MMobile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination Coordination M OBILE A PPS P RIORITIZING P RIVACY , E
FFICIENCYAND E QUITY : A D
ECENTRALIZED A PPROACH TO
ACCINATION C OORDINATION
1, 3 , Rohan Sukumaran , Sheshank Shankar , Anshuman Sharma , Ishaan Singh , Haris Nazir , Colin Kang , Saurish Srivastava , Parth Patwa , Abhishek Singh , PriyanshiKatiyar , Vitor Pamplona , Ramesh Raskar
PathCheck Foundation, 02139 Cambridge, USA. MIT Media Lab, 02139 Cambridge, USA. Renaissance School of Medicine, Stony Brook University, 11794 Stony Brook, USA. [email protected] A BSTRACT
In this early draft, we describe a decentralized, app-based approach to COVID-19vaccine distribution that facilitates zero knowledge veriﬁcation, dynamic vaccinescheduling, continuous symptoms reporting, access to aggregate analytics basedon population trends and more. To ensure equity, our solution is developed towork with limited internet access as well. In addition, we describe the six crit-ical functions that we believe last mile vaccination management platforms mustperform, examine existing vaccine management systems, and present a model forprivacy-focused, individual-centric solutions.
The efﬁcient and rapid distribution of COVID-19 vaccine doses demands that every step in theprocess is carefully planned to address logistical, communication, privacy and ethical challengesBae et al. (2020).In this paper, we describe six critical functions that we believe last mile vaccine management plat-forms must perform. We examine existing vaccine distribution/management systems and present amodel for privacy-focused, individual-centric solutions.Here, we propose a decentralized, mobile app approach to address challenges in COVID-19 vaccinedistribution, while preserving patient privacy, and maximizing public engagement. In our recentwork, we proposed a similar solution based on QR codes which enables it to function without anapp Bae et al. (2021). However, our app based solution can facilitate zero knowledge veriﬁcation,dynamic vaccine scheduling, continuous symptoms reporting, access to aggregate analytics basedon population trends and more. Furthermore, our mobile app solution is aimed to work with limitedaccess to the internet as well.
SE CASES AND FUNCTIONAL REQUIREMENTS OF VACCINE MANAGEMENTPLATFORMS
We identify six critical functions that must be performed by systems facing vaccine recipients inthe continued distribution of COVID-19 vaccines. Each of these six critical functions addresses theimportant challenges in equitable vaccine distribution that were previously identiﬁed and describedin Bae et al. (2021). 1 a r X i v : . [ c s . C Y ] F e b obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination Coordination2.1 V ACCINATION ELIGIBILITY VERIFICATION
The current phased vaccination schedules adopted by several national governments Samal et al.(2021) prioritize speciﬁc subsets of the population for vaccination, to maximize the societal beneﬁtof initially limited vaccines. In the United States, healthcare workers and long-term care facilityresidents and workers will be the ﬁrst to receive a vaccine, with the following phases includingessential workers, seniors, and those with high-risk medical conditions MPH (2020). Conﬁrmingthat an individual is part of an eligible population will be important in preventing fraud and to ensureequitable vaccine distribution. Since some eligibility requirements are based on PII, this processmust be done in a privacy preserving way to ensure that this data is not misused.2.2 V
ACCINE SCHEDULING AND ADMINISTRATION
Coordinating the vaccination of large groups within small time windows will require efﬁcientscheduling systems to optimize the number of individuals being vaccinated. These scheduling sys-tems must be accessible and interoperable with an assortment of vaccination sites across a diverserange of populations and locations Jercich (2021). Although multiple such systems have been de-veloped, none have been widely successful Ramer (2021).2.3 S
ECOND DOSE COORDINATION AND RECORD LINKAGE
Most vaccine candidates likely to reach widespread distribution require a minimum one dose andmaybe followed by a booster shot for full immunogenicity. For maximum public utility, it is imper-ative that individuals consistently receive these doses of a COVID-19 vaccine.Furthermore, because studies have not yet been performed to determine whether taking a ﬁrst doseCOVID-19 vaccine from one manufacturer can be effectively complemented by a second dose fromanother manufacturer, current guidelines recommend that individuals should receive both vaccinedoses from a single manufacturer for Disease Control & Prevention (2020b). Effective systems mustbe implemented to facilitate this process and to monitor the relative efﬁcacy of multi-manufacturerdose schedules if these guidelines are changed in the future. Record keeping and reminder systemsmust be developed to ease the logistical burden of coordinating adherence to these speciﬁc vac-cine protocols for Disease Control & Prevention (2020a). Also, the same would be applicable forcoordination of booster shots and long term adverse effect tracking.However, it is important to acknowledge that single-dose vaccines are in development, and the ap-proval of such a vaccine would make this requirement completely obsolete Bloomberg (2021).2.4 V
As more of the population get vaccinated, methods of assessing and conﬁrming vaccination statusbecome increasingly important for the relaxation of certain public health measures and shutdownsfor Disease Control & Prevention (2020c). Therefore, before policies dependent on immunizationstatus can be enacted, secure, fraud-resistant methods must be developed to conﬁrm that an individ-ual has been vaccinated.2.5 S
AFETY EFFICACY MONITORING
The novelty of COVID-19 vaccine platforms as well as the limited Phase III clinical trial data ontheir long-term efﬁcacy and side effects can be supplemented by long-term health data collection.This will be important in the development of vaccination policies, public health measures, and canfurther elucidate differences in side effect manifestation and efﬁcacy in diverse populations (US).Furthermore, this data can be used for quality assurance processes and aid vaccine manufacturers inimproving vaccine technologies. Several challenges exist in the secure, privacy-focused collectionof this individual protected health information (PHI).2obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination Coordination2.6 T
RUST AND COMMUNICATION
Every intersection between user engagement and any vaccine management system is an opportu-nity to build trust and provide transparent communication between all stakeholders involved in thevaccine distribution pipeline (coupon distributor, vaccinator, the guard at a venue, etc). Effectivecommunication across these user-facing systems as well as thorough messaging surrounding theirfeatures and usage will be important in gaining public trust and increasing engagement (WHO).
ENTRALIZED A PPROACHES WITH
Centralized systems including the Vaccine Administration Management System (VAMS) and theV-Safe After Vaccination Health Checker platforms, are being developed by the government to ad-dress various required functions in vaccine administration for Disease Control (CDC). The VaccineAdverse Event Reporting System (VAERS) is a long-standing centralized system for safety andefﬁcacy monitoring as well. Some of these are developed in conjunction with private sector compa-nies. The primary intended audience for these systems varies, and therefore there is also variance inuser-experience.3.1 U
SER F LOW
VAMS is a multifunctional platform for vaccine administration and monitoring meant to be usedby healthcare providers, employers, vaccine clinic managers, and vaccine recipients. The systemincludes processes for vaccine eligibility prioritization, appointment scheduling, dose recording,second dose reminders, and vaccination status veriﬁcation. The separate Vaccine Adverse EventReporting System (VAERS) and V-safe After Vaccination Health Checker platforms enable the re-porting of side-effects and symptoms that may be associated with vaccination for Disease Control(CDC).3.2 C
RIVACY AND DATA SECURITY
VAMS requires the input of extensive protected health information (PHI) including questions con-cerning HIV status, cancer diagnosis, and other pre-existing conditions for Disease Control (CDC).The storage of this sensitive private data in a centralized manner opens the potential for the lossof personally identiﬁable information (PII) and PHI for large portions of the population if securitybreaches occur.3.2.2 L
OGISTICS AND EFFICIENCY
Due to requirements for the input of substantial amounts of information, usage of centralized gov-ernment systems including VAMS, VAERS, and V-safe is an arguably time-intensive and complexprocess. This can create unnecessary friction in the vaccine distribution pipeline.3.2.3 E
NGAGEMENT AND USER - TRUST
Existing barriers to user trust and current vaccine hesitancy trends may be exacerbated by centralizedsystems requiring the input of large amounts of PII. Ofﬁcials have voiced concerns that the collectionof this PII is unnecessary for the monitoring of health outcomes and efﬁcacy, and may be usedfor other purposes such as the identiﬁcation of undocumented immigrants 7 (2020). This has thepotential to discourage vaccination in minority populations that are already being disproportionatelyaffected by COVID-126.96.36.199 M
ONITORING OF HEALTH OUTCOMES
Though centralized systems promise to comprehensively monitor health outcomes by the collectionof large volumes of information, there are challenges to the use of this information in improvingcontinued vaccination efforts. Despite increased information collection, the potential decrease in3obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination Coordinationuser engagement can create a net deﬁcit in reported vaccine side effects and efﬁcacy when comparedto lower-friction, privacy-focused solutions. Second, there has been no clear messaging on howcollected data will be used and it is unclear whether vaccine manufacturers will be provided accessto this information to continue to improve vaccine development RICHARDS (2020).Figure 1: Flowchart depicting the Vaccine Recipient User Flow.
N APP - BASED APPROACH
ACCINE R ECIPIENT U SER F LOW
Our proposed mobile app approach for vaccine coordination focuses primarily on user engagementand individual health outcomes. This app will be computationally lightweight while also fulﬁllingnumerous functions including eligibility conﬁrmation, vaccine schedule, side effect reporting, andvaccination veriﬁcation. We also believe that it will be easily integrated into existing systems suchas VAMS, ideally supplementing these approaches.Entry into our proposed app-based solution for vaccine distribution would be non-restrictive. Anyindividual has the opportunity to download the open-source app and can utilize features includingthe FAQ, symptom/vaccination dashboards, etc.4.1.1 V
ACCINE ELIGIBILITY CONFIRMATION
In order to book a vaccination appointment, the app will require a state or local government-issuedconﬁrmation. This might take the form of a physical vaccine “coupon” provided to individualsphysically either through the mail, an employer, or at a government pickup site. Veriﬁcation of auser’s eligibility for vaccination will be managed by the jurisdiction in providing these “coupons.”Once a coupon is obtained by a user, it can be inputted into the app. One-time passwords (OTPs)could be used to prevent access to digitally stored QR codes. At this point, our proposed app willnot require the user to provide any personally identiﬁable information (PII).4.1.2 V
ACCINE SCHEDULING AND ADMINISTRATION
After the veriﬁcation of a valid vaccine coupon, the user has the ability to create a vaccinationappointment. Because the user’s app has been veriﬁed by the input of a coupon, vaccination can be4obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination Coordinationanonymized. Information about vaccination clinics and the vaccination methods that they supportwill be listed within the app (drive-through, walk-in, anonymous, etc.). Once a user has conﬁrmeda vaccination appointment, they will receive a QR code (issued by CDC) that can be used to sign-inat a vaccination clinic.The process of receiving a vaccine can also proceed anonymously. First, a user will be asked toprovide relevant information concerning their eligibility for a COVID-19 vaccine within the app.For instance, current COVID-19 vaccines have not yet been tested in children, pregnant women,and immunocompromised populations. Once a user has provided this information, the app willdetermine if the user is still eligible for vaccination. PHI and PII are not stored and are only usedfor eligibility conﬁrmation. Once this information is conﬁrmed, the app will generate a QR codefor check-in at a vaccination clinic. It is at this point that our proposed vaccine app solution mightinterface with VAMS in order to supply basic vaccine information. No PII will be transferred, butinformation about the clinic, ﬁrst or second dose status, and non-identifying information such as age-range, race, and sex may be communicated to VAMS for record-keeping purposes. A randomizeduser identiﬁer will be transmitted to VAMS in the place of a user’s name.4.1.3 S
ECOND DOSE COORDINATION AND RECORD - LINKAGE
Following vaccination, an individual can receive second-dosage information by using the mobileapp to scan a clinic-provided QR code. In some cases, this might be in the form of barcodes al-ready being created by various vaccine manufacturers for each dose. Otherwise, these codes mightbe printed by vaccination clinics or provided on physical information sheets handed to recipientsfollowing vaccination. Upon scanning this code, the app will store information about the vaccinedose an individual has received and schedule a reminder for a second-dose appointment with thesame vaccine. This reminder could be adjusted later based on the supply of doses. The vaccine appwill also generate a unique vaccine stamp indicating that the user has received the ﬁrst dose of aCOVID-19 vaccine. Second-dose scheduling and vaccination follow the same workﬂow as above.4.1.4 V
Following second-dose vaccination, a vaccination veriﬁcation badge will be generated for an indi-vidual. This can be used in the same way as a VAMS generated vaccination certiﬁcate as publichealth policies change and evolve to accommodate various forms of proof of vaccination status.Additionally, our proposed app will enable a health veriﬁcation challenge-based communicationsystem. This enables the quick identiﬁcation of vaccinated users in a privacy-minded, anonymousfashion. If vaccination becomes a requirement for entry to venues or participation in events, thissystem can be used to quickly and privately identify vaccinated individuals.4.1.5 S
AFETY AND EFFICACY REPORTING
Following the receipt of a ﬁrst-dose COVID-19 vaccine, a user will be periodically prompted tocomplete a symptom and side effect survey to monitor any potential side effects of COVID-19 vac-cines. This enables the tracking of both long and short-term side effects as well as the efﬁcacy ofthese vaccines. This data is not initially automatically uploaded from a user’s device. Instead, it isstored for an individual to personally use in symptom and side-effect tracking and for comparisonagainst aggregated trends. Should a user so choose, they can send an anonymous report of their datafor aggregation and inclusion in studies surrounding the long-term efﬁcacy and effects of COVID-19vaccines. We envision this anonymized data being provided to both vaccine manufacturers for qual-ity control and vaccine technology improvement as well as government agencies for the continueddevelopment of public health policies. This anonymous data sharing is another point of potentialcontact between a decentralized app and systems such as VAERS or V-safe. At this stage, a useris still not required to input PII but can choose to do so if they desire a response from a govern-ment agency regarding any side effects or symptom concerns. Users can also receive notiﬁcationsregarding safety and efﬁcacy via push notiﬁcations rather than via personal contact information.4.1.6 T
RUST AND COMMUNICATION
Our proposed app would contain clear guidelines sourced from government public health policy.Further, the open-source, open standards nature of the app allows careful examination by the public5obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination Coordinationto build user trust. It should be noted that user engagement with our proposed app solution willnot end following vaccination. Continuing users will continue to be periodically prompted to in-put updates to their health status and any side effects that they may experience. This longitudinalplatform can help supplement efforts to study and monitor the long-term efﬁcacy and side effects ofCOVID-19 vaccines. At any point a user can choose to delete the app, clearing all data recorded byit.4.2 C
RIVACY AND DATA SECURITY
Our proposed decentralized solution is intended to be exceedingly privacy-focused with little oppor-tunity for data breaches or spooﬁng. The primary potential vulnerabilities exist only if a user shouldmisplace their smartphone or with the possibility of targeted cyber attacks on the phone itself. How-ever, because there is no centralized repository for personal information, these attacks cannot resultin the loss of multiple individuals’ records.4.2.2 L
OGISTICS AND EFFICIENCY
For an individual user, an app-based solution would be designed for convenience and user experi-ence. We have outlined several points at which such an app might be interoperable with centralizedsystems such as VAMS and VAERS, but there still may be challenges in developing cooperative re-lationships enabling this interoperability. Nonetheless, our proposed app would be a highly efﬁcientsingle source of all vaccine-related functionality for an individual who needs to be vaccinated.4.2.3 E
NGAGEMENT AND USER - TRUST
A primary difﬁculty in adoption of a vaccine management app is ineffective public messaging thatdoes not detail the privacy-minded characteristics . User engagement and trust will hinge largelyon effective communication and education surrounding the privacy and ease of use of app basedsolutions and the many privacy-preserving features they enable in contrast to existing centralizedsystems such as VAMS. The open-source nature of our approach enables a comprehensive descrip-tion of features and security measures with complete transparency, which may be complementedwith effective educational messaging to increase understanding of the relative beneﬁts of app-basedsolutions.4.2.4 M
ONITORING OF HEALTH OUTCOMES
While this decentralized app-based solution may solve several challenges faced by centralized sys-tems with respect to privacy, convenience, and user engagement, it may still be difﬁcult to properlyincentivize users to report symptoms. Furthermore, should the app use anonymized data in aggregatefor statistical purposes, there may be hesitancy and privacy concerns despite the lack of collectedPII.
The high volume PII requirements of VAMS facilitate country-level insights into vaccine distributionat a granular level stratiﬁed by a variety of individual identiﬁers. However, several challenges alsoexist in the widespread adoption of these systems due to concerns over data privacy and barriers toease of use of these systems. Here we propose an app-based solution for vaccine coordination thatcan supplement centralized approaches and is user-focused, privacy-preserving, efﬁcient, and easilyscalable.Key characteristics of our proposed vaccine monitoring app supplement include the opportunity foranonymity and privacy in most steps of the vaccination process. Furthermore, this app consolidateseach of the six most critical functions in COVID-19 vaccination into a single platform, streamliningthe user experience and ideally increasing engagement. Our app also provides the opportunity forlarge scale, participatory data collection efforts to monitor side-effects and efﬁcacy of COVID-196obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination Coordinationvaccines without compromising privacy, ideally providing a source of de-identiﬁed health informa-tion for government policy development and vaccine manufacturer insights.We also propose our SafePaths card-based approach to extend privacy-preserving vaccine manage-ment systems to low resource areas and those without access to mobile devices.Crucially, our privacy-preserving app and SafePaths card systems would be interoperable with othervaccine coordination monitoring and administration platforms such as VAMS and VAERS, reduc-ing the difﬁculty of integrating this new approach. We believe that this app-based approach canincentivize vaccination for individuals valuing personal privacy including undocumented immigrantpopulations and those with pre-existing health conditions.A
We are grateful to Riyanka Roy Choudhury, CodeX Fellow, Stanford University, Adam Berrey, CEOof PathCheck Foundation, Dr. Brooke Struck, Research Director at The Decision Lab, Canada,Vinay Gidwaney, Entrepreneur and Advisor, PathCheck Foundation, and Paola Heudebert, co-founder of Blockchain for Human Rights, Alison Tinker, Saswati Soumya, Sunny Manduva, BhavyaPandey, and Aarathi Prasad for their assistance in discussions, support and guidance in writing ofthis paper. R EFERENCES
Eyewitness News ABC 7. Cuomo: Feds want personal informa-tion as part of vaccine plan, 2020. URL https://abc7ny.com/cuomo-covid-vaccine-social-security-passport/7585438/ .Joseph Bae, Darshan Gandhi, Jil Kothari, Sheshank Shankar, Jonah Bae, Parth Patwa, RohanSukumaran, Sethuraman T. V., Krutika Mishra, Srinidhi Murali, Aishwariya Saxena, Kasia Jaki-mowicz, Vivek Sharma, Rohan Iyer, Ashley Mehra, Alex Radunsky, Priyanshi Katiyar, SunainaAnand, Shailesh Advani, Jagjit Dhaliwal, and Ramesh Raskar. Challenges of equitable vaccinedistribution in the covid-19 pandemic, 2020.Joseph Bae, Rohan Sukumaran, Sheshank Shankar, Saurish Srivastava, Rohan Iyer, Aryan Mahin-dra, Qamil Mirza, Maurizio Arseni, Anshuman Sharma, Saras Agrawal, Orna Mukhopadhyay,Colin Kang, Priyanshi Katiyar, Apurv Shekhar, Sifat Hasan, Krishnendu Dasgupta, DarshanGandhi, Sethuramen TV, Parth Patwa, Ishaan Singh, Abhishek Singh, and Ramesh Raskar. Mitsafepaths card (misaca): Augmenting paper based vaccination cards with printed codes, 2021.Bloomberg. Single-dose johnson & johnson covid vaccine could soon head to reg-ulators, 2021. URL .Center for Disease Control and Prevention. Reminder systems and strategies for increasing child-hood vaccination rates, 2020a. URL .Center for Disease Control and Prevention. Timing and spacing of immunobiologics, 2020b. URL .Center for Disease Control and Prevention. Vaccine needs assessment: A series on standardsfor adult immunization practice, 2020c. URL .Center for Disease Control (CDC). Vaers — vaccine safety — cdc, 2020a. URL .Center for Disease Control (CDC). Vams — covid-19 vaccination reporting systems — cdc,2020b. URL . 7obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination CoordinationCenter for Disease Control (CDC). User manual: Vacccine recipient, 2020c. URL .Kat Jercich. States rely on wide range of it systems to manage covid-19vaccines, 2021. URL .Kathleen Dooling MD MPH. Phased allocation of covid-19 vaccines, 2020.Holly Ramer. New hampshire to ditch federal vaccine schedul-ing system, 2021. URL .SARAH ELIZABETH RICHARDS. Pﬁzer vaccine results are promis-ing, but lack of data ‘very concerning,’ experts say, 2020. URL .Chirag Samal, Kasia Jakimowicz, Ishaan Singh, Mehrab Singh Gill, Orna Mukhopadhyay, ParthPatwa, Qamil Mirza, Sualeha Irshad, Saras Agrawal, Saurish Srivastava, Sheshank Shankar, Ro-han Iyer, Rohan Sukumaran, Ashley Mehra, Krishnendu Dasgupta, and Ramesh Raskar. Vacci-nation worldwide: Strategies, distribution and challenges, 2021.National Academies Press (US). Institute of medicine (us) forum on medical and public health pre-paredness for catastrophic events. the 2009 h1n1 inﬂuenza vaccination campaign: Summary of aworkshop series, 2010. URL .World Health Organization (WHO). Vaccinations and trust: How concerns arise and the role ofcommunication in mitigating crises, 2020. URL . F REQUENTLY A SKED Q UESTIONS W HAT ARE THE BENEFITS OF THIS APP FOR VARIOUS STAKEHOLDERS ? For public health agencies: Interoperability:
Integrates with existing systems with processes for easy informationsharing.2.
Coordination and Efﬁciency:
Reduced dependency on digital IT systems working seam-lessly with one another (hospital EMR systems, clinic management systems, centralizedmonitoring systems).3.
Feedback and monitoring:
App-based reporting of symptoms and efﬁcacy directly fromvaccinated individuals can be reported in nearly real-time.4.
Possibility for targeted, contextual messaging and information sharing.5.
Data aggregation and dashboard visualization:
Granular data anonymously reportedfrom users can be used to monitor population-level trends.
For users: Privacy:
End-to-end system for vaccination without requiring the sharing of PII.2.
Allows anonymous access to all marginalized and vulnerable populations. TheVaxSafe card system extends this to those without mobile app access.3.
Single platform for all functions of COVID-19 vaccination. Reduced require-ment for redundant and intrusive data input.
For pharmaceutical companies and vaccine makers:
Clear pipeline for side-effect data sharing that can supplement adverseevent reports from VAERS.2.
Monitoring and Reporting:
Opportunity for collaboration to build systems reporting themost relevant efﬁcacy and side-effect information to monitor long-term side effects andefﬁcacy.3.
Opportunity for ‘recall’ of vaccine lots with reduced efﬁcacy and ability toalert affected users.H
OW WILL WE ENCOURAGE USERS TO DOWNLOAD THE APP ?First, we believe that the beneﬁts of a privacy-focused app will attract users to prioritize data-securityin the COVID-19 vaccination process. We also believe that the efﬁciency and ease of use of ourproposed vaccination framework will appeal to many individuals. Additionally, we plan to tap intoan already large existing user-base of EN contact tracing app users. Finally, we will build on existingpartnerships with medical centers and state governments.I
S THIS VACCINE APP A REPLACEMENT FOR EXISTING
OR STATE SYSTEMS ?No. Systems such as VAMS/VAERS/V-Safe/IIS/IZ will still be important in widespread COVID-19vaccination efforts. Our proposed app would provide an alternative method for vaccination that isprivacy-sparing, efﬁcient, and equitable while serving as a supplemental source of vaccine monitor-ing information.H
OW WILL THIS INTERFACE WITH
AFE / IIS/IZ? W
HAT CHANGES AREREQUIRED ?Vaccine diary, second-dose, and health status alert, and informational features of our proposed appwould be independent of existing systems. The input of vaccination information upon administra-tion of a vaccine and side effect/efﬁcacy reports are two areas with potential for integration withgovernment systems.To verify and record vaccine administration, vaccination clinics or governments would need to pro-vide signed QR codes that can be printed/copied by pharmacies or by users. This QR code wouldhave information regarding the lot, manufacturer, and dosing of a vaccine which can then be veriﬁedby others with the appropriate digital key.For interoperability of symptom/side effect reports, state or federal systems will need to allow thepseudorandom identiﬁer associated with a user to be used for data identiﬁcation purposes rather thanPII such as name, address, etc. This is already part of the PPRL (privacy-preserving record linkage)protocol for VAMS and IIS.I
F YOU DON ’ T HAVE
HOW CAN A DOCTOR OR HEALTHCARE PROVIDER GET IN TOUCHWITH THE USER ?Doctors and public health ofﬁcials can contact users regarding pertinent information about theirspeciﬁc vaccine lot and other important details via app-mediated push notiﬁcations and contextualalerts. This is similar to ‘recalls’ in auto-parts, food safety, toys, etc.W
HAT DIFFERENCE WILL IT MAKE ? W
OULDN ’ T EVERYONE BE VACCINATED ANYWAY ?Signiﬁcant chunks of the population still exhibit vaccine hesitancy and many may be unwilling toreceive a COVID-19 vaccine. This app aims to address potential barriers to vaccination by protectingdata privacy, creating a convenient, streamlined user experience, and providing multiple vaccine-related functionalities in one platform. 9obile Apps Prioritizing Privacy, Efﬁciency and Equity: A Decentralized Approach to COVID-19Vaccination CoordinationI
S THIS APP PRIMARILY A VACCINE PASSPORT OR VERIFIABLE CREDENTIALS ?This app does support vaccine veriﬁcation while also including modules surrounding eligibility con-ﬁrmation, dose scheduling and reminders, health assessments, and symptom reporting, and provid-ing users with push-notiﬁcations and contextual alerts.H
OW WILL YOU REACH MARGINALIZED AND LOW - RESOURCE COMMUNITIES ?We have also proposed state-produced physical vaccine cards that can be used for many of thefunctions of our app solution. This enables a privacy-focused solution for vaccination. Please see athorough explanation in section 6.W
HY SHOULD USERS TRUST THE APP ?Our app is developed using open-source code and open standards.W
HY DO CENTRALIZED SYSTEMS INCLUDING
REQUIRE SO MUCH
HPI?PII including name, date of birth, and contact information is primarily used for user identiﬁcation,contact, and record-keeping. Health information is stored to determine eligibility for vaccinationbased upon exclusion criteria and to track the interactions between various medical conditions andvaccination. Other personal information might be used for aggregate analysis and statistical purposesregarding equitable distribution among diverse populations. Our app-based approach addresses eachof these functions without the use of PII.Identiﬁcation of an individual for record-keeping is performed using a pseudorandom identiﬁcationnumber rather than name or date of birth. Previous health information can be inputted into the appfor exclusion determination where it is not stored. As soon as the app determines eligibility for vac-cination information shared in these questions will be deleted. Symptom and adverse event reportingcan be performed either anonymously or with personal information that might lend insight into thevaccine and medical condition interactions. All demographic information can be anonymized andaggregated for reporting.W
HAT IF THE USER DOES NOT HAVE A SMARTPHONE ?We expect users seeking a privacy-oriented approach to vaccination to use a physical card containinga digitally-signed QR code from the government.W
HAT IS P ATH C HECK AND WHAT ROLE CAN IT PLAY ?PathCheck is a nonproﬁt organization originating in Dr. Ramesh Raskar’s lab at MIT. We are theworld’s largest open-source, open standards non-proﬁt organization for COVID-19 and research abroad array of problems stemming from the pandemic. PathCheck was the ﬁrst organization tolaunch an EN app for contact tracing in COVID-19, successfully partnering with 6 US states andterritories.W
AFE P ATHS ? W