The COVID-19 pandemic uprooted many lives, planting them within the walls of the Internet. My life since, after one brief plane journey last year, has consisted of staring at multiple screens for large parts of the day.
After some initial grumbling and minor technical issues, logging on became a habit, like running hurriedly to class. But what lingered throughout—and only became more apparent to all— was the larger issues that came with online learning and the digital divide. Everyone did not own a gadget, everyone did not have a stable Internet connection, and if they did, it wasn’t available at all times of the day.
These issues in my small classes magnified exponentially when India’s COVID-19 vaccination policy in the country was launched on 16th January for healthcare and frontline workers. The CoWIN platform—also known as the Covid Vaccine Intelligence Network—was to be used by citizens between the ages of 18-44 to book vaccination slots for the vaccine. However, the use of a largely digital platform—in a country where only hundreds of millions do not have access to smartphones and 11 percent to any type of computer—entrenched inequality in accessing the vaccine.
Clearly by its (digital) design and operations, the system has posed a significant hurdle in the mass inoculation of 1.4 billion Indians against COVID-19, with public health experts estimating that complete inoculation may only take place by early 2022. As technologist and public policy researcher Rohini Lakshané notes in an interview with The Bastion, “right now, the biggest problem is the vaccine shortage, which is exacerbated by the exclusions of CoWIN.”
So, why was a wholly digital platform like CoWIN—one that is largely accessible to the technology-owning elite—used for something as essential as mass vaccine registration? A deep dive into the history of CoWIN’s development over the last year reveals the ambitions of India’s digital State, one that is yet to fully gauge the needs and rights of all the citizens who depend on it.
Why Was the CoWIN Model Chosen?
The discussions regarding the development of what would eventually be the CoWIN platform began in mid-2020, when COVID-19 cases were peaking during the country’s first wave.
The specific decision to use a digital platform to register Indians for inoculation aligns with the government’s Digital India mission. Over the last year, the initial idea for the platform that eventually became CoWIN has been heavily influenced by Nandan Nilekani, the chairman of UIDAI and former chairman of Infosys. The larger use of the Aadhaar card as a unique identifier in Digital India—which propelled landmark privacy judgements by the Supreme Court in 2018—was also interestingly the brainchild of Nilekani.
With building an integrated platform- #NDHM, the digital delivery of health services will become a possibility, revolutionising healthcare in India, says @rssharma3. He addressed the plans in place to make the #CoWIN app more user-friendly. @ET_Government https://t.co/dBv4C6Xfyk
— National Health Authority (NHA) (@AyushmanNHA) June 11, 2021
Once a digital platform had been decided on, then came the question of how to build and design it. The Ministry of Health and Family Welfare (MoHFW) had an existing vaccination distribution system that could be used: eVin, or the electronic vaccine intelligence network. Pre-pandemic, eVin was used to inoculate mothers and children across the country under the National Health Mission. The network was jointly funded by Gavi (the Vaccine Alliance) and the United Nations Development Program (UNDP).
Initially, the MoHFW sought to develop eVin, such that it suited and fulfilled current demands for COVID-19 vaccination, with added features of user authentication and vaccine delivery modules. However, the UNDP’s contract with the company that originally developed the tool expired in October of 2020. To avoid hassles related to contracts, the Ministry delegated the work of managing the logistics of developing CoWIN to the UNDP, which according to The Ken, outsourced some of this work to Mumbai-based Trigyn Technologies.
In spite of these shifts while developing the technology behind CoWIN, the government was continuously involved in some capacity—yet, even then, it failed to take into account the long term issues of a digitised vaccine drive in ‘Digital India’.
The CoWIN model, purportedly suggested to streamline the vaccination process for the country and make distribution and tracking easier, inevitably became a means to exclusion. As early as March 2021, various doctors, public health experts, and civil society organizations listed their concerns with the early phases of CoWIN’s launch. Designing a registration platform for a small percentage of the country’s citizens was a clear and obvious issue that received attention.
The Perils With Digital Solutions During A Pandemic
It is not a novel revelation that there is a scathing digital divide in India, especially between urban and rural areas. Yet, this truth only resurfaces when a new system or application is launched. “A vaccination program in the middle of a pandemic is not the time to experiment on the most vulnerable in our society,” says digital activist and researcher Srinivas Kodali in an email exchange with The Bastion. “This has only resulted in the rich taking over vaccines by allowing them to book slots across the country.” As Lakshané asserts, “CoWIN is perfectly fine for those constituencies that can successfully and easily use it.”
While the CoWIN platform has been in use since the vaccine drive was kickstarted for essential workers, it was only mandatory to register on it when the vaccination program for the 18-45 age group opened on May 1st of this year. Many citizens reported facing glitches when trying to log in to the app to register for vaccine slots: for some the app crashed, while for others, the OTPs required to log in to CoWIN were delivered late. While some of these pain points have been resolved since, the situation became frustrating for those who were eventually able to log in: thanks to vaccine shortages, CoWIN’s limited vaccination slots filled up in seconds.
i think you should change this tonality. it’s not some game people are enjoying to play. shows bad on your part to not be able to open more slots at more centre on more number of days. #justsaying
— CS (@chin80) May 4, 2021
To solve this issue, a handful of largely urban programmers set up codes that communicated with the app and immediately notified them once precious vaccination slots were available. Groups on the messaging app Telegram mushroomed, some with thousands of users, where these alerts were sent to notify them of vacancies in their cities and towns. Once again, this was a lucrative alternative for the coders and the relatively elite citizens who received their vaccines thanks to these alerts.
However, the snowball effect of CoWIN and vaccine shortage ultimately resulted in hindered access to the vaccines to those without such sophisticated technological access, or those living in rural areas. With codes notifying urban citizens of available slots across cities and towns, people travelled from cities to get their shots in rural areas. These urban bookings were usually made before rural citizens had booked slots in their nearby centres.
“When I got my first COVID-19 shot at a hospital in Mysuru, most of the people waiting with me were from Bengaluru, which is around 160 kilometres away,” says Lakshané. “They travelled all the way because it was not easily available there for the general population below the age of 45… the population density there is higher and there are more people trying to register for it on CoWIN.” Reports of similar migrations from cities to towns and villages have appeared across the country.
One of the end results of this chain of events is that “CoWIN makes it hard for the very people who need vaccines,” says Kodali. Instead, “it gives them to a class of people who are not involved in any essential work and are potentially safer compared to other deserving people.”
How Does CoWIN Affect People’s Privacy?
If democratic India is to transform into democratic Digital India, then having robust privacy mechanisms in place to protect citizen’s digital rights is paramount. Given CoWIN’s central position in our digital governance paradigm currently, it could have been an opportunity to enact and mainstream stringent privacy policies.
The government itself was obtuse on these discrepancies. Law student Aniket Gaurav filed a Right To Information (RTI) application to the Ministry of Electronics and Information Technology (MeitY) to find out more about who exactly developed CoWIN. In January of 2021, MeitY responded by stating that “with regard to information sought, no information is available with Innovation and IPR Division, MeitY.”
This ‘problem’ has larger implications on the democratic strength of ‘Digital India’ the Centre is trying to build. “The computer operator who uses CoWIN and verifies your Aadhaar is also opting you into the National Digital Health Ecosystem (NDHM) with the National Health Authority, where along with your Aadhaar, your health-related data will be shared,” explains Kodali. The NDHM, launched in 2020, is an attempt by the Centre to “digitize all health records to help more Indians access affordable healthcare in a timely manner.”
Kodali continues, saying, “The problem with this digitization process is, it violates the Electronic Consent framework drafted by the Ministry of Electronic and Information Technology. There seems to be no particular rules around this [relevant to CoWIN]. There were also reports of using facial recognition or authentication linked to Aadhaar for CoWIN registration, yet another experiment which has no place in vaccination [due to privacy concerns].”
In a positive step for India’s #COVIDVaccination drive, the Delhi High Court in Manisha Chauhan vs Govt of Delhi NCT and Anr (along with other COVID related proceedings) issued several directions to the Government of India, upon referring to concerns flagged by IFF.
— Internet Freedom Foundation (IFF) (@internetfreedom) June 3, 2021
Could India Have Done Things Differently?
In a technologically-driven world, it is likely that every country would have had at least partially digital vaccination drives. So, how have other countries fared in relation to India?
Consider the Chinese model, a “near-perfect” system that is winning authorities both short term and long term strategic gains. Vaccination programs for selected groups were initiated as early as December 15th of last year, using locally developed and produced Chinese vaccines. The process was further digitally streamlined for those who needed to travel abroad for their studies or work. For example, Shanghai’s Healthy Cloud app required this category of people to log their flight details and provide their reason for travelling abroad, before being administered two doses of the vaccine within a fortnight at their local community health centre. The app may also be used in the future as an ‘immunity passport’ to facilitate inter-provincial travel amidst any new outbreak. It also has the potential to provide authorities with primary data about the efficacy of inoculation.
However, considering that the Chinese state routinely hoards sensitive information about its citizens, ‘efficiency’ in this scenario arises largely from the techno-autocratic nature of the Chinese government.
On the other hand, the United States of America, a country with extensive privacy jurisprudence, seems to have adopted a very different model. Most states in the USA are predominantly distributing vaccines through establishing hotline numbers, which residents can call to schedule their appointment, indicating an ‘opt-in’ approach of sorts. Some states even allow residents to preregister for the vaccine if they are presently ineligible, arranging to notify them when they become eligible. Most states also require residents to visit a clinic, provider, or health centre only with an appointment.
The question that remains: what aspects of these models can be adopted in India, given that a significant part of the vaccine drive remains incomplete?
“The strategy [from the get go] is a centralized one for the entire country with minimal options for states to deviate from,” says Kodali. “States can always use mechanisms available to them to design better ways to distribute the vaccines.”
Lakshané further suggests that a host of methods be used in tandem to inoculate the Indians: along with CoWIN, ensuring a fixed number of ‘offline’ walk-in appointments per day, or setting up an IVRS telephone line where users can register themselves and receive a call or SMS with an appointment, or door-to-door vaccinations are also options. “We are dealing with a very large population, with a lot of social and economic disparities. So, all of these methods can accommodate different sections of the population with different levels of privilege, technical knowledge, and digital literacy,” Lakshané argues. “Depending on CoWIN only is not going to get the whole country vaccinated.”
It is submitted that, as on 23.06.2021, out of the 32.22 crore beneficiaries registered on Co-WIN in the country, 19.13 crore (59%) beneficiaries have been registered in the onsite [walk-in / Non digital] mode
— Bar & Bench (@barandbench) June 26, 2021
Perhaps keeping in mind months of similar critiques of its vaccination policy, on June 7 the Centre announced that vaccines will be administered free of cost at government facilities. Simply put: states wouldn’t have to shell out funds to pay for vaccines anymore. The use of CoWIN will also be limited for those now getting vaccinated at government centres, given that limited walk-in slots are now available for those above 18.
The changes in vaccination policy, although welcome, have been introduced later than needed. As this timeline has shown, a registration strategy that was inclusive by design from the get-go would have gone a long way in inoculating India’s millions—and winning against COVID-19 this devastating second wave.
Featured image courtesy of Sumita Roy Dutta (CC BY-SA 4.0).