How direct engagement with residents helped Hackney tackle COVID-19 - and what this means for local pandemic preparedness.
By Edward Grierson
The London Borough of Hackney suffered heavily during the COVID-19 pandemic of 2020-21. By April 2020, it had the third highest COVID-19 death rate of all local authorities in England. In response, Hackney Council implemented a robust system of contact tracing, which centred building trust with residents, while integrating the COVID-19 response with other local services.
This community-led response is now the subject of a report by Dr Richard McKay, affiliated with the Department of History and Philosophy of Science, and Dr Alexa Hagerty, affiliated with the Minderoo Centre of Technology and Democracy. It was a collaboration between the Department of History and Philosophy of Science, Hackney Council, and Mapping for Change, which uses maps to visualise complex issues. The project’s principal investigator is Dr Freya Jephcott, of the Centre for the Study of Existential Risk.
The report, titled ‘Contacts are Community: Hackney’s experiences of COVID-19 contact tracing’, is based on research carried out from 2020 to 2023. It uses interviews with contact tracers and participatory research with Hackney residents to study the success of Hackney’s pandemic response. From this, it offers a blueprint for local healthcare and future pandemic preparedness.
National and local support – a complex landscape
The COVID-19 pandemic hit a public health system in England that was still getting to grips with a significant reorganisation in 2013, and that had been subject to sustained funding cuts since. Hackney is one of London’s most diverse and deprived boroughs, with a 28% poverty and an especially high child poverty rate at 43%. An estimated 40% of Hackney’s population are from Asian, Black, and mixed or multiple ethnic groups. Factors such as race, ethnicity, deprivation and occupation impacted the risk of infection and death from COVID-19, with South Asian and Black British adults facing higher death rates than their White British counterparts, largely due to pre-existing social health inequalities.
To reduce the spread of COVID-19, the UK government prioritised contact tracing, wherein infected people were identified and isolated to contain the virus. In May 2020 they launched NHS Test and Trace, which attempted to make the process more efficient through swab testing and a call centre network. However, concerns quickly arose that Test and Trace was not meaningfully reducing the spread of COVID-19.
Those who experienced this system described confusion over constantly changing government guidelines, and excessive calls from the Test and Trace call handlers. If multiple family members contracted COVID-19, each one would be contacted separately. All call handlers were given a standard script to recite to those contacted, which led to recipients feeling the calls were overly impersonal.
The times of day that people were contacted were also arbitrary, and did not consider people’s individual schedules. When this happened repeatedly over a day, with people hearing the same script multiple times, many were left frustrated. The UK government also attempted to introduce a national contact tracing app to enhance NHS Test and Trace. Initially, a centralized model was developed in 2020, but concerns over data privacy, technical limitations, and interoperability led to its abandonment. Instead, the UK adopted the decentralized Apple-Google Exposure Notification system, which was used in multiple countries. While this international model offered greater privacy protections, it still faced major challenges.
Despite early excitement, the app struggled with adoption, accuracy, and trust. It assumed that contact tracing could function purely as a data exchange – alerting individuals based on proximity via Bluetooth – without recognising the complexities of human behaviour, trust, and public health engagement. This data-driven approach overlooked the relational and reciprocal nature of effective contact tracing, where personal interaction, community trust, and tailored public health messaging played a crucial role in persuading people to follow isolation guidelines.
These difficulties interested McKay, who had previously researched contact tracing in the history of sexual health and HIV. He found that the UK government’s highly centralised and digitally focused approach did not reflect what he knew about effective contact tracing.
“There was a disconnect with the contact tracing that was being suggested through the media, at a national level with an app taking care of everything in a seamless way,” he explains. “It didn't accord with what I knew about contact tracing, as a complex, highly skilled and interdependent practice. You were also seeing reports of public health directors in communities saying that they were being shut out of the process.”
McKay teamed up with Hagerty and together they approached the London Borough of Hackney in the summer of 2020, just as the local authority’s public health department was planning its own initiative, led by Dr Andrew Trathen.
Building trust
In September 2020, Hackney Council set up a local contact tracing programme to supplement the work of NHS Test and Trace, and McKay and Hagerty shadowed their work for months. What differentiated Hackney’s system from the national one was its use of what McKay and Hagerty have called a “relational-reciprocal approach.” In contrast to the one-size-fits-all system of NHS Test and Trace, this approach emphasised personalising interactions between callers and handlers. Doing so helped build trust on both sides.
“We were motivated to get involved with local contact tracing, not just to add capacity to the national system, but because we felt there was an opportunity to serve our community better by doing it,” explains Dr Sandra Husbands, Hackney’s director of public health.
Hackney Council trained a small group of its customer service employees to carry out contact tracing work. When making calls, the tracers were encouraged to speak to people directly and allocate as much time as necessary for each one. As the report put it, ‘rather than framing contact tracing as an uncomplicated transfer of information, it emphasised the importance of cultivating relationships and recognising the experiences and needs of residents.’
The call handlers attended daily briefings, which provided public health expertise and updates on evolving government guidelines, and set up peer support sessions, which they ran collaboratively.
“The people who worked on the customer support line for Hackney Council looked and sounded like the Hackney residents,” says McKay. “There were demographic equivalents between the community and the customer call lines. So having that diverse representation in the people who are responding to the calls, and trained to become the local contact tracers, is going to be an effective approach.”
Adaptable solutions built by local experts
From the start, contact tracing formed part of Hackney’s wider pandemic response, and Hackney Council developed a system in which contact tracing was bundled with other local services such as food and medicine delivery. Having locally trained call handlers meant they could connect residents to these local services as needed.
But to efficiently integrate these local services, Hackney Council needed to develop technological solutions. Designed by the council’s IT Team, ‘Here to Help’ was Hackney’s local, open-source system that brought together contact tracing and other support services.
Unlike the national contact tracing app, which attempted to automate the process without human engagement, ‘Here to Help’ was designed with the principles of relational and reciprocal support at its core. While the national system assumed individuals would respond to automated alerts, Hackney’s approach recognized the importance of direct communication and trust-building. This human-centred approach allowed for more effective public health interventions, ensuring that residents not only received the necessary information but also the support they needed to follow public health guidelines.
This local development of public health technology interested Hagerty, who had previously been involved in research on the societal impacts of artificial intelligence.
“I had already been thinking about AI systems, algorithmic systems, and their use in public health,” she says. “Very often, people developing these AI systems had very little knowledge of public health themselves, and very little contact with public health officials or people in the communities.”
Without meaningful collaboration between AI developers and public health professionals, these systems risk being ineffective, inequitable, and disconnected from the lived realities of the communities they aim to serve. Recognizing these challenges, Hackney took a different approach – one that prioritized local expertise, trust, and direct engagement.
In addition to contact tracing, 'Here to Help' could be used to provide residents with bereavement support, arrange deliveries of food and prescription medicine, and book vaccinations.
The overall result was that healthcare services became more accessible. The contact success rate for NHS Test and Trace increased by 12% from September 2020 to January 2021. Hackney’s contact tracing likely contributed to this. Zoe Tyndall, the former Head of Service at Hackney Council, also estimates ‘Here to Help’ saved local contact tracing managers 72 to 102 minutes a day.
A blueprint for the future?
The ‘Contacts are Community’ report makes several important points about future pandemic planning. It identifies the need for consistent government protocols, integration between local and national healthcare systems, and more funding for local governments.
However, the most crucial issue highlighted by ‘Contacts are Community’ is the need for pandemic responses to be attuned to the needs of local communities. Doing so means involving these communities in the planning process.
Hackney Council’s relational-reciprocal approach to contact tracing showed how to implement this. They prioritised making calls friendlier and more personal and integrating healthcare with other services. By doing so, they improved people’s trust in the services, which made them more willing to share health information.
“Having that local expertise was so important, because you're communicating about something personal and sensitive, something that impacts people’s health, and their families, and their ability to work and care for loved ones,” explains Hagerty.
“That local expertise and knowledge will lead you toward different solutions, tailored to particular places. But if you think about what happened in Hackney – taking the community very seriously and learning from local knowledge – then that is a lesson that can be repeated.”
‘Contacts are Community’ is available to view on the Hackney Council website as a visual research report. Its layout and design, by Sophia Luu, are intended to make it accessible to people outside of medical science.
“We really wanted to honour the spirit of this project”, says Hagerty, “as a community-based collaborative project, and have our first output be not just accessible, but engaging.”
This person-centric approach has been adopted by the UK COVID-19 Inquiry. Its ‘Every Story Matters’ programme has invited members of the public to contribute their experiences of the pandemic, to inform future pandemic policies.
“Doing exactly what Hackney did won't work for every community,” says McKay. “But the spirit of what they did absolutely will.”