Questions/Answers

The Government Technology Agency of Singapore (GovTech) – which drives Singapore’s public sector digital transformation – approached the national public health authority, the Ministry of Health (MOH), to propose a digital contact tracing solution in response to COVID-19. The TraceTogether app was developed in-house and rolled out nationwide in eight weeks. It was developed and published before the announcement of the Google-Apple Exposure Notification (GAEN) interface and was not dependent on the technology. As the first Bluetooth® contact-tracing solution used at nationwide scale, Google and Apple consulted with GovTech in the weeks prior to the initial release of GAEN. COVID-19 exacts a toll on healthcare systems and resources, particularly in relatively densely populated urban environments with a lot of cross-border contact, such as Singapore. Human-led manual contact tracing been a keystone of pandemic control, but the speed and scale of the spread of COVID-19 was large and could overwhelm the available manual contact tracing capacity, allowing a vicious cycle of further disease transmission. The prospect of technology-aided contact tracing was a means to accelerate contact tracing and more quickly arrest the spread of an infectious disease. The challenge was to come up with a technical solution that could assist the contact tracing process. At the same time, it was understood that a common challenge to using new technologies is covering the whole of the population, a critical factor in contact tracing. Fortunately, mobile technology has advanced significantly since the previous major disease outbreaks of SARS in 2003 and MERS in 2015. It was also recognised that not everybody is willing or able to download and use an app on a smartphone. This was particularly important for COVID-19 as the most vulnerable cohort for this disease - the elderly - are also less likely to be frequent users of newer technology.

Education and awareness programmes drove adoption. Frontline workers are encouraged to adopt the solution as part of work safety measures. To expand utility, the SafeEntry QR code scanning function was integrated. SafeEntry, which complements TraceTogether to expand and enhance coverage of digital contact tracing, is Singapore’s national digital check-in system to log places visited to expeditiously identify potential Covid-19 clusters. The TraceTogether application was also made open source for other countries. This improves transparency around the functionality of the app and improved trust in the solution. It also allowed other countries to quickly adapt the pioneering solution to their own situation.

Goal 3: Good Health and Wellbeing(3D.) Development of TraceTogether and the release of opensource codes inspired and enabled other Governments to potentially adopt the solution for their country. The opensource codes meant faster time to market, and cost savings, in turn would more quickly help with mitigation of health risks. Goal 17: Partnerships for The Goals (17.6 and 17.7) Given the pandemic, TraceTogether further promoted bilateral relationships and multi-stakeholder partnerships. This was necessary to ensure that not only our own nation, but neighbouring countries and international countries could share knowledge and initiatives to collectively tackle COVID-19. TraceTogether is a project that would not have succeeded as well if it was purely driven without public-private and societal partnerships. While we had an in-house Agile team, we also collaborated with radio experts, cryptographic experts, privacy and data protection personnel, loan of headsets from major tech companies amongst many others. We also engaged and developed the product together with the community, via on-ground feedback and suggestions.

Long-term measures in motion allow for the Singapore Government as a whole, to strive for a more seamless and less disruptive process. And this has been the fruition of collaboration with other agencies as well as bringing the agile methodology to the forefront in receiving real-time feedback and delivering continuous improvements. Building expertise internally, as well as knowledge sharing both internally and externally, promote safeguards in processes and allow teams to focus on delivery and as opposed to frivolous matters. These, in turn, pave the way for posterity and blueprint for future applicable scenarios where contact tracing is necessary.

Contact tracing has been imperative to reducing the spread of infectious diseases but contact tracing processes have remained largely unchanged for years. The pervasive carriage of mobile devices and use of digital technology presents an opportunity to transform how contact tracing is done. Singapore has the ready digital infrastructure and engineering manpower within the government to develop effective digital contact tracing tools to supplement and support manual contact tracing, to drive better and faster contact tracing outcomes.

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The combination of the TraceTogether app and the token represents approx. 99% coverage of the population or more than 5.6 million users as of September 2021. Effective contact tracing is seen by many governments as a key tool to minimising or avoiding widespread lockdowns. Automated tracing does not replace, but instead supplements manual contact tracing efforts by the MOH. Validation undertaken by the Singapore contact tracing teams and GovTech report a high degree of precision and corroboration between close contacts identified by TraceTogether and by manual contact tracing. The high adoption of TraceTogether has helped to mitigate possible concerns around the scalability of contact tracing in Singapore. Manual contact tracing took an average of four days in the early months of the pandemic. With the support of the TraceTogether solution, combined with other data sources and contact tracing systems, this can now be performed under 1.5 days. This allows the government to take quicker action to isolate close contacts and curb the spread of the virus. Since TraceTogether’s launch, over 60 countries or cities have also indicated interest in adopting a similar solution or learning from the team, with Australia, Canada, and Poland adapting the open-sourced version of TraceTogether.

The TraceTogether app uses Bluetooth® signals to record encounters between users in an anonymised fashion, to quickly identify users who have close contact with a COVID-19 case and establish links between clusters. TraceTogether does not rely on the users’ memory and works with unacquainted contacts who are also TraceTogether programme participants. It attempts to plug the gap of identifying close contacts with unacquainted contacts, by recording who a user has been in contact with, but not where. The privacy-by-design approach led to a hybrid model - decentralised proximity logging with a limited data retention period, with a central authority in place. Data is provided to the public health authority only if a user is diagnosed with COVID-19 who may then voluntarily submit the data. This balances operational effectiveness and user privacy. GovTech leveraged contemporary practices, the importance of engaging stakeholders, and developing a deep knowledge of their processes and motivations. The team used recommended Agile practices such as Human Centred Design (HCD), shadowing contact tracers to empathise with their challenges. TraceTogether is an on-going effort that taps on the iterative process, captures user feedback for constant improvements, tackles earlier limitations, and enables better user experiences. Understanding adoption barriers led to the inclusion of a standalone physical token (TraceTogether Token). With the physical token, the separate tracing function from phones is separated. With over a million tokens already distributed, this physical dimension improved the reach of the digital contact tracing programme, and enabled a more inclusive approach including less tech-savvy demographics such as seniors, or those with financial constraints or no access to smartphones that support the app. Amidst all activities, critical measure in place was also ensuring decisive implementation, and seamless integration with pre-existing systems and workflows to minimise disruption to on-going processes. This included the development of a central data intermediary for data-pre-processing, fusion and downstream consumption.

No such system had been deployed anywhere in the world in such scale. The design centred around weighing privacy and utility, as well as optimal use of Bluetooth, forming the basis of the product and its evolution. This was addressed through knowledge exchanges with experts. In the initial phases when community cases remained low it was a challenge to push for adoption numbers, which were bolstered by publicity, marketing and community engagement. This also was flanked by the introduction of the Tokens for inclusivity purposes when not everyone has access to a smartphone.

The TraceTogether App was the first digital tool developed to support the national contact tracing programme in Singapore, and the first of its kind in the world. It promotes the novel use of pervasive (Bluetooth) technology to support public health ops.

Part of the inspiration comes from understanding researcher Katayoun Farrahi’s article published in 2014, and then student Rohan Suri’s work in a international science and engineering fair in 2015.

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Since TraceTogether’s launch, over 60 countries or cities have also indicated interest in adopting a similar solution or learning from the team, with Australia, Canada, and Poland adapting the open-sourced version of TraceTogether.

Refer to Section 7a.

GovTech assembled a cross-functional agile team, based off initial volunteers, from a pool of internal specialists, combined with augmented support from private collaboration. The initial team grew up to 40 strong to cater for tracks in product management, development, design, testing and support operations. To cater for various facets of domain expertise and technical front, GovTech tapped into the knowledge of subject matter experts, such as cryptography, and privacy and data. There was also engagement with Apple and Google.

In the past, product development was commonly outsourced to vendors. Even though documentation was made, knowledge gaps still existed during the handover of projects. Building a cross-functional team from a pool of internal specialists, combined with augmented consultants from a vendor pool, means that the know-how stays within the organisation and can be maintained over time, while still facilitating knowledge transfer from the private sector to the government sector. This is a more sustainable solution, both in financial and institutional terms, than fully outsourcing the development of the product. The arrangement results in a more efficient use of time and resources, while concurrently developing internal expertise.

Yes

TraceTogether was evaluated by the Ministry of Communications and National Centre for Infectious Diseases. Another evaluation was on risk of COVID-19 transmission, and the effectiveness of Bluetooth contact tracing that was conducted onboard a cruise ship. A total of 42 close contacts were identified of which 11 were identified through manual contact tracing and 31 via Bluetooth-based contact tracing. Please see appended evaluation report for more details.

The Ministry of Communications and National Centre for Infectious Diseases looked at the sentiments received, based on a public satisfaction survey which showed that in August 2020 (about 5 months into the TraceTogether programme) that the awareness of the initiative was high and promising.

The recommendation from the Ministry of Communications and National Centre for Infectious Diseases was to continue providing assurance on privacy concerns as well as frame the marketing to the younger audience.

TraceTogether aligns closely to the MOH’s goal of overseeing healthcare and reduction of health risks. GovTech harnesses technology to enable and support digital transformation to various sectors, including health, in making life safer and more convenient for society. Within MOH, the IT, business and policy team work closely together with the TraceTogether team to meet the crucial needs of contact tracing and reduction in transmissional risks. Within GovTech, the development team works closely with other divisions, including data-driven teams as well as the behavioural insights experts to improve the extrapolation of available analysis.

TraceTogether is a collaboration between GovTech and the Ministry of Health, and multiple government agencies and private entities as collaborators, to ensure a more robust cog in the bigger healthcare wheel in the fight against COVID-19. These included cryptographic and radio experts, data and privacy, behavioural specialists, healthcare workers amongst many others.

This was a novel use of pervasive technology as never done before. It required on the go learning and application of the Agile methodology to get a Minimal Viable Product going quickly, and in retrospect contributing to technical and design debts. Furthermore, given the short span of eight weeks from brainstorming to conceptualisation to development, approval, and launch, it was difficult to have foreseen potential hiccups or roadblocks. This experience has been crucial towards the importance that technology plays in times of pandemic. What this means is that everything that we’re facing now, the adjustments we’re making in the way we apply technology, the blind spots we discovered in our systems – this is really a dress rehearsal and we need to learn from these lessons so that we will be better prepared when another epidemic takes place.