“Contact tracing is a 500-year-old solution.… It was then, and is now, a matter of using personal data to secure public health. That raises both its promise and its perils, and the leadership task is to navigate the balance.”

—PROFESSOR MITCHELL WEISS

“Contact tracing is a 500-year-old solution.…It was then, and is now, a matter of using personal data to secure public health. That raises both its promise and its perils, and the leadership task is to navigate the balance.”

—PROFESSOR MITCHELL WEISS

As COVID-19 was sweeping the globe in January 2020, public health officials in Singapore implemented a tried and tested tool to help contain infectious disease: human-led contact tracing, the process of tracking down and notifying individuals who have been exposed to the illness. Singapore’s Ministry of Health (MOH) used contact tracing as an adjunct to screening, free testing and treatment, and strict quarantine measures, drawing on the city-state’s previous experience with pandemics, including SARS, H1N1, MERS, and Zika. Then in March 2020, Singapore deployed the world’s first Bluetooth-based contact-tracing system, TraceTogether, a new digital tool to assist human contact tracers in the fight against COVID-19.

Government-led innovation such as this is a subject that fascinates Mitchell Weiss (MBA 2004), a professor of management practice and Richard L. Menschel Faculty Fellow at HBS. Upon hearing that Singapore’s Government Technology Agency (GovTech) was working with the MOH to devise a new way to do contact tracing, Weiss says, “I became very interested because I’ve been so focused on the question, ‘Can governments try new things?’”

Bluetooth vs. GPS Technology

When TraceTogether is downloaded and left running, the mobile application harnesses the signal strength of Bluetooth in Android and Apple smartphones to determine proximity between people, and thus assess their potential exposure to the coronavirus. A random ID attached to a user’s phone number generates temporary, encrypted IDs. When users’ phones are within 30 feet of one another, the app exchanges these IDs, timestamps the occurrence, and logs the length of the encounter. Because it employs Bluetooth rather than GPS, the app doesn’t track users’ location. This helped address some, though not all, privacy concerns. In the event an app user tests positive for the virus, the MOH sends a request to access encrypted data on the phone so contact tracers can notify those who have been near the person and provide them with health care guidance.

The development of the app—an example of government-supported technological innovation for public health—had all the necessary ingredients to pique the interest of Weiss, who, prior to HBS, helped shape Boston’s municipal innovation strategy while serving as chief of staff to former Boston Mayor Thomas Menino, a position he assumed after working in Menino’s office as an HBS Leadership Fellow.

“We have heard many times over that necessity is the mother of invention. What we’ve witnessed in these past months is so many health care workers and health care companies becoming instant entrepreneurs, and also public officials becoming public entrepreneurs—all of them inventing ways to keep people safe,” says Weiss of the pandemic-inspired innovation taking place across sectors, especially health care. “We also witnessed inventions that went awry.”

Weiss relates that in March, he had just completed the final draft of his new book, We the Possibility: Harnessing Public Entrepreneurship to Solve Our Most Urgent Problems, when he heard about TraceTogether. It subsequently became both the subject of his book’s final chapter and the focus of a case Weiss coauthored and taught this fall in his Public Entrepreneurship MBA elective course, which is designed for MBA students who are thinking about founding, joining, or funding private startup companies that work with governments to solve complex problems, or becoming innovators inside government itself. Weiss has also taught the case as part of the Technology and Public Purpose Project at the Harvard Kennedy School’s Belfer Center for Science and International Affairs, and in the HBS Young American Leaders Program, which he helped to develop.

A Supplement to Manual Tracing

See more from the online-only December Alumni Bulletin Impact section’s exploration of how the digital revolution has improved health care delivery and discovery.

Digital Transformation of Health Care

See more from the online-only December Alumni Bulletin Impact section’s exploration of how the digital revolution has improved health care discovery and delivery.

Digital Transformation of Health Care

The “TraceTogether” case highlights the efforts of protagonist Jason Bay who, with his GovTech team and partners across Singapore’s government, raced to create a technology that would supplement Singapore’s manual contact-tracing efforts. Over the course of eight weeks, the software developers went from “what if?” to a fully viable app that within a week of its March 20 launch, 910,000 Singaporeans—roughly 16 percent of the country’s residents—downloaded on their phones. Shortly after, the government announced plans to open source the app’s code, and more than 50 governments expressed interest in using TraceTogether in their countries. Since then, others, including Apple and Google, have entered the digital contact-tracing arena.

According to the World Health Organization, as of December 1, Singapore had 58,228 confirmed cases of COVID-19 and 29 deaths. “Singapore had a very comprehensive approach to dealing with the pandemic. To make this work, you need testing, tracing, and isolation. TraceTogether is actually only a small part of that, even though it’s become a meaningful contributor to the overall response, shortening the time between when you test positive for COVID and your contacts get notified,” Weiss says.

Raises Privacy Concerns

Contact tracing has been in existence for 500 years. It was first used in rudimentary ways to help curtail the bubonic plague and outbreaks of syphilis in 16th-century Europe. In recent years, it has been an effective component of the “test, track, and trace” strategy employed by public health officials, in person or by phone, to combat the spread of contagious diseases, including HIV, Ebola, and COVID-19. Weiss points out that contact tracing and exposure notification have raised privacy and discrimination concerns for as long as they have been used. These worries have come to the fore as digitally driven tracing tools have become more prominent.

Weiss explores privacy issues in the case and writes of alternatives to TraceTogether that don’t provide governments access to any individualized contact information. “What the TraceTogether team says in the case is, ‘Look, we understand the privacy benefits of government not being in the loop. We get why people don't want Big Brother. We’re just saying, there’s a cost to that,’” notes Weiss. The downside Bay points to is that if users don’t give the government access to their data, public health officials aren’t as able to help those who may be affected with the virus get the care and services they need, and also assess the extent of the virus’s spread in the population.

The issue of government’s role in health-related data collection is not a new dilemma nor is it a simple one to resolve, says Weiss. “Contact tracing is a 500-year-old solution. It used to be called epidemiological surveillance. It was then, and is now, a matter of using personal data to secure public health. That raises both its promise and its perils, and the leadership task is to navigate the balance.”

MORE STORIES ABOUT IMPACT:

The Digital
Transformation
of Health Care

Digital Health Care: Empowering Consumers

Finding the Right Patient-Provider Match

AI Enhances Diagnostic Care

Post a Comment