Contact Tracing: Barriers and Facilitators

Wafaa M. El-Sadr, MD, MPH, MPA; Joey Platt, MPH; Melanie Bernitz, MD, MPH; Melissa Reyes, MPA


Am J Public Health. 2022;112(7):1025-1033. 

In This Article

Abstract and Introduction


Contact tracing—the process of identifying, isolating, and managing infected persons and their contacts—is a recognized public health measure for controlling the transmission of infectious diseases. In the context of the COVID-19 pandemic, contact tracing has received intense attention. We provide a brief overview of the history of contact tracing during several major disease outbreaks in the past century: syphilis and other sexually transmitted infections, HIV infection, tuberculosis, Ebola virus disease, and COVID-19. Our discussion on the barriers to and facilitators of contact tracing offers a perspective on societal and institutional roles and dynamics, stigma as a major barrier to effective tracing efforts, and how the nature and epidemiology of the infection itself can affect its success. We explore the evolution and adaptation of contact tracing and provide insights for future programming and research.


Contact tracing is acknowledged as a key strategy for controlling the spread of infectious diseases. It entails locating, isolating, and managing individuals who have an infectious disease (cases), identifying individuals who had contact with the case (contacts), and quarantining such individuals and referring them to testing and other relevant interventions.[1] Timeliness and thoroughness in collecting information are critical to the success of contact tracing. In the COVID-19 pandemic, with hundreds of millions of cases reported to date, it has become critically important to monitor the spread of infection and to interrupt the potential for the ongoing spread of disease.[2,3]

Stigma is a major threat to the efficacy of contact tracing. Stigma is characterized as a negative attitude or behavior toward a person or a group who shares distinguishable traits of a health condition or disease. Stigma can provoke and perpetuate relations of power and control, allowing some groups to devalue others.[4] It is often a response to fear or threat of a serious disease, especially one with highly uncertain and fast transmissibility.[5] Evidence suggests that stigmatizing a medical condition is greatest when the condition is associated with behavior or actions that may be perceived as inconsistent with social norms[6] or when its cause is regarded as one's responsibility.[5,7,8]