Will Singaporeans use a contact tracing token?
Singapore was a leader in deploying a contact tracing app to help manage the COVID-19 epidemic. So far, the takeup rate has been around 25%, a number which government officials have conceded is too low.
"25% is good, but it is not good enough, and we need to raise that number significantly," Minister-in-Charge of the Smart Nation Initiative Dr Vivian Balakrishnan said at a media conference on 5 June.
The difficulty has been twofold — getting people to download it, and getting people to use it. Not everyone has a smartphone, and complaints that the app is a battery drain have persisted. And some Singaporeans are concerned about potential privacy issues too.
Now, the Singapore government is introducing a wearable version. The TraceTogether Token operates the same way as the app, by logging close contacts using Bluetooth. But it doesn't require a smartphone, and can be worn on a lanyard.
So will Singaporeans be more willing to use a token if it means the app's tech problems are no longer an issue? And if so, can an app help to contain the pandemic?
Why contact tracing apps matter
Many who use the app perceive it as a layer of protection, allowing them to know if they have been in contact with someone who has had COVID-19 so that they can get tested. But at a public health level, TraceTogether is really all about speed.
Without the app, the government says it takes two to three days of laborious work for a contact tracer to reconstruct the activity map of a COVID-19 patient. And if the patient is particularly unwell, they might have a hard time fully communicating their past activities.
For example, if a contact came through a delivery worker or shop assistant, the app makes it easy for contact tracers to find the worker directly, instead of having to go through the company to track them down and figure out when they might have come into contact with a suspected case.
TraceTogether presents a shortcut, which has enabled contact tracers to issue stay at home notices (SHN) to potential COVID-19 contacts within a day.
And speed certainly matters. A study of Singapore cases found that 6.4% of cases were transmitted before a patient even showed any symptoms, although the extent of asymptomatic transmission is still the subject of some debate. And patients are most infectious just as they start to feel unwell.
But if 75% of people aren't using the app, then by definition it's missing many points of contact. A widely cited pre-publication paper from Oxford suggests that at least 60% of people need to use the app to effectively control the disease (although tracing apps can still have a positive impact with a lower uptake).
Can contact tracing apps deliver on their promise?
Currently, most experts think contact tracing technology alone is unlikely to be enough to solve the problem. Jason Bay, a Senior Director at Singapore's Government Technology Agency and the product lead for TraceTogether, made it clear the app is no substitute for traditional contact tracing.
"If you ask me whether any Bluetooth contact tracing system deployed or under development, anywhere in the world, is ready to replace manual contact tracing, I will say without qualification that the answer is, No," he wrote in a blog post.
He points out that tracing can't take into account many factors, such as ventilation in a room where a contact may have taken place, or whether someone was engaged in an activity that might help to spread the virus, like singing or shouting.
Limited evidence from overseas suggests that it's certainly not a panacea. Even in the country where uptake of contact tracing apps is highest — Iceland, at 38% — COVID contact tracers said it was not a "game changer".
In Australia, an app similar to Singapore's TraceTogether has yet to identify a single additional case even though more than 6.2 million Australians have downloaded the app. While that may sound disappointing, it's partly good news as it reflects low case numbers in the population.
Using Bluetooth has unearthed other technical problems. Research from Ireland using TraceTogether found that the bluetooth signal
can vary significantly depending on where the phone is, which means it might not be ideal for measuring distance between contacts. This is one reason the app
has been delayed in the UK.
"Despite the excitement, so far contact tracing apps have delivered much less than their enthusiasts hoped. From Australia to Singapore, it has been hard to get enough people to download them, while many apps have been dogged by technical issues," said James Crabtree, an Associate Professor in Practice at the Lee Kuan Yew School for Public Policy.
Why are only 25% of Singaporeans using the app?
Polls indicate that majority of Singaporeans see the value of a contact tracing app. A survey by the LKYSPP Institute of Policy Studies found that 59% of respondents agree that the app should be compulsory for anyone entering "public places, like shopping centres and wet markets", as long as the technical bugs were ironed out. The same survey found that 49% of respondents would be fine with the authorities using mobile data without user consent.
But if a strong majority of Singaporeans would be willing to make an app mandatory, why have so few taken it up?
One of the biggest complaints is the inconvenience of the app's functions. The app needs to be kept open in the foreground, and substantially drains battery life. This is particularly true for Apple phones, as the operating system suspends Bluetooth scanning if the app is running in the background.
For others, it might be an issue of privacy. Singapore-based polling group Blackbox Research found that 45% of respondents did not download TraceTogether, even though they were aware of the app, with the main consideration being they "did not want the government tracing their movements".
While TraceTogether has received fairly strong endorsements from privacy advocates, it hasn't convinced everyone. Nearly 40,000 people have signed this petition, which is demonstrably incorrect in many places. Neither the token nor the app "would allow contact tracers to locate a person's whereabouts based on their proximity to other persons' phones, cell towers, or potentially their wearable devices themselves," as the token does not have GPS or internet connectivity.
"It is not a tracking device. It is not an electronic tag, as some Internet commentaries have fretted about," said Dr Balakrishnan during the media conference.
It does, however, suggest that some people have strong feelings about the app. The profusion of apps globally has probably added to the confusion on how the app works, given that many overseas apps use GPS or a mix of Bluetooth and GPS. Israel and South Korea have been using high-tech methods of tracking people’s whereabouts using GPS. And Iran's first app was kicked out of the Google Play store for harvesting more data than was permitted.
A digitally inclusive society
Dr Balakrishnan said the adoption rate for the app and the token together should ideally be above 75%. For those who are worried about the functional effects on their smartphone, the token should make life a little easier. But the biggest difference might be for those who don't own a smartphone at all.
Even though Singapore is one of the most plugged-in countries on earth, there are still people who do not have a smartphone, such as the elderly and some youths. And a 2015 survey found that only 53% of migrant workers had a smartphone, and by one estimate about 20-25% of migrant workers were still on 2G phones shortly before the signal was switched off in 2016. The government plans to distribute the token to those without a smartphone first.
Nevertheless, the government has thus far been reluctant to make the tokens or the app mandatory, although the app is already compulsory for migrant workers living in "high risk" situations.
But they have yet to rule out mandating the tokens either. If conditions deteriorate in Singapore, it's possible the government could adopt a harder line. And some experts think that might not be such a bad thing.
"Mandating the use of this technology, if it can be done with widespread public acceptance, would undeniably make them more effective too," Crabtree said.
Whatever position the government eventually adopts, it's clear that apps and tokens are likely to form a central part of the government's response to the COVID-19 pandemic for the foreseeable future.
(Photo credit: zydeaosika)