PONE-D-21-05671

Do you have COVID-19? How to increase the use of diagnostic and contact tracing apps

PLOS ONE

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Reviewers' comments:

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Reviewer #1: Partly

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: N/A

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: This study investigates the important issue of uptake of COVID-19 related apps intended for self-diagnosis and digital contact tracing. Using a survey experiment among a large sample of Facebook users in Mexico, it asks whether emphasizing data privacy, as many governments have done, is a useful messaging strategy or whether it might backfire by making privacy concerns more salient to the public. The authors find evidence in support of this idea: survey respondents primed with a message about data privacy were less likely to state that they would download hypothetical diagnostic and contact tracing apps, compared to a control group and to groups that received other messages.

This is an important contribution as governments and app developers consider why the uptake of such apps has been low and the study is generally well-executed. However, I have several suggestions for improvement, mostly related to the interpretation of certain results, scope conditions, and interpretation and implications. In the attached comments I discuss each of these, listed roughly in order of importance and list some additional more minor comments.

Reviewer #2: The paper presents original results about the way governments' messages regarding privacy safeguards, contrary to their intended aim, may actually trigger concerns and undermine citizens' willingness to download COVID-19 symptom checkin and contact tracing apps. I have read the article with great interest. I think the paper is solid and well-written.

I have only one suggestion that I hope the authors will be willing to take into account. The discussion section could be expanded and engage with two bodies of literature. On the one hand the empirical literature on public attitudes towards COVID-19 apps in other geographical contexts. For instance:

Saw, Y.E., Tan, E.Y.Q., Liu, J.S. and Liu, J.C., 2021. Predicting public uptake of digital contact tracing during the covid-19 pandemic: results from a nationwide survey in Singapore. Journal of medical Internet research, 23(2), p.e24730.

Zimmermann, B.M., Fiske, A., Prainsack, B., Hangel, N., McLennan, S. and Buyx, A., 2021. Early perceptions of COVID-19 contact tracing apps in German-speaking countries: comparative mixed methods study. Journal of medical Internet research, 23(2), p.e25525.

On the other the literature (mostly in the field of ethics) stressing privacy as the main (ethical) concern, especially in the case of contact tracing apps. For instance

Mello, M.M. and Wang, C.J., 2020. Ethics and governance for digital disease surveillance. Science, 368(6494), pp.951-954.)

Parker, M.J., Fraser, C., Abeler-Dörner, L. and Bonsall, D., 2020. Ethics of instantaneous contact tracing using mobile phone apps in the control of the COVID-19 pandemic. Journal of Medical Ethics, 46(7), pp.427-431.

This literature focuses mostly on privacy and autonomy (voluntariness) in their ethical analysis.

Some other scholars in ethics instead have highlighted the narrow focus on privacy, see:

Martinez‐Martin, N., Wieten, S., Magnus, D. and Cho, M.K., 2020. Digital contact tracing, privacy, and public health. Hastings Center Report, 50(3), pp.43-46.

It would be nice if you could situate your results in this broader context.

On last observation. Your point (e.g. in the last paragraph) that focusing on benefit increases the willingness to download the app, is a bit undersold. Discussing it in light of the above mentioned debates would do it more justice. But other than that, at a more general level, this kind of consideration reminded me of a - now dated - paper by bioethicist Bruce Jennings on Public Health and Civic Republicanism (available here: https://www.researchgate.net/publication/262724398_Public_Health_and_Civic_Republicanism). In this paper Jennings argues that exclusive emphasis on human rights and individual interest will not do the job of providing a credible public justification to public health measures (page 57). Jennings appeals instead to messages centred around civic virtues (i.e. doing it for the good of all). I thought you could take this into account as a theoretical backdrop towards the end of your discussion.

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Reviewer #1: No

Reviewer #2: No

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Do you have COVID-19? How to increase the use of diagnostic and contact tracing apps

PONE-D-21-05671R1

Dear Dr. Scartascini,

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