September 17 was a massive Covid-19 vaccination day for India. The country recorded 2.5 crore (25 million) doses as being delivered in a single day. Politicians from the Bharatiya Janata Party hailed the massive figures, describing it as a gift to Prime Minister Narendra Modi, whose birthday was that day.

Among the states, Bihar topped the charts. It recorded 33,98,685 vaccinations until the midnight of September 17 – ahead of Karnataka, Uttar Pradesh, Madhya Pradesh and Gujarat, all states in which the BJP is in power. Bihar is ruled by an alliance government of the Janata Dal (United) and BJP.

On average, 2,000 vaccination sites are functional in the state on any given day, but on September 17, the number went up to 14,483. Over 50,000 healthcare workers were roped in to vaccinate beneficiaries and upload the data online.

But behind the massive success in Bihar, primary health centre officials and data entry operators from several districts claim they “were under tremendous pressure to perform”. While they carried out large-scale vaccinations on September 17, a significant chunk of data uploaded on that day was actually of people vaccinated offline over the previous two days, several officials told, on the condition of anonymity.

Offline vaccination describes immunisations delivered at a site where data of beneficiaries is physically noted down but not uploaded on the government’s CoWIN portal. An online vaccination means the data is uploaded on portal as vaccinations are being administered.

Officials said if data is uploaded on CoWIN on September 17, it would reflect as an inoculation carried out on that day.

‘Offline’ doses

An official who monitors the Electronic Vaccine Intelligence Network, a portal that records the utilisation of vaccine doses and the status of the supply chain, said that he was surprised to see the portal show negligible utilisation of vials in Bihar on September 16, even as the routine Covid-19 immunisation procedures were underway.

“I started ringing up district officials,” the official said. “They said vaccination was happening offline. They had instructions to upload data on September 17.”

Bihar had 1,333 vaccination centres functional on September 16, but they reflect only 86,253 doses administered on CoWIN. For September 15, only 1,45,593 vaccinations were uploaded on CoWIN. An average daily vaccination count in Bihar in the preceding week stood at 5.5 lakh doses per day.

Bihar vaccination trends. Credit: CoWIN portal.

In Darbhanga and Saharsa districts, local health officials said the district magistrates issued instructions to withhold uploading the bulk of vaccination data on the CoWIN portal on September 16.

Officially, Darbhanga district uploaded data of just 752 vaccinations on September 16 on CoWIN. District civil surgeon, Dr Anil Kumar, who oversees the vaccination drive, maintained that they had low vaccine stock on September 16. “We carried vaccination in just one centre that day in Town Hall and counted 752 vaccinations,” he said.

But in just Darbhanga Sadar primary health centre – one of 13 in the district – approximately 3,000 vaccinations were carried out on September 16. The entire data was uploaded on September 17, a local official said. The centre uploaded data on around 11,000 vaccinations on September 17 on CoWIN, including 8,000 vaccinations conducted on that day.

Apart from the Sadar primary health centre, officials at several centres in Darbhanga confirmed to that they carried out vaccinations on September 16, despite Kumar’s claim that the operation only took place in the Town Hall that day.

In Jalley primary health centre, 2,700 vaccinations were carried on September 16, the primary health centre submitted in its report to district. In K Asthan Satighat primary health centre, 1,460 vaccinations were conducted on September 16.

In Andauli village, a vaccination camp was held in the government school on September 16, local BJP leader Dharmendra Paswan said. “On September 17, we did not have a camp, since there was Vishwakarma puja and Modiji’s birthday that day.” He added that a special vaccination camp was organised in nearby village Milki Tola on September 17.

Mangal Mukhiya, another resident of Andauli village, said six members of his family went for the camp on September 16. Since the village falls under the Alinagar primary health centre, the names of beneficiaries were noted down accordingly and uploaded a day later. “We immunised 100 people that day, and gave all details to health department,” a village-level official in Andauli confirmed.

At several primary health centres in Darbhanga, the officials in charge were told that the “session site”, an online slot on CoWIN to log vaccinations, would be shut on September 16. “We were asked to carry out vaccinations offline,” a medical officer in one of the centres said, requesting anonymity. On September 17, the district reported 1.26 lakh vaccinations.

District magistrate of Darbhanga, S M Thiyagarajan, did not respond to calls and messages seeking clarification about this.

Delayed data

Saharsa district showed 253 vaccinations on September 14, zero on September 15, 79 on September 16 and 82,826 on September 17.

District magistrate Kaushal Kumar said no vaccinations were conducted on September 15. When asked whether vaccination data of September 14, 15 and 16 was uploaded on September 17, he said, “We uploaded data of whatever vaccination happened on September 17 on the same day.”

But local health officials said in the primary health centres in Kahra, Panchgachhiya and Banma Itahari, Covid-19 immunisations were conducted every day, including on September 15, even though the district has uploaded zero entries on CoWIN.

In the Banma Itahari primary health centre, 650 immunisations were done on September 14; 800 immunisations on September 15; 720 on September 16; and 2,080 immunisations on September 17. In the Kahra primary health centre, a health official said an average 300-400 vaccinations are administered every day.

“We had similar vaccinations on September 14, 15 and 16,” the official said.

The health officials said they passed the data to “higher officials” at the district level to upload on CoWIN.

In Saharsa, zero doses were shown administered on September 15 when at least three PHCs confirmed conducting routine vaccinations.

In Lakhisarai district, just seven doses are reflected on CoWIN on September 16 and 31,388 on September 17. contacted villagers who said that the routine immunisation programme was conducted at medical camps on September 16.

“I could see a queue on September 16 outside the centre,” said Kunal Kumar, who lives right next to a vaccination centre in the Samudaik Bhavan, or community centre, in Lakhisarai block. “Vaccination was happening as usual.”

Ravinder Sharma, another resident of Lakhisarai block, said vaccinations were was also carried out at a centre in Town Hall on September 16. “I live in the neighbourhood. We come to know whenever there is vaccination in our block,” he said.

However, Lakhisarai district immunisation officer Dr Ashok Kumar Bharti maintained that no vaccinations were administered in the district on September 16, except in Sadar hospital.

Bihar has so far immunised 4.19 crore people with the first dose, and fully immunised 98.62 lakh adults. The state has covered 33.4% of its adult population with the first dose and nearly 8% with both doses, considering its population of 12.4 crore based on Unique Identification Authority of India estimates for 2020. The state is among the five lowest-performing states in India.

Before September 17, its last highest single-day vaccination was on August 31, when it administered 27.57 lakh doses.

Administration pressure

Data entry operators said when daily vaccination numbers are very high, the uploading of data could spill over to the next day or be passed on to the district office to be uploaded. “That usually happens when we conduct offline camps in villages,” said one operator. “By the time we return to the office it is too late to upload on CoWIN, so we do it the next day.”

But a data entry operator in Purnia district said that on September 17, they “were under a lot of pressure to perform” to mark the prime minister’s birthday. The Bihar government paid Rs 150 as an incentive to operators to work extra hours that day. Several operators worked till beyond midnight from home to upload as much data as possible.

Darbhanga district had a target of uploading 1.50 lakh vaccinations. Civil surgeon Anil Kumar said that they roped in 486 vaccinators and over 700 data entry operators, up from the regular number of 200 vaccinators and over 400 operators.

On September 17, data about over 40,000 immunisations were getting uploaded per minute in India. By afternoon, the country hit the one crore mark. Of the 2.5 crore vaccinations recorded on September 17, 1.7 crore was in rural regions – the maximum so far in a single day.

Pappu Khan, a politician affiliated to Insaaf Manch who is running for Zilla Parishad elections in Darbhanga, said that local health officials were under pressure to show high vaccination numbers on Modi’s birthday. “PHCs can’t immunise beyond a certain capacity,” he said. “Several had no option but to manipulate data to spike vaccine consumption on September 17.”

But Pratyay Amrit, the additional chief secretary (health), expressed ignorance about this. “This is news to me,” he said. “I have no idea about this.” also sent an email to the State Health Society, which is managing the vaccination drive in Bihar. Its response is awaited.

“This kind of fudging to please the Centre must not happen with vaccination data,” said Dr Shakeel, from the Bihar chapter of the Jan Swasthya Abhiyaan, a network of people’s movements that works on health rights. “There should be transparency in the entire vaccination programme to build confidence in the population.”

Bihar Chief Minister Nitish Kumar has announced the state will carry out 6 crore vaccinations by December. “The administration is putting a lot of pressure on the health system,” a senior official in the state government said. “The entire vaccination is handled by district magistrates. Civil surgeons just follow instructions.”

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.