“…if it is a fact that people like to have examples given them, men of the type they call heroic, and if it is absolutely necessary that this narrative should include a “hero,” the narrator commends to his readers… this insignificant and obscure hero who had to his credit only a little goodness of heart and a seemingly absurd ideal.” – La Peste, Albert Camus
The Covid-19 testing effort in Utah was underscored by an attitude to challenge the medical establishment. Last April, Utah Governor Gary Herbert announced an ambitious plan to double the state’s Covid-19 testing capacity by working with companies affiliated with Silicon Slopes, a promotional group for Utah’s technology industry. Governor Herbert made this decision after a number of tech executives, who had no prior knowledge or experience in lab testing, came together “virtually overnight” out of goodwill to suggest solutions for testing infrastructure in the state.1 TestUtah was born, clad in the colors and social media campaign of a high tech startup with a philanthropic twist.
TestUtah was conceived as an experiment in ‘disruptive innovation.’ The term originates from a 1995 paper by the late Harvard Business School Professor Clayton M. Christensen and may very well be the most popular business concept of the 21st century. Formally, disruptive innovation describes a process in which a smaller business, with fewer resources, upsets industry leaders by going after the low-end market. As the story goes, while incumbent players are too concerned with incremental improvement on established innovations, newcomers have the opportunity to ‘disrupt’ the market by perfecting a product’s most desired features at a lower price. Successful disruptors build on their initial success with low-end customers to attract the mainstream market, eventually capturing much of the market or creating a new one altogether.
Over the years, the disruptive ethos has become a distinctive feature of Silicon Valley’s self-branding. In ways more akin to Joseph Schumpeter’s constant turmoil of industrial mutation through ‘creative destruction’ than to Christensen’s business theory, tech has embraced ‘disruption’ as a kind of techno-Darwinism. To prevent a tech startup from upending the arrangement of industries is tantamount to a war against nature. How exactly a company goes about this does not particularly matter to be known as a ‘disruptive innovator’ colloquially. Disruptive innovators enjoy a popular understanding as underdogs, innovative rookies who can see what the giants cannot. The established powers are at the mercy of a certain kind of fatalism of bloated bureaucracy and blindness. The supposed panacea for inventing a better world is ‘disruption’, in the form of young technologists keen on solving problems through the lens of fresh eyes and creativity rather than domain expertise.
The theory-cum-slogan of Silicon Valley is one more malleable category that supports the industry’s self-conception. Uber, for instance, doesn’t fit the theory as Christensen understood it, yet it is perhaps the most-famed ‘disruptor’ of the past decade. In the Valley, truthful description of what a company does is often secondary to the project of the entrepreneur creating that which does not exist. To encourage people to invest, build, and buy into an idea requires persuading others to accept a make-believe future. Bending the truth a little and ‘faking it till you make it’ is an accepted part of what it takes to be a founder. The looseness in which a term like ‘disruption’ is used has made it challenging for people trying to think about how the tech world actually understands itself. It’s unclear what should be taken seriously. One thing is for certain: Uber, 12 years after its founding, craves to be seen as an innovation rather than a yet-to-be profitable business whose existence gravely depends on employment status laws. The image of being a ‘disruptor’ has weight. It is sought after to signal not that you have everything figured out, but that you’re a different kind of competitor altogether.
In March 2020, when Covid-19 cases exploded in the United States, local and state government officials welcomed anyone willing to help coordinate testing and first responders. This was in part due to the failure of federal agencies to present a coherent testing strategy at a time when some countries were already delivering thousands of tests per day.2 By the end of March, the majority of America’s testing capacity was through commercial labs.3
It was clear to many in March that any kind of mass participatory testing or contact-tracing infrastructure would require novel, convenient, consumer technology-based solutions. Developing effective tests would only be part of the challenge. States needed to figure out how to source the test kits, coordinate test sites, obtain the appropriate instruments to run them, manage data while respecting privacy, and make this data accessible to healthcare workers and policymakers.
TestUtah was launched in April as a volunteer effort of software, medical, and biotech companies coming together to do just this. The testing expansion project was marketed as a novel kind of public-private partnership in close collaboration with local hospitals and the state’s health department. Mark Newman, CEO of Nomi Health, a health-care startup part of the handful of companies behind TestUtah, saw their role as “the exact same story of Clayton Christensen and disruptive innovation.”4 TestUtah aimed to bring the tech startup brand of innovative resourcefulness to the Covid-19 crisis. Using the lens of disruptive innovation, their solution would be to take on the public and commercial laboratories in the state (which include some of the largest facilities in the country) and prove that a tech startup model could do it better.
TestUtah was plagued with problems from the outset. Accusations of conflicts of interest, delayed results, and, later, questions over the accuracy of the tests themselves worried public health officials. The tests’ sensitivity were questioned after an investigation by The Salt Lake Tribune reported TestUtah’s positive test numbers were less than half of others testing in the state.5 In Nebraska, the positive rate was less than a third of the overall testing rate. One month later, Timpanogos Regional Hospital, the site where TestUtah processed its tests, was found to be “not in compliance” with federal certification guidelines.6
Utahns discovered quite quickly that there were enormous accountability challenges with a program like TestUtah. Despite promoting themselves initially as a philanthropic partnership, the companies behind the program have been awarded no-bid contracts in Utah, Iowa and Nebraska totaling more than $80 million.7 More, the public will never know with certainty whether or not these tests were flawed. After the program came under scrutiny, TestUtah and Timpanogos Regional Hospital declined to participate in a collaborative experiment with other labs in the state to confirm the quality of their tests.8 In September, after three failed attempts to reliably ensure the accuracy of the tests by other means, state officials forced TestUtah to change its test provider and processing lab.
Struggling to meet volume and process test results on time were not uncommon problems of early state testing initiatives. The dysfunction of TestUtah, on the other hand, appears to be a symptom of entrusting inexperienced technology companies to tackle complex public health problems. The urgency of a crisis demands circumventing some of the normal operating procedures of business as usual. Although, in a moment when the system was overwhelmed, TestUtah offered itself not just as a helping hand, but as a new kind of arrangement between government and business: an adversarial partnership. Emails later obtained through public records requests show that’s exactly what the state got. Utah Department of Health officials and epidemiologists were sidelined, given mostly advisory roles in the state’s flagship Covid-19 response programs.9 The chief infectious disease scientist at the Utah Public Health Laboratory wrote to a colleague that the Governor’s budget office behind TestUtah had gone rogue. In trying to outdo public health officials, state labs, and other experts responding to the crisis, the state may have wasted millions of dollars and months of time with faulty tests.
Proper recognition of TestUtah’s failures need not discourage ambitiously reimaging alternatives to the status quo. It will certainly not be the last ‘novel public-private partnership’ to claim heritage in the Silicon Valley mythos. It may be the case that TestUtah is just one example of how loose ideals of public ‘disruption’ unfold in practice. Yet, public health infrastructure is by design not the manifestation of a single founder’s vision; it is a negotiated effort, iterating on old methods and reforming institutions in ways that are in touch with those who understand why existing structures were created.
Disruptive innovation, or whatever has become of its popular distortion, prescribes a design sprint in isolation, moving fast, and leaving others who can’t keep up behind. The solution to competently mitigating public health crises is not indiscriminately offloading responsibility to market solutions, regardless of how ‘innovative’ they may present themselves to be. Fixing the massive coordination problems of inefficient bureaucracy is not as simple as running the public health programs like a tech company. Be that as it may, the past year has made it clear that too many public officials buy the Valley’s marketing and mythology at face value.