open for it to work — something most users would find incredibly inconvenient. Any time, for example, a user took a phone call, read an email or put their phone in their pocket, the app would not be running.
The tension over virus-tracking apps reflects a major power imbalance between the tech giants and state and local health officials, who argue that Apple and Google’s technical decisions have undermined their response to a global health emergency. It also highlights the tech giants’ ability to exert unfettered control over how billions of smartphones work.
“They are exercising sovereign power. It’s just crazy,” said Matt Stoller, the director of research at the American Economic Liberties Project, a Washington think tank devoted to reducing the power of monopolies. Apple and Google have “decided for the whole world,” he added, “that it’s not a decision for the public to make. … You have a private government that is making choices over your society instead of democratic governments being able to make those choices.”
Some developers who had run into the functionality issue in their own contact-tracing apps asked the companies for help. But they were told they could only get around that rule if they used the Apple-Google system, which would prohibit them from recording location data or sharing information with contact-tracing teams.
In North Dakota, developers had built a contact-tracing app, Care19, that logged people’s smartphone location data as a memory tool: If the person tested positive, a public health worker could ask for their permission to review that data over the previous two weeks to piece together where they had gone. They had been hopeful that the Apple-Google system would further refine its accuracy.
But Apple’s restrictions against sharing data with health authorities have forced developers there to start from scratch. They are now building two separate apps — one for contact-tracing teams, the other on Apple and Google’s system — even though they fear that will lead to lower public adoption, greater confusion and longer delays for lifesaving data.
“Every minute that ticks by, maybe someone else is getting infected, so we want to be able to use everything we can,” said Vern Dosch, the contact-tracing liaison for North Dakota. “I get it. They have a brand to protect. I just wish they would have led with their jaw.”
The coronavirus represents a massive challenge for contact tracing around the world, and some experts have said public health teams need all the help they can get. Researchers at Johns Hopkins Center for Health Security have estimated that the U.S. will need to recruit and train 100,000 contact tracers to help identify the sick and quarantine the exposed.
Contact tracers today use phone calls and interviews to track people’s movements, and rely almost entirely on people’s memory. Minute-by-minute location logs recorded by people’s phones, some officials have argued, could ease that burden by providing a more precise and automated way to track new outbreaks.
“We’re sort of at the point where we just can’t do traditional contact tracing. There’s just not the manpower,” said Tyler Shelby, a graduate student at Yale’s medical and public health schools who is working on contact-tracing software.
But state teams that have tried to use apps to help with contact tracing have been stymied by the tech giants’ rules. Developers in Alberta, Canada, had built their own contact-tracing app that struggled with reliability on iPhones due to Apple’s Bluetooth restrictions. Quinn Mah, executive director of information management at Alberta Health, said he pleaded with Apple for help, but the company refused. Alberta health officials now are debating whether to give up on those plans and go with Apple’s contact-tracing system, even though it could greatly reduce their ability to track infections.
“A segment of our population has said, ‘Well, Google and Apple have done this, so why aren’t you guys adopting this?’” Mah said. “'Why would government think they could do something better than Apple and Google?’”
The companies have argued that limiting the data the apps use could bolster their adoption rate, because people may not trust or use an app that logs their location for later use by public health authorities. A Washington Post-University of Maryland poll found last month that a larger group of Americans said they trusted public health agencies more than Apple and Google to keep their information secure.
Some privacy advocates have applauded the companies’ stance around anonymity and security concerns. Amos Toh, an artificial intelligence and technology researcher at Human Rights Watch, said he worries that authoritarian governments might compel the companies to change the terms so that data can be scooped up and used to suppress human rights.
“It opens up a dangerous new front,” Toh said. “These technologies are unproven and we have questions about their accuracy and repercussions for the most vulnerable groups.”
But some parts of the U.S., including Apple and Google’s home state, say the restrictions have rendered the apps effectively useless. In California, epidemiologists in charge of contact tracing are ignoring the Apple-Google approach and have decided the best course for contact tracing is to train thousands of people to do the work.
“The limitations of those kind of apps are extensive,” said Mike Reid, an assistant professor of medicine at the University of California at San Francisco, who is leading the effort to train contact tracers in the state. “I don’t think they have an important role to play for most of the population.”
The contact tracers, he said, will be using software made by Salesforce and Accenture to help reach patients by phone and are trained on how to protect sensitive patient information.
“We go to pains to minimize the amount of data we take from people and we ask consent from people we’re talking to on the phone. We go to considerable lengths to ensure there are strong technical controls to ensure the anonymization of our platforms,” he said. “Can you say the same thing about these big tech companies? I’m not sure.”
Some security researchers have also questioned whether the companies’ restrictions on public health officials and technical methods have posed their own challenges.
With the Apple and Google approach, “We’ve overcompensated for privacy and still created other risks and not solved the problem,” said Ashkan Soltani, the former chief technologist of the Federal Trade Commission. “I’d personally be more comfortable if it were a health agency that I trusted and there were legal protections in place over the use of the data and I knew it was operated by a dedicated security team.”
Countries such as Germany, Italy and the Netherlands have said they will use the Apple-Google system, though other nations, including Norway and the U.K., are building and testing more centralized apps they hope will work around the companies’ restrictions. France’s digital minister, Cédric O, said in a TV interview last week that it was deeply regrettable how Apple had failed to help the country’s efforts during the crisis, and that officials would remember the slight.
But some public health experts believe the push toward unproven virus-tracing apps has wasted time and missed the point. Tom Frieden, the former director of the Centers for Disease Control and Prevention now working with the health organization Vital Strategies, said the proximity-tracing system as proposed by Apple and Google has “been largely a distraction.”
“There are very serious questions about its feasibility and its ability to be done with adequate respect for privacy, and it has muddied the water for what actually needs to happen,” Frieden said in an interview Wednesday. “This was an approach that was done with not much understanding and a lot of overpromising.”
His group is now working with New York state officials to build three smartphone apps tackling more basic problems: assisting quarantined people with remote health-care visits and food deliveries, and helping contact tracers do their jobs. He said developers grappling with the Apple-Google system would have a greater impact focusing on simpler struggles for local health departments as opposed to pursuing “magical thinking.”
The proximity-tracing systems are “a bright shiny object,” he said, “but right now they’re doing nothing to stop the pandemic.”