The pandemic technology left out the public health experts. Here’s why that should change.

Susan Landau, Tufts University professor of cybersecurity and informatics, is the author of People matters, a book on how and why contact tracing apps were created. She also posted a essay in Sciences last week arguing that new technology to support public health needs to be thoroughly examined for ways it could increase the injustice and inequalities that are already ingrained in society.

“The pandemic will not be the last that humans face,” Landau writes, calling on societies to “use and build tools and support health care policy” that will protect the rights, health and safety of people and enable a greater equity in health care.

This interview has been condensed and edited for clarity.

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

The technologists who worked on the applications were very careful to make sure they spoke with epidemiologists. What they probably didn’t think enough about was: these apps will change who is notified about potentially being exposed to covid. They will change the delivery of [public health] services. That’s the conversation that didn’t happen.

For example, if I received an exposure notification last year, I would call my doctor, who would say, “I want you to get tested for covid.” Maybe I would isolate myself in my bedroom and my husband would bring me food. Maybe I wouldn’t go to the supermarket. But other than that, it wouldn’t change much for me. I don’t drive a bus. I am not a food service worker. For those people, receiving an exposure notification is really different. You need to have social services to help support them, which is something public health knows about.

Susan landau
Susan landau


In Switzerland, if you receive an exposure notification and if the state says “Yes, you must quarantine yourself,” they will ask you, “What is your job? Can you work from home?” And if you say no, the state will come with you. some financial support to stay home. That’s putting social infrastructure in place to support exposure notification. Most places did not, the United States, for example.

Epidemiologists study how the disease spreads. Public health [experts] look at how we take care of people, and they have a different role.

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

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

There is also the question of how effective this is. That ties into the issue of equity. I live in a somewhat rural area and the closest house to me is several hundred meters away. I will not receive a Bluetooth signal from someone else’s phone that results in an exposure notification. If my bedroom is right next to the bedroom in the next apartment, I could get a lot of exposure notifications if the person next door is sick; the signal can pass through wooden walls.

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

Where you’ve been is really revealing because it shows things like who you’ve slept with or if you stop at the bar after work. It shows if you go to church on Thursdays at seven but never go to church at another time, and it turns out that Alcoholics Anonymous meets in church then. For human rights workers and journalists, it is obvious that tracking down who they have been with is very dangerous, because it exposes their sources. But even for the rest of us, who you hang out with, the proximity of people, it’s a very private thing.

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

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

Singapore said: “We will not use your data for other things.” Then they changed it and are using it for police purposes. And the app, which started as a volunteer, is now needed to enter office buildings, schools, etc. There is no choice but for the government to know who he is spending time with.

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

I work in cybersecurity, and in that field it took us a long time to understand that there is a user at the other end, and the user is not an engineer sitting at Sun Microsystems or Google in the security group. Is your uncle. It’s your little sister. And you want to have people who understand how people use things. But it’s not something that engineers are trained to do, it’s something that public health people or social scientists do, and those people should be an integral part of the solution.

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