At the beginning of the second wave of coronavirus infections, in the autumn of last year, one of the pillars of the Italian government's strategy to counter the pandemic was the Immuni contact tracing app, released to the public in June 2020. But several months later, and despite some initial attempts by the government to support the app, Immuni has made no significant contribution to containing the pandemic, and indeed has soon gone out of both public discourse and government strategy. by Giuseppe Conte: now his successor, Mario Draghi, will have to decide whether to try to relaunch the app or focus on other priorities.
The problems with contact tracing apps do not only concern Italy: in most of the countries where one was disseminated last year, the results were scarce or at least discussed, and there was some debate between those who believe that profound adjustments are needed to make apps truly effective and those who are now convinced that an app is not the right tool to try to track contacts during a pandemic.
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In Italy, however, the problem is compounded by a lower adoption rate than in countries like Germany, the UK and France – some of which have made a tracking app available to their citizens after Italy – and from the fact that in recent months the app seems to have completely come out of the public debate: the consequence is that Immuni's reporting activity has been slow for months and has become practically irrelevant, as shown by the numbers published on the official website of the app .
The numbers
Immuni's task is to warn those who installed it that they have come into close contact with a person who later tested positive. To achieve this, the two people's apps exchange anonymous IDs via Bluetooth technology, using a protocol developed by Apple and Google, which respectively manage iOS, the operating system of the iPhone, and Android. When one of the two people test positive, he uploads the necessary data to the Immuni server to alert his contacts – via the app and with the assistance of an operator. People who come in contact with the positive, in this way, are notified with a notification on their phone.
Things to know about the coronavirus The Coronavirus Post newsletter updates you on the latest news: it's free and arrives every Thursday at 18:00. To receive it, write your email address here and press the button below. Having read the information, I agree to send the Newsletter The Immuni site presents numerous data on the diffusion and use of the app, and they are all unconvincing. App downloads, after a good growth in the autumn, at the beginning of the second wave, have practically stopped: from the end of October 2020 to mid-February 2021 they went from 9.3 to 10.3 million. Furthermore, between the end of October and today, the number of positive people who uploaded their data to the app has gone from 1,530 to about 11,300, and the number of people notified by notification from 36,200 to about 88,200.
These are total data, which are very scarce if we consider that the new positive coronavirus cases detected in Italy have been tens of thousands a day in recent months and which testify to the irrelevance of Immuni during the second wave. There are no studies that have estimated how many infections the app has helped to avoid, but it is likely that this is a minor number. Obviously, every single contagion avoided is good news, but in the initial intentions the impact of Immuni should have been much wider and should have contributed substantially to containing the contagion, which did not happen.
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One of the reasons for this irrelevance is the low adoption rate, for which a certain inattention by the government is at least partly responsible: after a nationwide advertising campaign that began in September and continued for a few weeks, wanted by the Ministry of Innovation at the time. led by Paola Pisano and also picked up by some newspapers, the government has done practically nothing to promote Immuni, and even public opinion has practically forgotten about the app. One reason is that, with the arrival of winter, everyone's attention has focused on vaccines and the vaccination campaign. Furthermore, with the beginning of 2021, the crisis of the Conte government contributed to monopolize public discourse.
But the most serious reason for the failure of Immuni is its very little use. There were 10.9 million downloads: few, but it is still 19 percent of the Italian population, a figure that according to some research could already have an effect, albeit low, on the reduction of infections. The problem is that, of the millions of users who have downloaded the app, very few have used it to upload their data, if positive, and very few have received exposure notifications.
Let's make a comparison with Germany: at the end of January 2021, the number of downloads of the German app, which is called Corona-Warn-App, was 150 percent higher than the Italian one (25 million against 10 million). The gap is important, but not exaggerated and partly justified by the fact that the German population is a little more numerous than the Italian one. But the number of positive German users who uploaded their data to the app is completely off the scale: they were 240,000 against 11,000 Italians: it's 2,080 percent more. And this also doesn't mean that Corona-Warn-App was a great success, on the contrary: in Germany there is quite lively controversy over whether the app, even there, had little impact and disappointed expectations.
So, based on the numbers, the main reason for Immuni's failure is that the app has never really been integrated into the Italian health prevention system.
This was a very evident problem already last autumn: to allow positive users to upload data to the Immuni server, in fact, it was necessary for health professionals to intervene who communicated the result of the swab, carrying out a quick, but sometimes cumbersome procedure. . Some regions had even refused to upload the data, considering it a waste of time. Things got better, but not enough.
To solve this problem, at the end of October the government had ordered by decree the creation of a call center to facilitate data loading operations. It was the last relevant act of the Conte government regarding Immuni. The call center was built between December and January, but almost no difference was seen.
The call center and the loading of data on the app
With the decree of October, the government had financed the call center with 4 million euros, to facilitate data upload operations and also to provide assistance to Immuni users who had received the contact at risk notification. The latter activity was largely omitted, but the call center to upload the data is active: in January 2021 an experimentation began in Campania, Friuli Venezia Giulia, Lombardy, Molise and the autonomous province of Trento, and starting from the end of month has been activated in all regions.
In theory, uploading your data to Immuni should now be extremely easy: after you have received a positive result from a molecular swab, just tell the call center operator (the number is 800 91 24 91) your CUN code ( unique national code), which should have been sent by your ASL via SMS or on the swab report, together with the last eight numbers of the health card; at that point the operator will take care of unblocking data loading.
Furthermore, in the coming weeks, loading should become even easier: Immuni should receive an update that will allow you to enter the CUN code and health card data directly on the app, without the need to call the call center. The update is practically ready, but the approval of the Privacy Guarantor is still missing.
The call center, and later the app update, should greatly facilitate the Immuni activation procedure and allow it to start having a certain impact, but for now this is not happening: in the last few weeks the number of people tested positive the coronavirus that uploaded their data did not increase, if not imperceptibly.
It is possible that the situation will improve in the future, but there are still two relevant problems in this system: the first is that, even with a centralized call center, the smooth functioning of Immuni remains dependent on the collaboration of the regional health services, on which the provision of the CUN code. The fragmentation of the health service has been one of the biggest obstacles to the efficiency of the app in recent months, and to a large extent it still is: for example, some regions send the CUN code via SMS while others print it on the swab report, or they do both. There is still no precise data because the system was made public less than two months ago, but on an anecdotal level it can be said that the CUN code does not always arrive.
The second relevant problem is that the Conte government, in recent months and at least in public communication, had practically abandoned the app. Some improvements have been made (the call center, the future update) but have not been communicated sufficiently, and Immuni has left the public discourse.
What will the Draghi government do?
The central figure to understand what will happen to Immuni with the new government is probably Vittorio Colao, the new Minister for Innovation.
Immuni is a particular project also because the phase of birth and then of management of the app was divided between several ministries: the app was desired and supported by Paola Pisano, Minister for Innovation of the last Conte government, who established the calls for tender and the technical criteria for development. But the management of the app, for obvious skills, was entrusted to the Ministry of Health. Roberto Speranza, Minister of Health both in the Conte government and in the one led by Draghi, has never been particularly enthusiastic about Immuni: he has practically never mentioned in his public speeches, the level of involvement of ministry officials in the project it has often been quite small, and most of the operations have been placed under the responsibility of the extraordinary commissioner for the emergency, Domenico Arcuri.
For this reason it is likely that if there is a plan to revive Immuni it will come again from the Ministry of Innovation, which with Colao has obtained greater centrality. The new government is still in the process of taking office, Colao has not yet made public the appointments of its staff, and responding to a request from the Post, ministry officials said that the “ownership of the project” rests with the Ministry of Health, but it is things will likely change after a settlement.
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Furthermore, Colao has already expressed himself several times on Immuni and, in general, on contact tracing apps in the spring of last year, when he was appointed head of the so-called “task force” of experts wanted by the Conte government to formulate a plan on the so-called “phase 2”. In a speech published at the end of March in Corriere della Sera, before being appointed to the “task force”, Colao wrote that digital tracking would be effective “only if mobile network data are used in conjunction with a dedicated app with GPS”, which means that, in Colao's idea, it would also have been necessary to track the movements of people.
This is a function that has been explicitly excluded by Immuni for rather clear reasons of privacy protection, and which would be very complicated to enter: the app is based on a protocol created by Apple and Google, which categorically prohibit the collection of location data. of the user. To enter the tracking of the position it would be necessary to abandon the Apple and Google protocol, to give up compatibility with most smartphones and interoperability with foreign countries, and practically starting from scratch – not to mention the privacy concerns that this system would generate in citizens.
In general, Colao, who until 2018 was CEO of the telecommunications multinational Vodafone, over the years has expressed himself several times in a critical manner against the alleged excesses in the protection of digital privacy and against online anonymity, as noted by the journalist and digital policy expert Fabio Chiusi in a series of tweets that collect old statements. However, it is not certain that the opinions expressed by Colao as a manager will necessarily reflect his work as a minister.
In recent days, neither Colao nor other members of the Draghi government have publicly mentioned the Immuni app.
How it goes in other countries
Contact tracing apps have not been adopted uniformly all over the world: it can be said, indeed, that they are almost exclusive of the West. Virtually every country in Europe has one, plus many states in the United States, Australia and New Zealand. Some Asian countries such as China, South Korea and Taiwan – which have also been the most successful in containing the infection – have made extensive use of technological tools and have also developed some apps, for example to manage quarantines, but not have contact tracing apps comparable to Immuni.
In general, and with few exceptions, in all countries where a contact tracing app has been adopted there have been disappointments and failures. Let's give some examples.
In Germany, as already mentioned, the crown-Warn-App has become the subject of controversy, despite the enormously better numbers than those of Immuni. The app's impact in containing the pandemic has been small, and German politicians are wondering if the reason is that, due to the many limitations imposed by Apple and Google's protocol to safeguard privacy, the data collected by Corona-Warn -Apps are not sufficient for effective tracking. Last October Markus Söder, prime minister of Bavaria and one of the most important figures in the German center-right, described the app as a “toothless tiger”. The controversy has also renewed itself in recent weeks, although some government officials have recalled that the numbers, although small, are still good.
In France, the main problem of the TousAntiCovid app is that, by government decision, it does not use the protocols of Apple and Google, and therefore has serious compatibility problems with smartphones. In Spain, the downloads of the COVID Radar app were just over 7 million and the people with positive tests who uploaded their data were 50,000 in all: the media openly speak of “failure”. Taking into consideration projects from various states, The Verge website claimed in December that contact tracing apps “have not lived up to the great expectations”.
Simplifying a lot, the reasons for these failures or these partial disappointments are more or less always the same, albeit with obvious variations from country to country: low adoption rate, little use, poor integration with the health infrastructure.
Some governments, while not losing hope that digital contact tracing will work, have begun to integrate their apps with different functions. In France, Figaro wrote that TousAntiCovid is “less used as a contact tracing system and more as a means of information”: through the app, the government sends citizens useful information on measures to contain the infection and on the vaccine plan, including other things. Soon, the French app should adopt a system that allows those who frequent bars, restaurants and other public places to mark their passage by scanning a QR code, so as to be warned in the event that an outbreak occurs in that place. The same does the British app. The German Corona-Warn-App has also started showing more statistics and information. These are all functions that Immuni, for now, is missing.
An at least apparently positive case is the British one, which had had a difficult start. The government had first developed an app that didn't use Apple's and Google's protocol, and after realizing that it didn't work well, they abandoned it and redone another one, which was made available in September 2020: yes. it calls the NHS Covid-19 App and has been downloaded 21 million times in England and Wales (Scotland and Northern Ireland have their own apps). In recent days, a study published in early February by researchers from the Alan Turing Institute and the University of Oxford has been circulating a lot, who have studied the correlation between mortality and areas of the country where the app was most downloaded. and estimated that NHS Covid-19 App could have avoided between 200,000 and 900,000 infections between November and December of 2020.
Unfortunately, the study is based almost exclusively on the observation of correlations: “no randomized or systematic studies have been performed”, write the researchers, and “it is possible that the changes in the use of the app over time and on the basis of geographical areas other changes, and that our analysis incorrectly attributes the effect to the app “.
