It has been more than two weeks since the Central government rolled out the fourth phase of vaccinations making those between 18 to 45 years eligible for the jab. Yet, 38-year old Izhar Ahmad has still not been able to get a vaccine or even a slot for that matter.
“I do not have that kind of a mobile phone,” said Ahmad, referring to a smartphone that would allow him to use the internet to register online. Ahmad works as an assistant in a private firm in Faridabad in Haryana and lives in Jagdamba Camp, a slum cluster in South Delhi.
“Even if I have the phone, I do not know how to do it [register],” he said. “If I ask someone to do it, they say that my slot will come 40 km away.”
Ahmad is among the many who have been unable to access the vaccine because of a digital divide. On May 1, in the middle of a brutal second wave of infections, India opened up vaccinations for those between 18 and 45 years. But unlike the walk-in facility for those above 45 years, the Centre made it mandatory for each beneficiary below 45 years to first register on CoWin, its online platform, with a relevant identity proof.
After registration, users have to book a slot for themselves and are free to choose a centre in their chosen state and district. But this has been an impossible feat for many.
On April 28, when registrations opened for those above 18, the website crashed barely minutes after it launched. Once past this glitch, several users struggled to find relevant slots nearby at private facilities, government schools and dispensaries. But overnight, online resources and Telegram updates provided regular information whenever new slots were added.
Those who were able to book a slot mostly belonged to a mobile, tech savvy upper middle class that was able to navigate this online maze. As slots in cities were booked out, most of them did not hesitate to drive down to a healthcare centre in rural areas to get the shot there.
Rinki Nagpal, who resides in Gurugram, Haryana, spent two weeks looking for a slot in the city but was unable to find any. “It was like a game,” said Nagpal, 30, who teaches at a private school in Gurugram.
Finally, on the evening of May 14, she was able to secure four slots on the portal for herself, her husband, her brother-in-law and his wife – more than 30 kms away in Pataudi village.
“I am a cancer survivor so I just thought I had to get it done,” she said. “Distance was not an issue.”
Nagpal and her family drove to Pataudi on the day of the appointment. “It was a smooth drive, there was no rush or traffic,” she said. When she reached, she found the hospital to not be very crowded, and had to wait for an hour till the health workers returned from their lunch break. Once they did, she was vaccinated within ten minutes.
In other cities as well, city dwellers were driving far and wide to get their vaccine. In Pune, Maharashtra, beneficiaries from the city travelled 100 kms away to far flung villages to get their first dose of the vaccine, entering public health centres for the first time. A similar instance was reported from Noida, Uttar Pradesh, where a beneficiary drove for over 30 kms to get his vaccine in a village.
Upset at the city-dwellers swarming in, residents in two villages in Gurugram, Haryana, reportedly seized vaccines from healthcare workers and demanded not to administer them to “outsiders”.
A scattered policy
The digital divide in the current rollout is a result of India’s vaccination policy, which has been confusing from the very beginning.
As the fourth phase began on May 1, the Central government announced a differential pricing for states, allowing them to buy vaccine doses on their own. Before that, the Centre procured and allocated vaccines to states.
In the latest roll out, however, the Centre takes responsibility for sourcing only 50% of the doses for what has been categorised as the vulnerable population – those above 45 years, healthcare and frontline workers. This essentially means that vaccinations for all those below 45 years will have to be paid for by the states or by the citizens themselves. The Centre will not pay.
Most states including Uttar Pradesh, Delhi, Maharashtra, Kerala, Assam and Madhya Pradesh announced free vaccines for citizens at public centres. Yet, citizens would have to register online beforehand. This has turned into a hurdle for many.
A digital barrier
A resident of Jagdamba Camp, Ramjas Maurya, 44, said he did not have a smartphone to use the internet. “Mujhe online available karna nahi aata hai,” said Maurya, who works as a delivery person for a local grocery store. “I don’t know how to access anything online.”
There were at least two dispensaries in his locality, where vaccinations were taking place. Maurya was eager to get the vaccine so he could take the risk of travelling to visit his family in Amethi, Uttar Pradesh, he said. But officials at both the dispensaries told him he needed to register online first.
This was the case with Ahmad as well. His parents, who are above 50 years, had been vaccinated at a dispensary in the neighbourhood. They just had to walk in, and a doctor registered them with their Aadhaar card, he said. “Why don’t they do it for us?” he asked.
Residents in parts of the city recounted a similar experience. Mangal Dev, a worker in a plastic factory in Mayapuri, West Delhi, said he had a “simple phone” and did not know how to register himself online to get the vaccine. “I do not have the knowledge for this,” said Dev.
‘Commitment to inequity’
The current system of having each beneficiary to register online for a vaccine was exclusionary and that there has been a complete disregard for digital barriers, said Sunita Sheel of Forum for Medical Ethics Society. “If you leave out even a certain section of society [from vaccination] then it will not solve your problem,” said Sheel.
The forum was a signatory to a statement released on April 29 by various non-profit organisations including the Internet Freedom Foundation, Rethink Aadhaar and Swathanthra Malayalam Computing. It demanded equitable access to vaccines, of walk-ins at all facilities for beneficiaries and conducting vaccinations without the burden of providing identity proof.
The statement said: “Mandating online self-registration for vaccination without a walk-in facility will further entrench inequities in access to the vaccine. Only those with access to the internet and who can operate an app-based system will be able to register themselves, or will register themselves ahead of others, leaving the poor and vulnerable behind, creating an enormous divide in access to the vaccine.”
That the access to the vaccine had digital barriers was not unintentional, said Dr T Sunderaraman, former director of the National Health Systems Resource Centre, an advisory body of the Union Ministry of Health and Family Welfare.
“The current system of access is a system that is very easy only for the very privileged,” he said.
Another public health expert concurred. “This government is essentially reacting to the panic of the upper middle class,” said Indranil Mukhopadhyay, associate professor of health economics at OP Jindal University.
When vaccines were rolled out for those above 18 years, it was done knowing that there is a crisis at the supply end, Mukhopadhyay said. “There was a hue and cry among the vocal upper middle class educated sector who can get the jab and navigate all of this,” he said. As a result, affluent Indians would end up getting a disproportionate share in the limited supply of vaccines currently available in the country.
But what about those who cannot?
The Centre’s affidavit submitted in the Supreme Court on May 9 addresses this aspect and states that those “who do not have access to digital resources can take help from family, friends, NGOs, and Common Service Centres”. These centres have been established in almost every gram panchayat and provide internet access to those in rural areas, the affidavit claims.
But public health experts pointed to a different reality on the ground. “These service centres are in many places non-functional and are not able to play the role as access points for the poor and marginalised,” said Dr T Sunderaraman.
“They have not done many services in the past and there is very little they will do for this. The system is a dysfunctional system which will put extra costs on the poor,” he said. “It is a bluff.”
The Centre has also given multiple reasons for not carrying out door-to-door vaccination for Covid-19.
It has claimed that the process could lead to vaccine wastage, expose healthcare personnel to the virus in the homes of beneficiaries and put vaccinators at the risk of contracting the virus.
If a door-to-door outreach was not possible, health experts said it was prudent to at least run a bigger campaign to mobilise people to take the vaccine. “Go and do a proper publicity campaign to reach the vulnerable population,” Sunderaraman said.
“We mean education, public facilitation and creating centres that are easy to access. That is not something that is difficult to do,” he said. “They are not giving an explanation as to why they will not do it. It is a commitment to inequity.”
For the time being, it was imperative for the Centre to create a common registration system that was not exclusionary, set up camps and prioritise the elderly, said Mukhopadhyay. “They need to use local bodies, they are doing it so much more for RWA [Resident Welfare Association] colonies in Delhi but not for the slums or villages,” he said.