How Digital Contact Tracing Slowed Covid-19 in East Asia

How Digital Contact Tracing Slowed Covid-19 in East Asia

by Yasheng Huang , Meicen Sun and Yuze Sui - April 15, 2020

As Covid-19 steamrolls across international boundaries, public health officials are paying close attention to countries that are flattening the curve, slowing the spread of infection. Can other countries emulate their success? Top of mind has been whether authoritarian regimes have an edge over democracies, because they can mandate top-down measures like lockdowns and digital tracking of infected people’s movements and contacts. Indeed, China’s foreign minister Wang Yi proclaimed “Only in China and only under the leadership of President Xi can there be such effective measures to put this sudden and fast-spreading epidemic under control.”

But the latest information from Our World in Data, which shows the doubling rate of cases by country, indicates that the type of regime is less important than it might seem. Both the top and bottom performers in Covid-19 containment span the spectrum from autocratic to democratic. It’s true that China is effectively flattening the curve, but so is South Korea, a vibrant democracy. Other democracies - the U.S., Spain, Italy, and France, are faring less well.

What, then, do the countries that have so far been effectively flattening the curve have in common? Part of the answer is that they tend to be in East Asia - China, South Korea, Taiwan, Singapore and to a lesser extent Japan - where a collectivist spirit may encourage civic-minded embrace of and a more willing compliance with governments’ infection control. In addition, these countries tend to be actively deploying technology to collect data on the virus’s progress and efforts to contain it, including tracking those who are infected and their contacts. These two aspects of East Asian societies do not work independently; they reinforce each other.

Clearly, applying technology in these ways can be an important tool in containing the pandemic. But this use of technology raises sobering policy questions about data sovereignty and privacy, issues that are more contentious in Western democracies than in the more collectivist societies of East Asia. The most effective deployment of technology for tracking individuals’ infection status, movements, and contacts hinges on three critical conditions that might each present difficult dilemmas for Western democracies: The adoption of the needed technologies (whether they are just strongly encouraged or made mandatory); a digital infrastructure enabled and activated by the government; and seamless data sharing between government and business that may afford few privacy protections.

Let’s look at each in detail.

Technology adoption

Drawing on the experience of countries that are effectively using technology for contact tracing, the first step - and a requirement - is to encourage, or, better yet, mandate, the installation of tracking apps on phones. In East Asian countries, this has been more mandatory than voluntary. In Singapore, a country known for its efficiency and no-nonsense government, citizens are encouraged by the government to install TraceTogether, which exchanges Bluetooth signals between mobile phones in close proximity. This is a modern counterpart to the traditional and time-consuming contact-tracing method, which relies on fallible human memory. A government poll reported in Nikkei Asian Review found that more than 70% of respondents supported this move. Hong Kong, which has also seen effective containment, recently implemented a mandatory 14-day quarantine upon entry for all overseas arrivals. To enforce this, the Hong Kong government required each new arrival to download the StayHomeSafe app and gave them a paired wristband that uses geofencing technology to help catch violators, and, as reported in Quartz, warned anyone violating the quarantine that they could face up to six months in prison and a $3,200 fine.

The more striking case of curve-flattening is South Korea, where The Washington Post reports that private developers took it upon themselves to develop apps that supplement official government contact tracing efforts, which many find insufficient. Corona 100m, which, according to MarketWatch, South Koreans downloaded over one million times in just a few weeks with “overwhelmingly positive reviews,” collects data from public government sources that alert users of any diagnosed Covid-19 patient within a 100-meter radius along with the patient’s diagnosis date, nationality, age, gender, and prior locations. Corona Map similarly plots locations of diagnosed patients to help those who want to avoid these areas and, as Business Insider reports, was the second-most-downloaded app in Korea. A vibrant democracy that has also won praise for its Covid-19 containment, Taiwan is believed to be the first to have used mobile phone tracking to enforce quarantines, which the government reportedly reinforces by calling those in quarantine twice a day to ensure they do not evade tracking by leaving their phones at home.

While mobile tracking of infectious disease has been available for at least a decade - Cambridge University’s voluntary FluPhone app developed in 2011 is an early example - the adoption rate varies dramatically across regions. Wired reports that fewer than 1% of the people in Cambridge signed up for FluPhone, for example, compared to the widespread adoption of mobile contact tracing we’re now seeing in East Asian countries. Concerns in Western democracies about privacy and civil liberty could create substantial impediments to rolling out such technologies in these countries and may have contributed to FluPhone’s low penetration. Even within democracies, there are clear cross-national differences in the degree of voluntary adoption of contact-tracing technologies. But without widespread adoption, such contact tracing efforts will fail.

Digital infrastructure

South Korea’s aggressive response to Covid-19 appears to have been enabled by its recent experience in handling epidemics. In 2015, the MERS outbreak there infected 186 and killed 36. Some consider the country’s aggressive data-sharing on Covid-19 to be a correction for the government’s reportedly opaque approach that marred its MERS response. A survey of 1,000 South Koreans found that most supported the government’s transparency in sharing travel details of Covid-19 patients and that most “preferred the public good to individual rights.”

Similarly, Taiwan was among the hardest hit during the 2003 SARS outbreak. It subsequently established a disaster-management system that enabled its rapid response to Covid-19, both technologically and institutionally: In one day, relevant institutions integrated infected patients’ past 14-day travel history with their identification data, which then facilitated ongoing mobile tracking. Later, Taiwan launched the Entry Quarantine System that sought to expedite entry by providing passengers with a health declaration pass via SMS, with all hospitals, clinics, and pharmacies gaining access to patients’ travel histories shortly after.

In an epidemic, timing is everything. South Korea’s and Taiwan’s experience indicate that the extra time gained from having a system of disaster-response infrastructure in place ready to be deployed proved critical in shaping the pandemic’s trajectory. The same lesson can be gleaned from China’s Covid-19 management, although China didn’t leverage an existing epidemic-response capability but rather repurposed its vast existing system of digital surveillance for Covid-19 tracking, The Economist reports. This approach has afforded the Chinese authorities a “more tailored approach” by “allowing most people to resume their normal lives while monitoring those who might be infected.”

As research by two of us (Yasheng and Meicen) with MIT’s Work of the Future Task Force has shown, China’s repurposing of existing digital technology in addressing Covid-19 is not limited to contact tracing. The Chinese high-tech firms, SenseTime and Megvii, for example, both known for their facial recognition technology, have developed and deployed AI-based contactless temperature detection software. SenseTime has also developed and deployed a “Smart AI Epidemic Prevention Solution” which, by integrating AI algorithms with infrared thermal technology, detects a fever within 0.3 C accuracy and identifies individuals not wearing a face mask with over a 99% success rate. China’s maturation in this arena of contactless detections, including facial recognition, has been actively supported by, and demanded from, the government.

Business-government collaboration

In China, impediments to information sharing among authorities, particularly on the local level, appear to have severely limited its effective response to Covid-19 especially in the earlier stage of the outbreak. The actors that hold the key to a data-driven pandemic response, the central government has long recognized, are giant tech firms such as Alibaba and Tencent. By harvesting colossal amounts of user data in real-time, these firms may know more about population movement than the government itself.

Efforts to control Covid-19 shine a spotlight on the advantage enjoyed by so-called “super apps” like WeChat.  It is not just the amount of data amassed by WeChat that makes it “super” - a little over a billion active users and more than double the average time spent on the app than on Instagram as of December 2019. Rather, it is the integration of social media, instant messaging, payment, food delivery, ride hailing, health care and thousands of other apps into its own platform that has made it a target of envy for the likes of Facebook.

This public dependency on one app can be weaponized to coerce the public into compliance when a pandemic requires it. The Chinese public’s heavy reliance on the mobile payment app Alipay was effectively leveraged by the Alipay Health Code that was recently rolled out by Alibaba’s sister company Ant Financial and that has since been adopted nationwide. The Health Code dictates users’ freedom to travel, The New York Times reports, by assigning them into one of three categories based on their Covid-19 risk factors calculated using self-reported and collected data: green for unrestricted travel, yellow for a seven-day quarantine, and red for a two-week quarantine. There are two broad concerns here: One is the issue of algorithmic black-box in generating the codes. Users have no idea why the app is quarantining them, as some have complained on Chinese media. The other one, perhaps more pernicious from a privacy perspective, is how it apparently uses troves of user data such as travel history gathered through integration with other apps like Alipay.

This technocratic approach in East Asia satisfies three requirements in an exponential-growth phase of a public health emergency: Scale, speed and a degree of compulsion. Can Western democracies achieve the results seen in East Asia without emulating their means? Probably not. There is likely a fundamental conflict between these requirements and deeply entrenched Western liberal values, such as the expectation of privacy, consent, and the sanctity of individual rights. Israel, the BBC reports, has invoked emergency powers to enforce its quarantine order and in effect has suspended some individual rights.

At the time of publication, at least three local governments in the United States are considering adoption of a contact-tracing app developed in a project led by MIT, Reuters reports. The app, called PrivateKit, combines encryption, open-source and Bluetooth technologies that preserve user anonymity and limit the scope of data being gathered. The download is voluntary and it is too early to tell how quickly and at what scale these technologies might be adopted to combat Covid-19. Another MIT-led team has developed a protocol called Private Automatic Contact Tracing (or PACT) which also uses Bluetooth communications to permit contact tracing while ensuring that no private information is revealed. And Google and Apple have teamed up to put software into billions of phones worldwide that would permit them to perform contact tracing on an opt-in basis, The New York Times reports. But for such technologies to be effective, compliance must be nearly universal. Without a government mandate in the U.S, it’s hard to imagine universal voluntary adoption of even a privacy-protecting tracing app.

Maybe Covid-19 is a sign of our future steady state. Different societies will make different choices about how to respond to the next pandemic. For Western democracies the time has come to either rethink our values around the tradeoff between personal privacy and public safety in a pandemic or to accelerate technology innovation and policy development that can preserve both.

Yasheng Huang is the Epoch Foundation Professor in Chinese economy and business and a professor of global economics and management at the MIT Sloan School of Management and a member of the MIT Taskforce on Work of the Future.

Meicen Sun is a PhD candidate in the Department of Political Science at MIT and a student affiliate with the MIT Taskforce on Work of the Future. Sun is a World Economic Forum Global Shaper at the Boston Hub.

Yuze Sui is a master’s degree student in East Asian Studies at Stanford University.