Hearing from teams at the sharp end of governments' coronavirus response

Last week, alongside David Eaves, I co-hosted a gathering of 60 people leading governments’ digital responses to coronavirus. It was humbling to hear about the intensity of the work, but also good to sense their justified pride in what they’ve delivered. David and his team at Harvard have kindly written up the event below. We’ll be running another soon, so please sign-up if interested. – Tom

Rapid solutions are key in this crisis. But it can’t come at the expense of privacy

By David Eaves is a Lecturer at Harvard Kennedy School and Tom Loosemore is a Partner at Public Digital with Tommaso Cariati is a student at Harvard Kennedy School and Stanford Graduate School of Business and Blank Soulava is a student at Harvard Kennedy School

Government digital services have proven critical to the pandemic response so far. Virtually every key government response in this crisis relies on digital elements. The operational pace of launching new services has been intense.

This has included anything from standing up new services to provide emergency funds, helping people stay healthy by making critical information accessible online, reducing the strain on hospitals with web and mobile based self-assessment tools or laying the groundwork for a gradual reopening of society by developing contact tracing solutions.

To share best practices and discuss emerging challenges Public Digital and the Harvard Kennedy School co-hosted a gathering of over 60 individuals from digital teams from over 20 national and regional governments around the world. On the agenda were two mini-case studies: an example of collaboration and code-sharing across Canadian governments and the privacy and interoperability challenges involved in launching contract tracing apps.

We were cautious about convening teams involved in critical work, as we’re aware of how fast these teams are running. However, there was so much positive feedback and engaging learnings that we plan additional meetings for the coming weeks as this crisis evolves. They will lead up to the annual Harvard / Public Digital convening of global digital services taking place virtually in June this year. (If you are part of a national or regional government digital service team and interested in learning more please contact us).

Case 1: sharing code for rapid response

In early March as the COVID crisis gained steam across Canada, the province of Alberta’s non-emergency healthcare information service became overwhelmed with phone calls. Some calls came from individuals with COVID-19 like symptoms or people who had been exposed to someone who had tested positive. But many calls also came from individuals who wanted to know whether it was prudent to go outside, who were anxious, or had symptoms unrelated to COVID-19 but were unaware of which symptoms to look out for. As the call center became overwhelmed it impeded their ability to help those most at risk.

Enter, the Innovation and Digital Solutions from Alberta Health Services, led by Kass Rafih and Ammneh Azeim. In two days, they interviewed medical professionals, built a prototype self-assessment tool and conducted user-testing. On the third day, exhausted but cautiously confident, they launched the province of Alberta’s COVID-19 Self Assessment tool. With a ministerial announcement and a lucky dose of Twitter virality, they had 300k hits in the first 24h, rising to more than 3 million today. This is in a province with a total population of 4.3 million residents.

But the transformative story begins five days later, when the Ontario Digital Service called and asked if the team from Alberta would share their code. In a move filled with Canadian reasonableness, Alberta was happy to oblige, also uploading the code to GitHub.

Armed with Alberta’s code, the Ontario team also moved quickly, launching a localized version of the self-assessment tool in three days on Ontario.ca. Anticipating high demand, a few days later they stood up and migrated it to a new domain — covid-19.ontario.ca — which has since evolved into a comprehensive information source for citizens, hosting information such as advice on social distancing or explanations about how the virus works with easy to understand answers.

The Ontario team, led in part by Spencer Daniels, quickly iterated on the site, leveraging usage data and user feedback to almost entirely rewrite the government’s COVID-19 advice in simpler and accessible language. This helped reduce unwarranted calls to the province’s help lines.

Our feeling is that governments should share code more often. This case is a wonderful example of the benefits it can create. We’ve mostly focused on how code sharing allowed Ontario to move more quickly. But posting the code publicly also resulted in helpful feedback from the developer community and wider adoption. In addition, several large private sector organizations have repurpose that code to create similar applications for their employees and numerous governments on our call expressed interest in localizing it in their jurisdiction. Sharing can radically increase the impact of a public good.

The key lesson. Sharing code allows:

• Good practices and tools to be adopted more widely – in days, not weeks
• Leveraging existing code allows a government team to focus on user experience, deploying and scaling
• The crisis is a good opportunity to overcome policy inertia around sharing or adopting open source solutions
• Both digital services still have their code on GitHub (Ontario’s can be found here and Alberta’s here).

The amazing outcome of this case is also a result of the usual recommendations for digital services that both Alberta and Ontario executed so well: user-centered design, agile working and thinking, working in cross-functional teams, embedding security and privacy by design and using simple language.

Case 2: Contact tracing and data interoperability

Many countries hit hard by the coronavirus are arriving at the end of the beginning. The original surge of patients is beginning to wane. And then begins a complicated next phase. A growing number of politicians will be turning to digital teams (or vendors) hoping that contact tracing apps will help re-open societies sooner. Government digital teams need to understand the key issues to ensure these apps are deployed in ways that are effective, or to push back against decision makers if these apps will compromise citizens’ trust and safety.

To explore the challenges contact tracing apps might create, the team from Safe Paths, an open source, privacy by design contact tracing app built by an MIT led team of epidemiologists, engineers, data scientists and researchers, shared some early lessons. On our call, the Safe Paths team outlined two core thoughts behind their work on the app: privacy and interoperability between applications.

The first challenge is the issue of data interoperability. For large countries like the United States, or regions like Europe where borders are porous, contact tracing will be difficult if data cannot be scaled or made interoperable. Presently, many governments are exploring developing their own contact tracing apps. If each has a unique approach to collecting and structuring data it will be difficult to do contact tracing effectively, particularly as societies re-open. Apple and Google’s recent announcement on a common Bluetooth standard to enable interoperability may give governments and a false sense of security that this issue will resolve itself. This is not the case. While helpful, this standard will not solve the problem of data portability so that a user could choose to share their data with multiple organizations. Governments will need to come together and use their collective weight to drive vendors and their internal development teams towards a smaller set of standards quickly.

The second issue is privacy. Poor choices around privacy and data ownership — enabled by the crisis of a pandemic — will have unintended consequences both in the short and long term. In the short term, if the most vulnerable users, such as migrants, do not trust a contact app they will not use it or worse, attempt to fool it, degrading data collection and undermining the health goals. Over the long term, decisions made today could normalize privacy standards that run counter to the values and norms of free liberal societies, undermining freedoms and the public’s long term trust in government. This is already of growing concern to civil liberties groups.

One way Safepaths has tried to address the privacy issue is by storing users data on their device and giving the user control over how and when data is shared in a de-identified manner. There are significant design and policy challenges in contact apps. This discussion is hardly exhaustive, but they need to start happening now, as decisions about how to implement these tools are already starting to be made.

Finally, the Safepaths team noted that governments have a responsibility in ensuring access to contact tracing infrastructure. For example, they struck agreements to zero-rate – e.g. make the mobile data needed to download and run the app free of charge – in a partner Caribbean country to minimize any potential cost to the users. Without such agreements, some of the most vulnerable won’t have access to these tools.

Conclusions and takeaways

This virtual conversation was the first in a series that will be held between now and the annual June Harvard / Public Digital convening of global digital services. We’ll be hosting more in the coming weeks and months.

Takeaways:

• The importance of collaboration and sharing code within and between countries. This was exemplified by code sharing between the Canadian provinces and by the hope that this can become an international effort.
• Importance of maintaining user-centered focus despite of the time pressure and fast-changing environment that requires quick implementation and iteration. Another resource here is California’s recently published crisis digital standard.
• Privacy and security must be central to solutions that help countries deal with COVID-19. The technology exists to make private and secure self-assessment forms and contact tracing apps. The challenge is setting those standards early and driving global adoption of them.
• Interoperability of contact tracing solutions will be pivotal to tackle a pandemic that doesn’t borders, cultures, or nationality. As the SafePaths team highlighted, this is a global standard-setting challenge.

Harvard and Public Digital are planning to host another event on this series on the digital response to Covid-19, sign up here if you’d like to participate in future gatherings.

— David Eaves and Tom Loosemore with Tommaso Cariati and Blank Soulava.

This report was also published on apolitical.

A series of blog posts on Coronavirus

Introducing the California crisis standard by Stacey Phillips

Government data: We’re all in beta now by Mike Bracken published on Sifted

The end of business as usual by Ben Terrett

What excellent digital government teams are doing right now by Andrew Greenway

Making things open is making things better by Tom Loosemore