Testing New Contact Tracing Approaches in a Pandemic

BRIAN KENNY: Here’s a shared experience in the age of the internet of things. You’re sitting in your kitchen, having a conversation with your partner about what model car you’re thinking of buying. You jump on the internet to do some research and before you can type in the model and make, a banner ad pops up featuring exactly what you were discussing. Coincidence? Maybe or is your smart speaker eavesdropping on your conversations and feeding that information back to some big data warehouse in the cloud where it’s being accessed by nefarious marketers.

If you’re paranoid about safeguarding your personal information, you’re not alone. In fact, Pew Research reports that roughly six and 10 US adults say they do not think it’s possible to go through daily life without having data collected about them by companies or the government. And 73% feel that most of what they do online or on their cell phones is being tracked. But what if your life depended on it? In the age of COVID-19, it just might. Today on Cold Call, we’ll discuss the case entitled, “TraceTogether,” with case author Mitch Weiss. I’m Brian Kenny, your host, and you’re listening to Cold Call brought to you by Harvard Business School

Professor Mitch Weiss is an expert on public entrepreneurship who studies digital transformation and innovation ecosystems. He also has a book coming out, Mitch, is that still on line to come out soon?

MITCH WEISS: It’s available for pre-order now, Brian, and will be out January 19th. It’s called, We the Possibility. And it’s a book about possibility government. And I think it’s especially timely in these moments.

BRIAN KENNY: That’s great. So keep an eye out for that. Thanks for joining me again on the show, Mitch. You’ve been on a few times and we love having you on. This COVID-19 pandemic is still around us and questions about how we can mitigate the spread of the virus, still loom large. People don’t have all the answers, but today maybe we’ll get some from this case. So I think people will really enjoy hearing about it. Let me ask you to start by sharing with us, how would you start this case discussion in the classroom? What would your cold call be?

MITCH WEISS: Well, some cases as you know, start out with the sort of final question. In this instance it’s, do you want something like Singapore has invented a Bluetooth tracing app for tracing COVID contacts in your own country, but that’s not actually where I would start. Where I would start this case because we’re living in such a live moment of COVID is where the case begins actually, which is with human contact tracing with public health workers and others who do the hard work of tracking down people and their potential interactions in order to try to cut the chains of transmission for COVID. And so the first question is simple, Brian, I think, which is in your jurisdiction, the city or the region in which you live, is there a human led contact tracing effort going on right now? And what unfolds from there is a conversation about well, yes, I think, and in fact, most jurisdictions at this moment would have human led contact tracing. It’s a 500 year old practice, which has been put into place writ large during COVID. And then you can ask, well, how’s that working? And then the conversation begins to unfold from there because the fact of the matter is if you don’t have human led contact tracing in your jurisdiction, you absolutely should at this moment. It will be essential ultimately for cutting chains of transmission and allowing people to return to some semblance of normalcy. But maybe there’s also this other thing you should have too, which is digitally supported contact tracing, which was the effort that TraceTogether became in Singapore.

BRIAN KENNY: And that opens up a whole bunch of issues that we’re going to talk about more, but let me ask you, how did you hear about this, I guess, why did you decide to write the case and how does it relate back to the kinds of things that you’re interested in as a scholar?

MITCH WEISS: Well, originally what happened was I had organized a sort of impromptu conversation back in March, amongst a bunch of chief data officers and digital officers, analytics officers of some cities and states mostly here in the US. It was a wide ranging conversation, but most on the topic of tracing and tracking around COVID in those early days. What became apparent to me on a conversation was that most data digital type leaders in the US hadn’t yet begun to think about anything close to digitally supported contact tracing in the US. I came away from that call believing that was for two reasons, one, they were rightly focused that moment on even more pressing concerns, like how many hospital rooms do they have and what did the data say about that? The other reason was that I think there was aversion to some of these approaches that were just being unfolded in other countries, including the TraceTogether example in Singapore. But I thought that there was a kind of looking away because this was happening in Asia. And I thought that there were lessons we could learn one way or the other. Certainly we should know about what they were doing and then make our own informed choices about whether we wanted anything like this or not. The other reason is as you and I have talked about in the past, I study examples of extreme invention inside government or bi-partisan companies for our government. In some ways I studied things government tries that probably won’t work. And a lot of people would put contact tracing in that bucket, including at the beginning. Jason Bay, the protagonist of this case, I think had a realistic sense that this might not work. So I was fascinated by yet another episode of trying something new that might only possibly work against the backdrop of a pandemic. In a crisis is that the moment to try new things? Things were being suggested to governments all over the world, new approaches to try. Like any public leader’s inbox was flooded with new ideas. And the question was, how do you sort out the ones that should be tried and the ones that are complete foolishness?

BRIAN KENNY: And for our listeners who don’t know, Mitch, your background is particularly well suited to this because you were the chief of staff for Boston’s mayor Tom Menino for several years. So you’ve had frontline experience of what it’s like to try and implement a new policy or a new initiative across a major metropolitan city. Does something that works in Singapore, work there because of the way Singapore has governed and how they’re set up. And is that make it difficult to implement that in other places, particularly as we look at the US for listeners who haven’t been to Singapore, can you just describe a little bit about how they govern themselves?

MITCH WEISS: Well, Singapore, as you said, it’s a city state and it’s a relatively young one and it’s got about 5.6 million people. The thing that struck me was how competent everybody was that we spoke to that worked in their government. And I say that carefully for a number of reasons. One, they obviously have a different form of government than say for example, here in the United States. And also I’m not one who buys into this myth that people in government are inherently incompetent. So that one should be surprised when you meet somebody who knows what they’re doing, I don’t believe that at all. But at Singapore puts an especially high investment in the quality and capability and resources of their government. If you think about, can you try something like TraceTogether where you are, I think you want to first understand that the people that built this are the best at what they do. They have people who think hard about privacy and privacy law. And again, I think that there’s a lot more of that in government than we ever give credence to, but this was a special case as well.

BRIAN KENNY: And they were pretty quick to recognize the threat of COVID-19 because the case starts back in, I think it’s January, they had experienced other pandemics in the past that probably put them in a more vulnerable and highly alert position. Is that safe to say?

MITCH WEISS: Yeah, that’s precisely correct. Obviously, they were much more proximate to say Wuhan or any parts of China than say we would be here in the United States. And then as you say, because of the prior pandemics that threatened the region, some had come not as bad as they had worried about in Singapore, but it had made them ready. On January 23rd, when the government confirmed the first case of COVID-19 in Singapore, they were already with a very comprehensive program to try to address it. That included among other things, a human contact tracing led effort out of their ministry of health immediately found a person who had traveled from China to Singapore. They had identified that this person had what we now know as COVID-19. And they had already traced his contacts and begun the same exercise with him that they were doing with thousands of others over the course of the next many months.

BRIAN KENNY: So their approach was that the manual contact tracing approach, which I think most people understand is, you’ve got somebody who tests positive. You try to ask them who they’ve engaged with, and then you try to track those people down and so on and so forth. Why not just stick with that? Were there gaps in that that they recognized early on that made them think about pursuing this other path?

MITCH WEISS: Jason Bay had some gaps in mind and was the one to suggest this to some of his colleagues at the Ministry of Health. He had in mind I think some of the potential weaknesses of manual tracing and especially in the context of COVID. So again, I want to be clear, I think Jason thought that manual tracing was absolutely essential. Like one of the first things that folks in Singapore would tell you was, if you’re thinking about doing digital only you’re making a mistake. Well, Singapore’s foundational effort was manual led tracing, and that was a key foundation. The way manual tracing works is we call you up, Brian and I say, where were you yesterday? And maybe you remember your visit to Starbucks or maybe you don’t, who were you in line with? Well, you don’t know who was behind you. One weakness is recall and recollection of who you were near and for how long and under what conditions. Other weaknesses include speed. As we know now, if we don’t quickly learn who potentially was infected and who else they might’ve potentially infected and cut those chains on transmission, then the community spread occurs and occurs widely. And so speed here is an issue in manual tracing can be laborious. It is laborious. There are other contexts where digitally supported tracing might be useful. You can imagine in countries where you can’t reach everybody by phone. And for example, this was the case during the Ebola crisis where health workers had to go in person and go visit people that adds another layer of danger to the manual led efforts. And so for reasons of speed, and then also of scale. The manual tracing is laborious and so it’s slow, but that also means that it’s hard to reach as many people as you would need if you’re in an environment where the disease is spreading quite swiftly. And so that’s why the day after Singapore had confirmed their first case, he also reached out to a colleague at the ministry of health in Singapore and said, “Hey, I have a question for you. What would you think about a digitally oriented effort?”

BRIAN KENNY: I love that you have the original email in the case. That’s so cool to sort of see that document and the exchange that they had. I also thought it was really interesting once they decided they were going to try to pursue a digital approach here where that idea originated from. Can you just describe that quickly? Who came up with the idea for the app that they ultimately pursued?

MITCH WEISS: Well, like all ideas, there’s probably many mothers and fathers, but I can tell you where Jason himself would trace back him hearing about the idea. So there were some computer scientists, including Katayoun Farrahi, who had written about this potential back in 2014. But I think one of the things that was on Jason’s mind, which had so struck me is why part of the case is that there were two 16 year olds, high school students in Virginia in the United States who back in 2015 had sort of won third prize at the International Science and Engineering Fair-

BRIAN KENNY: Third prize.

MITCH WEISS: Third prize.

BRIAN KENNY: Yeah.

MITCH WEISS: Yes, third prize. Yes, I would’ve given first prize. No, but yes, third prize for basically an idea about using smartphones and their ability to sort of detect proximity as a tool for contact tracing. What happened was this high school sophomore at the time Rohan Suri had been looking at what’s going on in Ebola, sitting in his high school class in the United States, halfway across the world, seeing the kind of risks and danger and limits that human led efforts had and was thinking about, could I invent something that would be supportive in that effort and proposed it and a few other times along the way, it sort of gets put on the shelf and is sitting there. And also in Jason’s mind, he happened to have heard about it when MERS emerged in Singapore and then later when COVID did. One of the things that we talk about in the book and also in my class on public entrepreneurship is about how do governments come up with new ideas. And one of the notions is that they need to open themselves up to the outside for ideas and yes, even sometimes high school sophomores on the opposite side of the world. So it’s a fascinating example of we’re inclined to trust the experts and God knows right now there’s been too little adherence and credence given to some of the world’s great experts. I’m not suggesting in any way that we start to ignore science quite the opposite, but in the search for new ideas and novel solutions, I think it’s important also to open yourself up to potentially other people as well. It also then raises for us how fraught this is, because sometimes it might be that the high school sophomore has an idea that’s worth running with. And so how do we sort that out is one of the great riddles of possibility government and public entrepreneurship.

BRIAN KENNY: So, tell us how does the app work? Like what’s the idea here? How do you digitize this process?

MITCH WEISS: The idea is that basically, if you can harness the Bluetooth that we all have in our smartphones, you can use its signal strength as a proxy for proximity. So Brian if you and I are close together and our phones can detect each other’s Bluetooth signals, and they’re quite strong than the app will know we’re close together and if we move farther apart, then the app would know that we were farther apart. And in theory, we could track basically the Bluetooth signals along people’s phones, we could understand how long they had been together and how close. And those two factors turn out to be very important for assessing the risk of transmitting COVID or catching it. The TraceTogether app that they built in Singapore, the way it works is it tracks these contacts on your phone, not in the cloud, not on some government website, it keeps it on your phone and told the moment in which say you get diagnosed positive for COVID-19 and you’re invited to upload that data to the Ministry of Health in Singapore. And what they will do with that list of… at this point, by the way, it’s all anonymous on your phone, but you upload it to the Ministry of Health. They’re able to use that information to supplement the manual led efforts to try to reach out to and contact some of the people you might have been in touch with. If both you and those people were running the app on their phone. And this turned out to be crucial. The app only works if both people in the interaction had the app and had the app running and running functioning on their phone. And at that point, the government does have access to these anonymized IDs that allow them to reach out to people who might’ve been in touch with you.

BRIAN KENNY: So, it’s Bluetooth based, not GPS, I guess that alleviates the concern about somebody knows all my movements, they know exactly where I’m going, but it does require active participation by anybody who has the app beyond just loading the app on your phone. There’s stuff you have to do. So how did they roll it out? What was the process by which they let people know about it?

MITCH WEISS: There was a big communications push on their social media, on the government’s WhatsApp page, through private companies, through labor organizations, there was a big push to invite people to put this on their phone. And I think that was a matter of partnership and it was also a matter of messaging. One of the messages in Singapore was that we’re all safer together. The notion is to protect yourself and protect your family, but also protect your community. This is a collective enterprise, if we all do this, we’ll all be safer together.

BRIAN KENNY: I’ve had the good fortune to be in Singapore before, it’s a beautiful place. And its people know about its reputation for being clean and orderly and well run. So there’s a cultural thing there where people are kind of willing to follow rules it seems. They know that the stakes are high if they don’t. And I’m wondering if that facilitated adoption of something like this, where the government says, we’re safer together. So you should really do this. And people actually listen.

MITCH WEISS: I think it’s certainly true that there is a sense of collective action there. It didn’t mean that this thing got downloaded wholesale, where there was an early burst of downloads. But as the case ends, it’s not clear that they’ll get anywhere near the penetration rate they need to make it effective. It’d be a mistake, at least as the case ends to think that, Oh, there was some simple adherence to this government wish and everybody went to download the app. It’s just that wasn’t the situation as the cases ending several weeks after the app has been launched. In addition here in the United States right now of course, we’re wrestling with this mask debate and the question of individual responsibility and collective responsibility. And I think, again, the people in Singapore would be the first to tell you shouldn’t adopt TraceTogether out of the box, for example, that you need to have certain things in place in your country, including a human led effort as a foundation, including trust in institutions and trust in government. It’s not clear at the moment that we have enough trust in government in order to make this work. And that creates a real problem. We then end up looking to the private companies and look to Google and Apple and what they are doing on exposure notification to try to supplement it, but it may well not be enough. And so one of the many great tragedies of COVID, one may be that we had such broken government in such broken trust in government that we weren’t able to protect ourselves or protect our communities in ways that we perhaps could have, or should have.

BRIAN KENNY: Certainly the case raises the issue of how safe is your data, right? And we’ve seen lots of examples, unfortunately in the last few years of major data breaches, not at the hands of government, but with private organizations like Equifax and Target and companies like that that have been hacked and had data leaked. And Europe has gone as far as passing laws to prevent some of those or to mitigate the possibility of those things with GDPR. So it makes me wonder how willing are people to allow themselves to be followed in this way or to relinquish this kind of information to a third party?

MITCH WEISS: We’ve seen leaks by private companies and by government. So yes, the Equifax or recently the hack of Twitter, but also at the office of personnel management in the US government. So we see this problem all over in public and private, and that’s why there’s been a response on the public and private side in terms of regulation here in the US. Less so of course, GDPR in Europe and regulation in other places. In Singapore, they have a robust set of practices around private company gathering data and also the public administration gathering and using data. The principles that they try to adopt in building TraceTogether, or to absolutely minimize the amount of data they had to collect at all to make this work, to make it completely voluntary, to make sure that citizens were informed about what they were doing, to try to adhere to the principles of something that would be in like a GDPR or in similar laws and policies they had in Singapore. In this example, what they’re collecting are these anonymized IDs that the Ministry of Health could eventually use to reach out to somebody and say, you might have been in contact with somebody who tested positive for COVID, but they don’t have your location again because it’s not GPS. How do you address people’s willingness? Well, one thing you do is you try to build these products or any product in order to minimize the amount of data collection in terms of amount and in terms of time. The other thing I think you have to do have a real deliberative conversation about the tradeoffs. Jason, for example, would say, look, there’s a tradeoff here between privacy and utility. Adoption is basically increasing function of both. So we can make these things more private, but then they’ll be less useful. We can make them less private, but then there’ll be less adopted. You have to strike the right balance. And a number of scholars have written that look whenever governments or private companies for that matter use crises as an occasion to insert in these kinds of activities, in the US you think back to 911, they don’t roll those back. So if you give the government temporary permission, these scholars would argue, you’re giving them actually long-term permission and I think that’s a very serious argument. When some of these apps were being rolled out people said, Oh no, privacy, privacy, privacy. This is surveillance. And I think one uncomfortable answer is yes, it is. Human contact tracing is called literally epidemiological surveillance. It’s been in place for 500 years and it’s come with good and bad. What you see now are societies and community individuals wrestling with that question.

BRIAN KENNY: Are there other similar apps that are being developed? So Jason’s got… he’s moving forward with this one. I would assume there’s other efforts that are being mounted elsewhere.

MITCH WEISS: There are lots. Many different countries and regions raced ahead with various efforts. Some are Bluetooth based. Some are GPS based, some weren’t organized at the individual level at all. Some were organized around how do we track overall levels of mobility data, or other things like that. There are entrepreneurs out there right now trying to build companies around this technology. I mentioned, of course, Rohan Suri is one of those people building those companies. The most prominent alternative to something like this is what Google and Apple have put together, a set of protocols to assess with what they now call Exposure Notification, is essentially walking around with your Android based smartphone or your iPhone and other people were running the same way. Then you could be notified if you had come in contact with somebody who eventually test positive for COVID, but interestingly, Apple and Google’s is explicitly not linked with providing the government your data. So in order to be even more privacy preserving, Brian, what would happen was if I had COVID and you and I spent time together, we’re obviously not together personally now, but we had spent time together, and I tested positive later, I would upload that information. Essentially, your phone would get a notification that somebody, you wouldn’t know who, somebody you were in touch with had been diagnosed with COVID-19, you’d be notified. That’s why it’s called Exposure Notification. The government is out of the loop in that situation, the public health workers are out of the loop in that situation. One of the contentions that Bay and his team had in Singapore is that while they understand the privacy benefits of doing something that’s even more decentralized in their own approach, it comes with the detriment that there’s no human loop to exercise judgment about how intense that exposure might’ve been. Were you singing in choir when this happened or was it something more passive? There’s nobody initiating a conversation necessarily to ask you about your supports. If you quarantine, will you have access to food? Do you have income? So the most famous alternative right now is the Apple and Google approach.

BRIAN KENNY: Mitch, this has been a great conversation. I’ve got one last question for you. And it’s just in terms of summarizing things. What’s the one thing you want our listeners to remember when they turn off the podcast?

MITCH WEISS: I think the most important thing is that new ideas are very hard to distinguish upfront whether they’re worthy or not. There was a very famous organizational behavioral scholar, his name is Jim March and he used to say that basically, “It’s very hard to distinguish inspiration from lunacy.” I think that’s true. And I think it’s been, especially on this COVID has been a lot of inspiration. There’s been a lot of lunacy and it’s very hard to distinguish upfront. It’s easy to understand that swallowing Lysol is lunacy, but it’s much harder if you look at the wide range of ideas. And I think our instinct is to discount too often ideas that might seem a little bit out there. I guess one thing I’d invite people from a case like this is to think about whether, instead of discounting those things upfront, but could you put together a process, an organization, and a process that use testing and experimentation and paid real attention to data and evidence that allowed you to try out new things that seem like maybe they wouldn’t work, but only possibly might. March also had said, “Look, what we need to do is be inpatient with old ideas and patient with new ones.” And I think that turns out to be an important lesson of the COVID response writ large, which has the things we had in place to deal with this maybe weren’t as sufficient as we thought they should be. Maybe we should have been more patient with new ideas, give new approaches some breathing room and some chance so we could fight this thing more adeptly.

BRIAN KENNY: Spoken like a true entrepreneurship professor there, Mitch. Thanks again so much for joining us today. And just tell us one more time, what the name of your book is? So if people are interested, they can go find it.

MITCH WEISS: So the book is called, We the Possibility.

BRIAN KENNY: Awesome. Thanks Mitch.

MITCH WEISS: Take care.

BRIAN KENNY: If you enjoy Cold Call, you might like other podcasts on the HBR Presents Network. Whether you’re looking for advice on navigating your career, you want the latest thinking in business and management, or you just want to hear what’s on the minds of Harvard Business School professors, the HBR Presents Network has a podcast for you. Find them on Apple podcasts or wherever you listen. I’m your host, Brian Kenny, and you’ve been listening to Cold Call, an official podcast of Harvard Business School on the HBR Presents Network.