The Argument for A Democratic Public Health Surveillance Program

A CDC scientist pipetting specimens in one of the Center for Disease Control’s (CDC) Biosafety Level-4 (BSL-4) laboratories, located in Atlanta, GA. Photo Credit: Public Health Image Library.

Minimizing the spread of coronavirus has been at the forefront of leaders’ and policymakers’ efforts since the onset of the pandemic. Evidently, the benefits of mass surveillance have been incalculable in countries that have slowed the spread of COVID-19. China, Taiwan, South Korea, Singapore, and Hong Kong have been able to flatten their curves in part by monitoring their citizens’ movements and health information.[i] In light of these successes, it has been argued that if the U.S. is to learn a lesson from its bungled response to the pandemic, it must gather data on its citizens. [ii] This process, known as contact-tracing, collects data and notifies citizens if they come in contact with someone who had tested positive, which can slow the spread of a secondary or future outbreak.[iii] The question is, how can the U.S. accomplish this while maintaining its liberal democratic values? 

I argue that the U.S. has two paths it can follow: 1) a private sector-led effort that prioritizes profit, opaqueness, and strengthens ‘surveillance capitalism’ or 2) a public sector-led effort that prioritizes democracy, transparency, and the rule of law.[iv] The first path, already favored by the Trump administration, entrusts the technology sector to collect data on US citizens and control their personal information, which may erode their powers and privacy. The second will place citizens’ sensitive information into the hands of a publicly accountable body that acts with the interest of the nation, rather than profit, in mind.

American citizens have found themselves hurdling down the private sector path since the explosion of what Harvard business and law professor Shoshana Zuboff calls “surveillance capitalism.” She describes our present economic system as “unilaterally claim[ing] human experience as free raw material for translation into behavioral data…,” which is then “fabricated into prediction products that anticipate what you will do now, soon, and later.”[v] In other words, companies like Facebook, Apple, and Google collect a wide range of personal information from their users and employ that information to predict, and even influence, their behavior in future products and digital services.

During the COVID-19 crisis, Apple and Google have teamed up to take advantage of the wealth of user information that is up for grabs. With the White House’s blessing, the two tech giants announced that they are building a contact-tracing tool that would help public health officials track the spread of the virus.[vi] According to Vox, “the contact-tracing tool… would have your smartphone log when you’ve come into close contact with other people. If one of those people later reports Covid-19 symptoms to a public health authority, your phone would send you an alert.”[vii]

While data collection is a vital resource in stopping the spread of the virus, owners of such personal information must act responsibly, transparently, and in the best interest of the American people. In a letter, Congress has warned the White House against allowing Apple and Google a free hand in collecting and using US citizens’ private information. The letter urges the administration to implement certain “procedures to protect the privacy of Americans,” including the aggregation, minimization, and anonymization of data. This would place much-needed restrictions on companies to only collect data health officials need to respond to the crisis, prohibit private companies from using health information for profit, ensure data security, and compel companies to destroy the data after the pandemic.[viii]

The collection, use, and destruction of data should be of particular concern to Americans. Crises provide opportunities for leaders and other elites to declare states of emergencies in which new powers are granted and new rules are put in place. Once those crises are over, however, it is difficult to revert to the way things were. For example, after 9/11, the United States built a massive state surveillance infrastructure that shows no signs of abating. This raises the question of how and when a return to normalcy may be achieved once emergency pandemic policies are adopted. For instance, the Prime Minister of Hungary, Viktor Orban, is using the crisis to grant himself dictatorial powers without any kind of sunset clause; on the US-Mexico border, American officials have deported thousands of undocumented immigrants to Mexico and effectively ended asylum because of coronavirus considerations, raising concerns that the policies will continue after the pandemic ends.[ix] The difficulty of returning to a pre-pandemic normalcy applies to data collection and contact-tracing, as well. Just like states, governments, and leaders, the private industry could be granted excess power and access to private data during a crisis. Once the pandemic ends, can Americans trust Apple and Google to destroy the massive trove of information they collected? Market logic and surveillance capitalismdictate that because tech giants can profit from the information, they have no reason to discard it. If you were Google, would you willingly give up raw data that could build your next AI platform? While private companies have established data collection abilities that can provide vital assistance during a public health crisis, these companies have no right to store and use this information for their own gain.

There is another path, though, which is one that prioritizes privacy, utility, democracy, and transparency. Instead of fearing government control over personal information, we should rally for it. For decades, neoliberalism has nibbled away at the ability of the federal government to provide for its citizens, a fact tragically on display at this moment. The tectonic shift from public to private production of goods and services has left the US pandemic response gutted and overwhelmed. It is clear from other countries successfully fighting COVID-19 that the United States must consider adopting mass public health surveillance to fight the next pandemic. It is also clear that this sort of data collection and storage should fall into the hands of the public sector.

The United States is not, however, Singapore or China. The U.S. is a liberal democracy that should rightfully place limits on the ability of the state to collect information on its citizens. In order to reconcile the privacy of the individual and the health needs of the nation, the U.S. must pursue a publicly owned public health surveillance regime. As Nicholas Wright argues, “surveillance forces should be made democratically accountable under legislation, and they should be embedded in national public health bodies such as the United States’ Centers for Disease Control and Prevention and in local public health organizations.”[x] This way, personal health information would be subject to privacy safeguards decided upon by the American people’s representatives in Congress, not the terms and conditions of Apple and Google. 

In a piece arguing for the break-up of Big Tech, Ganesh Sitaraman lays out the practicalities of moving American’s personal information away from technology corporations and into the hands of the federal government: “The United States could create a public data commons with data collected from a variety of government sources (and regulate it with strict rules about personal privacy).”[xi] While Sitaraman makes his pitch based on a national security argument, the same principle applies for public health reasons. Monopolies in the defense sector reap their government contracts while failing to innovate, which inhibits the effectiveness of the US military; similarly, Big Tech companies like Apple, Google, and Facebook prioritize profit over public health, which instrumentalizes personal information for their next product, not the next pandemic response. If the personal information of millions of Americans was instead safeguarded by the federal government, it would be both subject to checks on its use and utilized for the benefit of the American people.  

What is to be done? It is clear that the United States failed to control the spread of COVID-19, and this failure occurred at the federal level. Shortages of ventilators, masks, tests, and decisions of any semblance of leadership aside, mass public health surveillance will be critical in ensuring that future outbreaks do not yield the same results. While the U.S. cannot and should not replicate public health collection to the extent of South Korea, Singapore, Taiwan, and China because of unconstitutionality, there are endless opportunities for improvement. Any future mass public health surveillance program, however, must be pursued in a manner that conforms to the constitutional privacy rights of every citizen. To do this, mass data collection must be stored with the federal government, in a public body that is transparent, accountable, and regulated by legislation and all the checks and balances that come with it. In other words, public health should remain publicto the American people.


[i] Natasha Singer and Choe Sang-Hun, “As coronavirus surveillance escalates, personal privacy plummets,” New York Times, March 23, 2020.

[ii] Nicholas Wright, “Coronavirus and the future of surveillance,” Foreign Affairs, April 6, 2020.

[iii] Adam Clark Estes and Shirin Ghaffary, “Apple and Google want to turn your phone into a Covid-tracking machine,” Vox, April 13, 2020.

[iv] Tim Wu, “Bigger brother,” New York Review of Books, April 9, 2020.

[v] John Naughton, “’The goal is to automate us’: welcome to the age of surveillance capitalism,” The Guardian, January 20, 2019.

[vi] Adam Clark Estes and Shirin Ghaffary, “Apple and Google want to turn your phone into a Covid-tracking machine,” Vox, April 13, 2020.

[vii] Ibid.

[viii] Congress of the United States, March 19, 2020.

[ix] Maria Verza and Ben Fox, “US expels thousands to Mexico after largely halting asylum,” The Washington Post, April 9, 2020.

[x] Nicholas Wright, “Coronavirus and the future of surveillance,” Foreign Affairs, April 6, 2020.

[xi] Ganesh Sitaraman, “Too big to prevail,” Foreign Affairs, March/April, 2020.

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