“A government minister once compared Ireland’s health care system to Angola – a political minefield of dysfunction, bureaucracy, waste and inefficiency. The nickname stuck.
Yet this morass has just produced a shiny success: a Covid-19 contact-tracing app that is popular and appears to work.” [A more detailed description of how this was achieved here].
Since launching on 6 July, the Covid Tracker app was downloaded 1.3m times in eight days – the fastest-downloaded app per capita in Europe – and has started picking up cases of infection.
“We’ve been delighted by the take-up rate. It’s gone beyond the initial hopes,” said Colm Harte, the technical director of NearForm, the company that made the app for the Health Service Executive (HSE).
The app uses a phone’s Bluetooth signal to exchange a digital handshake with another device also running the app when users come within 2 metres of each other for more than 15 minutes. The anonymous keys are stored in a log on the phone, which health authorities may ask users to upload if they are diagnosed with Covid-19. The log can then be used to track unnamed contacts, who are alerted about possible infection.
NearForm made a similar app for Gibraltar, which launched last month, and one for Northern Ireland, due to launch within weeks. “It’s the same core platform. It’s built on the Irish solution,” said Harte.
“An Irish solution to an Irish problem” is a derisive term in Ireland for attempted fixes that are daft or quixotic. In this case, though, there seems no need for self-deprecation.
The NHS Covid-19 app was meant to roll out in England in May. That slipped to June. Last month, officials ditched the app in its original form and backed an alternative designed by Apple and Google. The government said it might launch in winter.
The Irish are not crowing. Authorities originally hoped to launch the app in March, only to encounter complications. And its effectiveness remains unclear. “It still has to prove its mettle,” said Seán L’Estrange, a social scientist at University College Dublin who has studied tracing.
Even so, the take-up rate is impressive, said L’Estrange. “What that shows is the credibility of the app, the confidence in the initiative, and the enthusiasm for participating in the collective project to contain the virus.”
The €850,000 (£773,000) price tag is “dirt cheap” given that the average cost of identifying each case of infection is €42,000, said L’Estrange. “Even if it fails to produce the goods, little has been lost.”
This suggests Ireland’s health system, plagued in normal times by bloated management, turf battles and duplication, can do well in a crisis.
“The whole of the organisation attuned itself and focused on coronavirus,” said Fran Thompson, a HSE spokesperson. The pandemic allowed the HSE to shortcut the regular tender process and select NearForm in mid-March. “It probably saved six to eight weeks,” said Thompson.
NearForm employs 150 people and builds software mostly for private clients. It is based in a former council office in Tramore, a seaside town in County Waterford, but has international pedigree, with developers scattered across 21 countries. Clients include Condé Nast, Intel and Microsoft.
Following Singapore’s lead, NearForm’s developers raced to build a centralised app that used smartphones’ Bluetooth connectivity to trace people who come into close contact with infected people.
By April, they had a version but were struggling with Bluetooth. It worked with Android but Apple’s iPhone operating system sent apps to sleep when unused and Bluetooth could not activate them.
“We quickly hit the same problems as other countries,” said Harte. A centralised system also raised alarms about storing data and breaching privacy.
Then Apple and Google came together and offered an app that would support public health apps and let Android and iOS phones connect even while locked. Their decentralised version held no data in a single official database, alleviating privacy concerns.
The Irish were among the first to grasp Silicon Valley’s offer in late April. “We got in early and it was full steam ahead. It allowed us to move on,” said Harte.
Britain, meanwhile, persisted with attempts to make a customised app until last month when it made a U-turn and embraced the model preferred by Apple and Google.
NearForm claims to be the only company to have built apps with interoperability across borders and jurisdictions – Northern Ireland and the Republic of Ireland, and Gibraltar and Spain.
Using the same source code and supplier should facilitate a coherent all-Ireland response to the pandemic – a decision that raised no political problems at the Stormont assembly.
Thompson credits Ireland’s fast take-up rate to the population’s trust in government, desire to do the right thing and good user experience based on consultation and behavioural research.
Big questions hang over the app. How many people are using it correctly? Will downloads hit 2.2m to reach 60% of the target demographic? Will public transport and other settings sabotage Bluetooth’s accuracy? How many people will be notified and tested that otherwise would have been missed?
Stephen Farrell, a computer scientist at Trinity College Dublin who has studied contact-tracing technology, said the app’s impact on the pandemic may remain unclear. “I’d not be surprised if we never end up with a definitive answer to that.”