State of the Art in Adoption of Contact Tracing Apps and Recommendations Regarding Privacy Protection and Public Health: Systematic Review

Abstract

Background During the COVID-19 pandemic, contact tracing apps have received a lot of public attention. The ongoing debate highlights the challenges of the adoption of data-driven innovation. We reflect on how to ensure an appropriate level of protection of individual data and how to maximize public health benefits that can be derived from the collected data. Objective The aim of the study was to analyze available COVID-19 contact tracing apps and verify to what extent public health interests and data privacy standards can be fulfilled simultaneously in the process of the adoption of digital health technologies. Methods A systematic review of PubMed and MEDLINE databases, as well as grey literature, was performed to identify available contact tracing apps. Two checklists were developed to evaluate (1) the apps’ compliance with data privacy standards and (2) their fulfillment of public health interests. Based on both checklists, a scorecard with a selected set of minimum requirements was created with the goal of estimating whether the balance between the objective of data privacy and public health interests can be achieved in order to ensure the broad adoption of digital technologies. Results Overall, 21 contact tracing apps were reviewed. In total, 11 criteria were defined to assess the usefulness of each digital technology for public health interests. The most frequently installed features related to contact alerting and governmental accountability. The least frequently installed feature was the availability of a system of medical or organizational support. Only 1 app out of 21 (5%) provided a threshold for the population coverage needed for the digital solution to be effective. In total, 12 criteria were used to assess the compliance of contact tracing apps with data privacy regulations. Explicit user consent, voluntary use, and anonymization techniques were among the most frequently fulfilled criteria. The least often implemented criteria were provisions of information about personal data breaches and data gathered from children. The balance between standards of data protection and public health benefits was achieved best by the COVIDSafe app and worst by the Alipay Health Code app. Conclusions Contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data. Overall, this review shows that a consistent number of apps appear to comply with standards of data privacy, while their usefulness from a public health perspective can still be maximized.

Tracing app technology: an ethical review in the COVID-19 era and directions for post-COVID-19

“…Some privacy infringements of these apps, however, are justified given their potentially positive role in saving lives and reducing enormous suffering from adverse impacts of propagation of diseases (Parker et al, 2020 ; Sharma et al, 2020 ; Suh & Li, 2021 ). Kolasa et al ( 2021 ) verify that “contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data.” However, this is considered by Ishmaev et al ( 2021 ) as a “false dilemma” and a tradeoff between privacy concerns associated with tracing apps and their positive health impacts has been an essential topic in ethical considerations among researchers (Bruneau, 2020 ; Ekong et al, 2020a , 2020b ; Klar & Lanzerath, 2020 ; Leslie, 2020 ).…”

Appsolutely secure? Psychometric properties of the German version of an app information privacy concerns measure during COVID-19

“…Yet, it was also associated with anxiety (i.e., concerns about data use, processing, and storage) and factor 2 (data misuse) in this study, respectively. Possibly, the context of contact tracing apps might have introduced this association, because it connects health-related anxiety and privacy concerns (e.g., Gupta et al, 2021;Jenniskens et al, 2021;Kahnbach et al, 2021;Kolasa et al, 2021;Tomczyk et al, 2021;Grundy, 2022). The authors did not develop the AIPC as a health-specific measure of privacy concerns, thus factors like specific health concerns (e.g., Rosenstock, 1974;Rogers, 1975) were not included.…”

“…The apps inform users about contact with positive (infected) cases, suggest adequate preventive and mitigation measures, and allow governmental institutions to define containment or hotspot zones (Kahnbach et al, 2021). Previous studies examined barriers and facilitators of adopting tracing app use and showed that they are effective in reducing infection rates (e.g., Jenniskens et al, 2021;Kahnbach et al, 2021;Kolasa et al, 2021). However, tracing apps often do not provide sufficient information about personal data breaches, which might increase privacy concerns and subsequently, reduce use intentions (Jenniskens et al, 2021).…”

Applied Ethics and Digital Information Privacy: Informing the Design of Covid-19 Contact Tracing Apps

“…Overall, many privacy-related aspects-in particular, voluntariness, user consent, anonymity (in terms of pseudonymisation), purpose specification, provision of app providers' contact information, and specification of data retention parameters and the decommissioning process (Klar & Lanzerath, 2020;Morley et al, 2020)-have been systematically addressed by the apps analysed. However, not all have adopted corresponding design principles in equal measure, and other potential threats to user information privacy, such as special protection of data collected from children, updates to the apps' privacy policy changes, and privacy breach notices (e.g., Hatamian et al, 2021;Kolasa, Mazzi, Leszczuk-Czubkowska, Zrubka, & Péntek, 2021), are not explicitly evident from the apps' accompanying documentation. While we expect that such issues have been addressed since our study was completed, it is revealing how even proactive privacy-sensitive app design may deviate at least from some of the previously suggested ethical standards.…”