The role of European governments in implementing digital health innovations amidst declining public trust: A case of Digital Contact Tracing (DCT) tools for COVID-19

Background: Contact tracing is considered as one of the safest and least invasive public health interventions to curb disease outbreaks. Since the beginning of the pandemic, digital contact tracing (DCT) tools have been implemented and deployed in European countries as a novel technology to slow the spread of COVID-19. European governments were the major driving force behind the design and implementation of DCT solutions ensuring the enforcement of data protection and privacy laws and having an active role of both a “scriptwriter” and “performer” of innovative solutions. In spite of this, the success of COVID-19 DCT tools was severely hampered, resulting in differences in their uptake across Europe. The aim of this study is to explore the reasons for the barriers to DCT usage in Europe in the light of emerging ethical, privacy and data protection concerns in a rapidly changing political interplay between policymakers and the public. Methods: We analysed the use of DCT tools in European countries in the light of declining trust in national governments. In order to better understand the reasons behind the low usage rates of DCT tools and establish an association between the use of mobile tracking apps and social trust in public policies during the pandemic, we compared the number of mobile tracking apps downloads (% of population, used as a surrogate for DCT usage), with OECD’s trust in government indicator. Furthermore, relevant policy measures towards implementing DCT solutions are explored and a summary of DCT solutions’ usage statistics in European countries alongside the applicable data protection legislation such as GDPR is provided as a basis for future discussions. Results: Discernible gaps in DCT tools’ usage were identified across Europe with the higher usage rates of DCT mobile apps being positively correlated with an increased trust in governments. Despite possible confounders, these results point to a link between the use of digital health technology and citizens’ trust in policymaking. As the main drivers of DCT innovation efforts during the pandemic, governments were under an increased scrutiny by the public resulting in differences in the DCT uptake. Conclusion: Digital innovations are usually seen as objective public health interventions that are detached from the trust invested in the governments’ decisions. Nevertheless, social trust seems to be crucial to managing public health crises, especially when the public opinion is crucial to digital health technologies’ uptake. The results of this research show the link between the citizens’ trust in their governments and the use of innovative DCT technologies during the COVID-19 pandemic. Speedy recovery of European societies requires an integration of reliable digital health technologies into trustworthy policymaking, as one is not effective without the other. A comprehension of the public as the main actor in the implementation of such solutions is crucial for this and possible future pandemics.