Ethical Compliance Assessment for COVID Safe Paths

Compliant

We comply with the recommendation

Supportive:

The recommendation applies to our Health Authority partners, rather than our technology, but we support them in meeting this recommendation

Partially compliant

We comply with the recommendation in part, but not in full (details provided)

Under Evaluation

We are in the process of assessing whether our DCTT complies with this recommendation.

In progress

We are not yet fully compliant with the recommendation, but we are actively working towards compliance.

Not compliant

We do not comply with this recommendation (explanation provided).

Utility to Public Health

Technologies or apps with the goal of enhancing public health capacity to identify cases and trace contacts in order to control the spread of SARS-CoV-2 should be designed to match functionality with that goal.

Compliant

Our products are designed with this goal in mind, in consultation with Public Health Authorities.

Technologies or apps may produce some false negatives or false positives, but they should be accurate enough that public health authorities feel confident that they support, and don’t detract from, contact tracing efforts. 

Under Evaluation

We are evaluating false positive & false negative levels in Pilots.

We are also working with Health Authorities to identify what might be acceptable levels.

DCTT approaches for public health should be designed to facilitate the following:

Identifying contacts, including those who may not be easily found otherwise

Compliant

We provide location history to aid patient recall during Contact Tracing.

We also hope to achieve this through BT & GPS exposure notifications

Finding and notifying contacts rapidly, before they develop symptoms if infected.

Compliant

BT & GPS exposure notifications can notify contacts more rapidly than traditional contact tracing

Analyzing the nature of contact to determine whether contact is high, medium, or low risk, to support decisions about whether quarantine should be mandatory, should be voluntary, or is not needed.

Partially compliant

We provide information on duration of contact.  We do not provide further details due to privacy concerns.

Following up with cases and contacts so that public health can provide resources to support isolation and quarantine at home. 

Not compliant

This is not a current focus of COVID Safe Paths

Data collected through DCTT should be made available to public health professionals and to researchers in de-identified form to support population-level epidemiologic analysis.

Compliant

Location information shared by infected patients is available to public health professionals and researchers (subject to user consent).

Collecting Data to Inform Policy and Practice

Reviews of DCTT systems must be conducted in part by an independent intermediary that has established the public’s trust.

In progress

We are working to build relationships with such independent intermediaries - e.g. https://forhumanity.center

!!! Need to progress this

Those who authorize use of DCTT within a particular jurisdiction or institution should continuously and systematically monitor the technology’s performance in that context. This should include monitoring for effectiveness and benefit, monitoring for harms, and monitoring for the fair distribution of both benefits and harms.

They should also monitor evidence that is being generated in other contexts about their selected technological solution and about other competing technologies.

In progress

We are working to develop a set of best practises for such monitoring by Health Authorities.

!!! Need to develop this.

Data should be available to users that would permit them to further investigate their personal risk with public health officials or other health workers to add a layer of protection against unnecessary quarantine.

Not compliant

Specific details about triggers for exposure notifications are withheld from users, out of concern for privacy.

It is not straightforward for users to further investigate their personal risk, following an exposure notification.

Public Trust and Public Attitudes

More research into public attitudes is needed. In particular, indepth qualitative research should examine public attitudes about perceptions of trust in DCTT among different communities, which features of DCTT influence trust, and the extent to which people are willing to provide different types of data through DCTT to help their community.

Compliant

Path Check is actively pursuing research in these areas.

!!! and publishing?  Can we provide examples?

States and localities that are considering adopting DCTT should engage with the public to increase their understanding of the acceptability of DCTT design features and uses among diverse communities.

Supportive

We support our deployment partners in this engagement.

Designing Flexible Technology to Maximize

Public Health Utility While Respecting Other Values

Technology companies should not alone control the terms, conditions, or capabilities of DCTT, nor should they presume to know what may be acceptable to members of the public.

Supportive

We are actively lobbying companies such as Google and Apple to reduce restrictions on the BT Exposure Notification technology, to enable applications that could have a greater public health impact.

A “values in design” approach to development of DCTT should be adopted (Flanagan, Howe, and Nissenbaum 2008; Knobel and Bowker 2011). Robust public- and user-engagement activities should be pursued to identify and incorporate, to the extent possible, a range of values into the design of the technology. These values may include privacy, but also autonomy, efficiency, equity, or others. Technology design should reflect an appropriate balance and prioritization of identified values.

In progress

Certain values such as Privacy have been central to design considerations from project inception.

We are working to analyze the interactions of our products with other key values highlighted, and identify how it could be brought further into line with these values. 

Technology design should not be static, but should be capable of evolving depending upon local conditions, new evidence, and changing preferences and priorities.

Compliant

As an open source project, Path Check products remain open to continuing evolution.

Since technology is provided at a no-cost basis, there will be no charges to Health Authorities to make additional functions available.

DCTT should be designed to have a base set of features that protect privacy, with layers of additional capabilities that users may choose to activate. An initial default should be that user location data are not shared, but users should be provided with easy mechanisms and prompts to allow for opting-in to this capability, with encouragement to the public if and as it is shown to be critical to achieving public health goals.

Compliant 

Location data is only shared when the user opts-in, providing clear consent to share their data.

We are working with Health Authorities to establish the value of location data sharing in achieving public health goals.

Policy Positions to Advance Widespread

Use of Digital Contact Tracing Technologies

DCTT use should not be mandated at this time given uncertainty about potential harms and benefits. Additional technology, user, and real-world testing is needed.

Compliant

One of our conditions for deploying with a Health Authority is that the use of the App must be voluntary.

!!! Check HA principles !!!

Incentives can be a useful complement to encouragements; however, any incentives for users to install and use DCTT must be equitable, should not be coercive, and should align with effective use of the technology.

Supportive

For Health Authorities considering incentives, we provide guidance on how this can be approached in an ethical manner.

!!! Do we? !!!

Trusted leaders should be enlisted to communicate effectively with the public about DCTT and encourage its use, should the technology demonstrate some potential. The limits of knowledge regarding effectiveness should also be explained along with what will be done to improve technological capabilities as understanding evolves.

Supportive

As we better understand the potential utility of DCTT, we will be working with a range of trusted leaders to communicate with the public.

We also have our own public communications about the potential of the technology, but also the uncertainty and areas for improvement that remain.

Disclosure and Authorization/Consent

A clear and concise module consisting of basic disclosure and voluntary authorization should be developed to accompany DCTT.

This module should not take the form of “clickwrap” terms of service or end-user agreements but rather provide only essential information necessary for an individual to make a decision. More detailed disclosures (such as FAQs in plain language) should be made easily accessible to those who wish to learn more, with no hidden surprises.

Compliant

When gathering user consent for a particular operation, we present the questions in simple terms, with just the essential information.

Further information is also available, and readily accessible at the Path Check website, with links provided within the App.

!!! Are we at this point yet? !!!

An opt-in approach to authorization should be instituted to accompany initial DCTT rollout. The feasibility and value of opt-out approaches should continue to be evaluated, informed by what is technologically possible, what local assessments of benefits and harms of the technology reveal over time, and our evolving understanding of the degree to which an opt-out approach is likely to increase or decrease utilization among different populations.

Opt-out approaches should not be precluded.

Supportive

We would be supportive of a move to an opt-out approach, if there were clear evidence in support of such an approach.

However there are significant technical barriers to overcome in order for DCTT to be installed automatically on users’ devices, without an explicit download of an App.

We don’t currently have any technical solution here.

Promoting Equity and Fairness

A commitment to equity means a commitment to ensuring that the benefits and burdens of DCTT are distributed fairly. Public engagement is an important tool for assessing impact and to rectify inequities.

Compliant

We are committed to ensuring that the benefits and burdens of DCTT are distributed as fairly as possible, and have published materials explicitly addressing this topic.

!!! For example…? !!!

!! could also mention support for old versions of Android, and Accessibility?

States, localities, and institutions that recommend widespread use of DCTT should provide technology (e.g., mobile phones, Bluetooth devices) and free data packages to those who desire but lack access to these devices.

Supportive

We are actively working with a range of organizations on these issues.

For example, in some countries, we have agreed zero-rating for the data downloads used by our product.

If there are lower rates of adoption of DCTT systems in some identifiable communities, public health authorities should identify ways to compensate. For example, directing more non-DCTT resources and efforts toward those communities to meet specific needs that are elsewhere being supported by technology.

Supportive

We provide Health Authorities with access to location data for infected patients.  This can support them in identifying communities with lower rates of adoption of DCTT, so that they can divert other resources towards supporting those communities.

If maps are generated based on DCTT to provide the public with the locations that COV+ individuals have visited, steps must be taken to minimize the stigma and potential financial losses that could result from being identified as a hotspot.

Supportive

While we do provide Health Authorities with the data that could be used to generate such maps, we are also active in highlighting to them the risks of harm that may be involved in publishing such data sets.

Instituting Transparent Governance and Oversight

Digital surveillance oversight committees should be established expeditiously, with diverse and qualified membership, to provide ethical and regulatory review prior to and concurrent with widespread use of a DCTT system.

Compliant

As part of our deployment with a Health Authority, we confirm that they have a suitable digital surveillance oversight committee in place.

!!! Not sure we do, but we should? !!!

Understandable and publicly accessible rules must guide the collection, access, control, use, storage, and combination of data by government authorities, public and private institutions, and other parties such as public health researchers.

Compliant

When we deploy with a Health Authority, we ensure that they have published such rules.

!!! Not sure we do, but we should? !!!

Only those data that are necessary and relevant for the public health response to COVID-19 should be collected and used.

Compliant

The only data collected by our Apps are location data (GPS position + timestamp) and records of Bluetooth tokens of other phones that have been identified within 6 feet.

Identifiable data should be kept only for the period of time needed for the public health response to COVID-19.

Compliant

All our products discard data after 28 days.  We also ensure that Health Authorities delete the data that we provide to them within that same timeframe.

!!! How do we enforce this? !!!

Identifiable data collected as part of this response should not be shared with anyone other than the relevant public health authorities without additional specific informed consent of individual users.

Compliant

Our products do not share identifiable data with anyone other than the relevant Health Authority, and this is done with user consent.

Redacted data reflecting locations that a user has been in, may be published more widely, but again only with user consent.

Before a government or institution adopts a digital contact tracing program, they should state the conditions under which the digital contact tracing program will be terminated.

Compliant

This is one of the topics that we discuss with Health Authorities prior to deployment of our solution with them.

!!! Is it?  It should be! !!!

Future use of DCTT to advance public health or other efforts (e.g., use in seasonal flu surveillance) would require independent justification. DCTT designed for public health use should not be used by law or immigration enforcement.

Compliant

Our agreements with Health Authorities explicitly limit the use of the DCTT we provide to the COVID pandemic.

Any other use would require a further agreement with independent justification. 

We are not entering into any such agreements at this time.

Further we explicitly agree with all Health Authorities that none of the information provided by our DCTT may be shared with law or immigration enforcement, or indeed with any organization that is not directly involved with public health.

!!! Wording on last bit can probably be improved.

!!! Is this true?  Should be.