Towards a public health identity? Health status apps, immunity certificates and biometrics

Our work | Identities and liberties

The risk that COVID-19 poses to individuals and society has suspended the usual balance of rights and freedoms, justifying an incursion on liberty and curtailment of rights for the sake of public safety. 

An emerging aspect is the development of a ‘Public Health Identity’ (PHI), a system for verifiably sharing private health data relevant to public health concerns. These can come in the form of a health status app or digital immunity certificate, which could be used to stream society based on an individual’s health or risk of COVID-19 infection or transmission. Streaming could formally or informally shape how citizens access parts of society, with possible employment, spaces, travel or interaction contingent on bringing personalised private health data into the public sphere.  

The risk that the virus poses to individuals and society has made the development of PHIs a possibility across the political spectrum, with work underway in ChinaGermany, the UK and Chile. As well as governments, private actors are already trialling apps to manage return to work and safe travel, including Ernest and Young and PwC. 

Modern digital technology plays a critical role in these questions, as it allows the real-time integration and verification of health-related data and sharing of that data with others, at a speed and scale not previously possible. This technology allows for iterative increases in scope towards more comprehensive digital identity, and for data used and terms of use to change more easily over time than a relatively static physical passportThis opens up the potential of increasingly granular risk assessment or monitoring, even down to the individual level. 

In the face of a crisis and the sweeping restrictions imposed across society, the case may be made that the creation of a public health identity is justifiable, but it will have to demonstrate its benefit to public health to justify its deployment. Beyond efficacyany form of PHI will need to grapple with the profound issues and societal risks raised across three sets of sociotechnical issues.  

  1. The issues arising from any form of biometric identity  the loss of privacy, the power and permanence of the information, the safety and security issues, and its underexplored future implications. 
  2. The issues arising from sharing personal health data  sensitive in itself and particularly so in the context of COVID-19 where long-term implications and correlates of contracting the virus are not yet understood.  
  3. The issues arising from ‘streaming society’ – whether through social nudges or legal requirements – around a health statuthat may generate or exacerbate existing inequalities, or lead to stigma or discrimination which may be hard to undo 

In the UK, an early manifestation of this looks likely to come in the form of a digital ‘immunity certification’. Health Secretary Matt Hancock has confirmed that work is underway, and Dido Harding has it explicitly in her remit to consider immunity certificates. There are also reports of the potential inclusion of ‘health status’ on the NHSX contact tracing app. 

The complexity and richness of these issues highlights the need for serious thought before any system is rolled out, and the evidence, policy, practice and social implications need monitoring and careful shaping.  

To support that, over the coming weeks the Ada Lovelace Institute will be tracking public and private applications of public health identityand collating and monitoring as details emerge into the public domain.  See more in our International Public Health Identity Systems Monitor

Alongside that we will be convening a series of public events to explore in greater depth the evidence and uncertainties, technical questions, legal concerns, governance requirements and social issues arising from any use of a public health identity. We will consider whether and how PHIs could be used with public legitimacy, and how their use now might shape any future society.  

‘Towards a public health identity?’ Event series:

  1. Testing immunity certificates: do the new antibody tests open the door to the creation of a ‘public health identity’? On Wednesday 3 June, four speakers from the fields of immunology, information systems and behavioural science discuss immunity certification.
  2. The societal impacts of introducing a public health identity system: legal, social and ethical issues. On Wednesday 25 June, we asked: on what grounds can the roll-out of these systems be justified? How do you weight any efficacy in improving public health against legal, social and ethical risks?
  3. Public Health Identities in the Private Sector. On Wednesday 29 July, we looked at the ethical and social implications of public health identity systems in the private sector. How are those uses currently governed and what steps should the government take, if any, to offer further regulation and guidance for the private sector?

This is part of Ada’s wider programme of work examining technological responses to COVID-19.  

Find out more:

-> What we know so far about the different forms of public health identity systems and governance of those systems are emerging around the world in our International Public Health Identity Systems Monitor 

-> The Ada Lovelace Institute’s Digital Contact Tracing Tracker – tracking digital contract tracing systems as they emerge around the world

-> Download Exit through the App Store? 1MB Colour PDF

-> Read about the Independent Review of the Governance of Biometrics Data

-> Download our report: No Green Lights, No Red Lines: Public perspectives on COVID-19 technologies

-> Contact the Identities & liberties team