Doubts rise in NZ about contact tracing apps
As countries around the world roll out apps to help trace the contacts of Covid-19 cases, New Zealand may be going its own way, Marc Daalder reports
The odds of a government-sanctioned contact tracing app taking a front-and-centre role in fighting Covid-19 appear to be dwindling.
After weeks of discussion, during which civil society and the tech sector have complained of lack of access to the government officials that will ultimately make the call on an app, New Zealand seems to be shying away from following in the footsteps of Singapore and Australia. Both countries deployed Bluetooth-based tracing apps as a central part of their Covid-19 response.
Prime Minister Jacinda Ardern has previously emphasised that she is sceptical about the efficacy of an app, noting that it would require high uptake and that the Bluetooth technology could create false positives.
"One thing that globally we're seeing acknowledgment of is that it is not a replacement for human and one-on-one contact tracing between someone who works in our public health units and someone who has Covid-19," she said on April 27.
"That is because it requires a large proportion of your population to be using the app and even if it has data between two people who have been in contact with one another, it picks up people at such a distance that you still want to verify. Some of the technology that's being talked about at the moment bypasses public health or health authorities. It means you could potentially have people who are being told they have to self-isolate who may not have been in quite close proximity and only human questioning will be able to determine that."
Ardern reiterated her scepticism during a press conference on Wednesday, emphasising that any digital solution would only supplement manual efforts and admitting that New Zealand could theoretically manage Covid-19 without the use of an app.
"Yes, you could [proceed without an app] because it is always an enhancement on top of what the World Health Organisation, from memory, characterises as 'public health boots on the ground'," she said.
"One of the issues in Singapore that they’ve freely identified was compatibility with iPhones. I note that they do have high Android use but that still would be a significant issue for the likes of New Zealand and Australia. My understanding is Australia overcame that. It was also a significant drain on battery life and it interfered with peoples’ Bluetooth headphones. Anything that acts as a barrier to making it as simple as possible to engage in a tool like that is a problem.
"That’s why you’ve heard me be sceptical, because I don’t wish for us to rely on that being the answer, because it never will be. It will be a helpful supplementary tool."
University of Otago contact tracing expert Ayesha Verrall, who audited the Government's contact tracing regime and found glaring errors in some of the processes, has also become more sceptical in recent weeks.
"I think my view on it has changed as well. I'm much more cautious about it than I initially was," she told Newsroom.
"I've had conversations with developers over the last month and none have shown compelling data on accuracy. That doesn't mean they're not working on it - they might be working on it - but a government contact tracing app would be a government public health intervention and should meet the standards expected of a government public health intervention in terms of accuracy."
"If an app generates a high number of false positive contacts, there is a point at which it would generate a lot of junk data for public health officials to sift through and secondly erode public trust. I think the accuracy issue is emerging as a greater concern than I originally understood."
Andrew Chen, a Research Fellow at the University of Auckland's Koi Tū - the Centre for Informed Futures, told Newsroom that not using an app would be a legitimate policy decision.
"I think if we don't use an app and then it gets proven that we didn't need an app, then that's fine. I think it's a legitimate policy decision to say, based on the number of cases we have in New Zealand, based on our projections, based on what our capacity is in the health sector, maybe manual contact tracing is sufficient," he said.
"I think what's important to note is that it's hard for anybody outside of government to really make that judgment call."
However, Chen also said he wasn't sure accuracy was as big an issue as others had made it out to be.
"My opinion is that if you're still using digital contact tracing as a driver for manual contact tracing, then you should not end up with any more false positives than you would otherwise have with manual contact tracing. The most common false positive argument - which is not that relevant in New Zealand given the way our housing structure works - is the idea that people who live very close to each other in apartment buildings might be false positives," he said.
"But actually, when the manual contact tracer calls and you tell them that John's your neighbour but you haven't been in contact with him for two weeks, then the manual contact tracer can tell you, clearly, you are not at risk. You avoid the false positive that way. Maybe there's a little bit more of a cost in chasing that down."
As it stands, New Zealand is set to release an early version of an app next week, Radio New Zealand reported. This will not be Bluetooth-enabled and will largely be a sign-up sheet for when a working app is debuted.
"We're still working on it, we want it to supplement what we're already doing. But the first phases of what you'll see in New Zealand will be the foundations rather than straight away the Bluetooth application," Ardern said last week. "Don't expect the first iteration to include things like Bluetooth applications because there are other pieces of information that we think would be useful to support our contact tracing in New Zealand."
Ardern also acknowledged on Wednesday that the Government is still examining all of its options, including a Bluetooth-enabled CovidCard that Newsroom first reported on in April.
"We’ve been considering a range of different supplementary options. And there’re a number of issues that you have to work through. Of course it all comes down to human behaviour. The thing that stops a person downloading an app might well be the same thing that stops a person carrying something with them. That’s not to say that we’re not giving really thorough consideration to all of the options. Final decisions on something like that though, you’d imagine, you’d have to take a lot into account," she said.
The app-talk during Wednesday's press conference also touched on another matter - the possibility of a non-Government-sanctioned option to address the needs of hospitality and retail outlets.
"One of the things that we of course already said to the hospitality industry, prior to lockdown, was you must ensure that you have ways of contact tracing everyone who comes into your premise. So whether or not you’re engaging technological tools to do that or doing it in a more traditional way, we do have an expectation that that will be occurring," Ardern said.
"I’ve been really impressed by the work that retailers and the Hospitality Association are doing because they can see, already, what needs to happen for people to be able to resume safely. One thing you also don’t hear people talking about too much, but I think is quite a useful device, is QR codes. That potentially removes the requirement to have people physically registering at the door when they’re coming into hospitality, for instance, bars, cafes, restaurants. QR codes are a simple, technological fix for that."
The question of uptake may have also been ameliorated in recent weeks. In order to trace even a quarter of contacts, 50 percent of the population needs to be correctly using the app.
In Singapore, just 20 percent of the population had downloaded the app after weeks of effort from the Government, meaning just 4 percent of contacts were being traced. Australia's app, however, has had more luck, with five million downloads in a country of 25 million after being on the market for just over a week. Technical issues have plagued Australia's COVIDSafe app, however, and the Government's goal of 40 percent uptake is only halfway reached.
In New Zealand, a poll conducted by Ipsos between April 24-27 found 62 percent of smartphone-owners would be likely to download a contact tracing app. Just over half of these said they would be "very likely". Similar polling in Australia found 45 percent of the population was likely to download an app - about double the current uptake.
Verrall said these numbers were promising but said she was still cautious. "That's a positive indication but we won't know what predicts the actual uptake until we have the app," she said. "The conversation around the app at the time it's introduced will influence that here. It's a positive indication - a high level [of uptake] like that would be required."
The survey also found significant gaps in willingness to download an app based on age and income. Low-income people were five times more likely not to own a smartphone. Just 29 percent of smartphone-owners in low-income households were "very likely" to download a contact tracing app, compared to 45 percent in high-income households.
Retirees were twice as likely to say they would not download a contact tracing app as the general population.
Verrall reiterated that despite the hopeful uptake indicators, apps were still unproven. Australia, for example, has too few daily cases to effectively test an app.
"One of the things is Australia is now in a low case number environment as well, so it's not the ideal laboratory for this," Verrall noted.
"That's why, in my report, I focused on the need for manual contact tracing, because we know that does work and the benefits of the app look speculative."
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