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What can our experience with the NHS COVID-19 contact tracing app teach us for future pandemics?

1 March 2023

Authored by Mustafa Al-Haboubi, Josephine Exley and Nicholas Mays

At the outset of the pandemic, digital contact tracing (or exposure notification) apps were widely promoted as a key weapon in the fight against COVID-19. Early modelling suggested that apps could effectively suppress transmission rates without the need for stringent “lockdown” measures if they were widely used by the public. Our latest research suggests we can draw three key lessons from the experience of using the app in England and Wales. These insights should be highly relevant when responding to future pandemics.

High levels of support

Before the roll-out of the apps, surveys in the UK and other Western countries suggested high levels of support for, and willingness to, download and use such technology to control the COVID-19 pandemic. People appeared to be more concerned about the virus and less so about any potential intrusion on their privacy.

The NHS COVID-19 app was launched in England and Wales in September 2020, six months later than originally planned, and following highly publicised technical issues resulting in the switch from a centralised design to a decentralised model based on technology developed by Apple and Google.

Our study

We recruited two groups of online study participants to track the changing views of the public in England and Wales on, and their use of, the contact tracing app. One was a representative sample of 2,032 smartphone users aged 18 to 79, the other a sample of 684 smartphone users aged 18 to 79 from six of the largest minority ethnic groups, who were purposively selected for the study. We surveyed the two groups seven times between October 2020 and September 2021.

Motivated by civic, public and social responsibility

Despite changes in government policy and case numbers, installation of the app remained stable at around 50% of smart phone users, with the majority of those who had ever installed the app doing so soon after it was launched. People’s desire to contribute to the common good was the main reason given for uptake among early adopters. Uptake was also higher amongst those who considered themselves vulnerable to COVID-19 or were concerned about the risk the virus posed to themselves and the country. A perceived change in the severity of the crisis was a trigger for installing the app in later months.

How to overcome the "intention-action gap”

Results from our study highlight a potential “intention-action gap”, with installation rates lower than might have been expected based on surveys conducted before the app was rolled out. The 50% level of uptake was well below the level initially estimated as required to suppress the virus. Increased focus would have been needed to encourage those who had not installed the app initially to do so later. Requirements for use of the app, such as the need to scan QR codes to gain entry to venues, could have encouraged greater uptake. There was only a limited window in which QR codes were required. Indeed, displaying QR codes at venues was not mandated in Wales during the pandemic. A key lesson for the future is that to increase uptake, people to have a day-to-day personal need to use the app in order to carry out their normal activities.

Allaying privacy concerns

We also identified a need to improve trust in the information provided by government and allay privacy concerns, since both factors were associated with lower installation rates in England and Wales. The highly publicised delays to roll-out associated both with privacy and false alert concerns potentially undermined support for the technology. The government did little to counter untrue claims regarding the so called ‘Pingdemic’ in the summer of 2021. Amongst those who uninstalled the app in this period, we found an increase in the perception that the app was sending false alerts. In future, governments must address privacy concerns head on, from the outset, by demonstrating how the technology works and robustly refute misleading media coverage.

Reaching groups with lower uptake

There were systematic differences in uptake in England and Wales by area, ethnicity, education and employment status. The lesson here is that future efforts to promote app use need to rapidly identify and find ways of reaching groups with lower uptake. These disparities cannot be explained in terms of the “digital divide” since all respondents to our survey were smartphone users. The reasons behind these differences also need to be explored in future research before the next pandemic.

The publication can be accessed here


This research was funded by the NIHR Policy Research Programme through the Policy Innovation and Evaluation Research Unit (PR-PRU-1217-20602). The views expressed are those of the author(s) and are not necessarily those of the NIHR or the Department of Health and Social Care.