Finnish Institute for Health and Welfare, Helsinki, Finland.
Gofore Oyj, Tampere, Finland.
JMIR Public Health Surveill. 2023 Jul 13;9:e46563. doi: 10.2196/46563.
Exposure notification applications (ENAs) or digital proximity tracing apps were used in several countries during the COVID-19 pandemic. In this viewpoint, we share our experience of implementing and running the Finnish ENA (Koronavilkku), one of the national ENAs with the highest proportion of users during the pandemic. With the aim of strengthening public trust and increasing app uptake, there was a strong prioritization of privacy and data security for the end user throughout the ENA development. This, in turn, limited the use of the app as a tool for health care professionals and deeper insight into its potential effectiveness. The ENA was designed to supplement conventional contact tracing, rather than replace it, and to serve as an early warning system and a trigger for action for the user in case of potential exposure. The predefined target of 40% uptake in the population was achieved within 3 months of the ENA launch. We consider easy-to-understand information produced together with communication experts crucial during the changing pandemic situation. This information educated people about the app as one component in mitigating the pandemic. As the pandemic and its mitigation evolved, the ENA also needed adapting and updating. A few months after its launch, Finland joined European interoperability, which allowed the ENA to share information with ENAs of other countries. We added automatic token issuing to the ENA as of mid-2021. If added earlier and more comprehensively, automatization could have more effectively saved resources in health care services and prevented overburdening contact tracing teams, while also notifying potentially exposed individuals quicker and more reliably. In the spring of 2021, the number of active apps started to gradually decline. Quarantine and testing practices for asymptomatic vaccinated individuals following exposure to the virus were eased and home tests became more common, eventually replacing laboratory testing for much of the population. Taken together, this led to decreased token issuance, which weakened the potential public health usefulness of the app. A self-service option for token issuance would likely have prolonged the lifespan of the app. The ENA was discontinued in mid-2022. Regularly conducted surveys would have helped gain timely knowledge on the use and effectiveness of the app for better responding to the changing needs during the pandemic.
在 COVID-19 大流行期间，有几个国家使用了接触者暴露通知应用程序（ENA）或数字近距离追踪应用程序。在这篇观点文章中，我们分享了在大流行期间，我们实施和运行芬兰 ENA（Koronavilkku）的经验，该应用程序是用户比例最高的全国 ENA 之一。为了增强公众信任并提高应用程序的采用率，在整个 ENA 开发过程中，始终将最终用户的隐私和数据安全作为首要任务。这反过来又限制了该应用程序作为医疗保健专业人员的工具，并限制了对其潜在效果的深入了解。ENA 的设计目的是补充传统的接触者追踪，而不是替代它，并作为用户在潜在暴露情况下的预警系统和采取行动的触发因素。ENA 推出后 3 个月内，就达到了在人群中达到 40%采用率的预定目标。我们认为，在不断变化的大流行情况下，与传播专家一起制作易于理解的信息至关重要。这些信息使人们了解到该应用程序是减轻大流行的一个组成部分。随着大流行及其缓解措施的发展，ENA 也需要进行调整和更新。ENA 推出几个月后，芬兰加入了欧洲互操作性，这使得 ENA 能够与其他国家的 ENA 共享信息。自 2021 年年中以来，我们已向 ENA 添加了自动令牌颁发功能。如果更早且更全面地实现自动化，那么它可以更有效地为医疗保健服务节省资源，并防止接触者追踪团队负担过重，同时更快、更可靠地通知潜在暴露者。2021 年春季，活跃应用程序的数量开始逐渐减少。对接触病毒后无症状接种疫苗个体的隔离和检测措施变得更加宽松，家庭检测变得更加普遍，最终为大多数人取代了实验室检测。所有这些都导致令牌发行数量减少，削弱了该应用程序在公共卫生方面的潜在作用。自动令牌发行的自助选项可能会延长该应用程序的寿命。ENA 于 2022 年年中停止使用。定期进行调查将有助于及时了解应用程序的使用和效果，以便更好地应对大流行期间不断变化的需求。
